The balance between professional autonomy and organizational obligations in resilient management of specialized health care: A Norwegian document study
Affiliations: [a] Department of Media and Social Sciences, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway | [b] Breast Cancer Research Group, Department of Surgery, Stavanger University Hospital, Stavanger, Norway | [c] The Nursing and Health Care Research Group, Department of Research, Stavanger University Hospital, Stavanger, Norway | [d] Department of Clinical Science, University of Bergen, Bergen, Norway | [e] Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway | [f] Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
Correspondence:
[*]
Address for correspondence: Anette Sleveland, Department of Media and Social Sciences, Faculty of Social Sciences, University of Stavanger, PO Box 8600 Forus, 4036 Stavanger, Norway. E-mail: [email protected]
Note: [†] Shared first authorship.
Note: [‡] Shared senior authorship.
Abstract: BACKGROUND:Adverse events in hospitals may jeopardize the safety of patients. Failure in professional autonomy, organizational learning or in the contact between these two factors may explain the occurrence of injurious incidents in hospitals. OBJECTIVE:To study reasons for failure in contact between professional autonomy and organizational learning in resilient management of specialized health care through document analysis. METHODS:A total of 20 reports from the Norwegian Board of Health Supervision were evaluated by a retrospective in-depth document analysis. In the analysis of adverse events, we applied the Braut model to identify function or failure of 1. Professional autonomy, 2. Organizational learning and 3. Contact between professional autonomy and organizational learning. RESULTS:Multivariable regression analysis showed that failure in organizational learning was the only explanatory variable for failure in contact between doctors and nurses autonomy and organizational learning. Failure in organizational learning had the strongest effect on failure in contact between doctors and nurse’s autonomy and organizational learning (B = 1.69; 95% CI = 0.45 to 2.92). Failure in professional autonomy showed no significant effect on this contact. CONCLUSIONS:Failure in organizational learning is associated with failure in contact between professional autonomy and organizational learning. Failure in professional autonomy did not influence this contact.
Keywords: Professional autonomy, organizational learning, resilience management, hospital, specialized health care, Norwegian Board of Health Supervision, Norway
