Kultur som barriere eller motivation for tværgående samarbejde om ledelse i sundhedsvæsenet

Abstract

Background: The purpose of this thesis was to explore culture concerning potential barriers and motivators for a cultural shift towards more collaboration within the organization and between leadership pairs.
Theory and Method: The empirical data comprised interviews with five pairs of middle managers, aiming to uncover their understanding of interdisciplinary collaboration, values, and culture, and how culture could be influenced to become more collaborative. For the analysis of interviews, Edgar Schein’s theory of the three levels of culture and Joanne Martin’s three perspectives on culture and change were chosen.
Results: There were four main themes in the interviews: collaboration, values, culture, and development. Overall, middle managers agreed on the importance of cross-departmental collaboration, but expectations and roles varied between leader pairs and across sections. Non-medical leaders had a clear picture of their management tasks, unlike medical leaders, who primarily focused on professional leadership. The understanding of “interdisciplinary collaboration” varied among professional groups and across sections. The cultural analysis using Schein’s three levels indicates fundamental assumptions rooted in historical hierarchies, reflected in values like “well-treated” and artifacts such as task distribution among middle managers. Martin’s three perspectives reveal a desire for integration through standardized leadership collaboration, yet a need to maintain differentiation, expressed in the division of subspecialties. The hierarchical division causes ambiguity, as while legally, doctors have the final say (in relation to patients), they are increasingly aligned with other professional groups regarding collaboration and decision-making competence. Despite subcultures, the analysis also reflects an overall culture that values cross-departmental collaboration, patient satisfaction, and employee well-being. This provides a solid foundation for further work in sharing leadership responsibilities.
Conclusion: A key to change is influencing the culture among middle managers to take collective responsibility. This may challenge existing structures, requiring collaborative interdisciplinary leadership development and strengthening leadership engagement. Clear communication, recognition, and shared leadership responsibility are essential to promote interdisciplinary collaboration and responsibility sharing. Identification and agreement on common values, along with continuous reflection on cultural norms, are crucial. Ambiguity can arise if these values are not clearly defined or practiced consistently. Further, it is essential for the head of the department to lead by example, demonstrating through words and actions how to work collaboratively.