4. Exploratory learning, transformative learning and exploitative learning mediate the relationship between presence of knowledge and skills and board task performance,
4.4 The qualitative results
4.4.2 Qualitative data collection in the case study
Healthy has an impressive portfolio of strategic documents covering the near and distant
future. These plans have been and will still be, translated into practical decisions and projects
which are broadly described in new project documents. All this information represents an
important and central source for the case study and will be utilised in the analyses. However,
a new strategic plan has been developed after the data collection in Healthy was finished. This
analysis will mainly lean on the strategy plan that was current at the time of data collection.
During the period of the field research, I collected articles from the biggest newspapers in
Norway when they presented news, issues, problems or results from Healthy. The table below
178
Table 30: Articles from newspapers
Date Newspaper Subject Issues General observations and comments
10th May 2011 "Verdens Gang" Reorganisations and cost cuts are destroying the quality of health service
The CEO at the Hospital agrees with the employees, but the general board members (local board) disagree and decide to go on with the reorganisation
The article explains that the problems that occupy the staff at the hospital (from the CEO to the union representative) are not
communicated to the general board members representing the main board. Lack of information/knowledge flows between the members of the two boards is indicated. Conflicts at a level becoming viewable in the medias seemed to be based on different information of the situation and lack of communication
20th May 2011 "Verdens Gang" Emergency Capacity - the employees are making protests Union representatives: Capacity is not what it should be - lack of staff, CEO: This co-localisation of the emergency services secure a higher quality in the health services, but no board members do not response)
The information/knowledge from the employees and the one from the TMT differ. Their “facts” based on information are different and are interpreted differently, too. These disagreements are not observable at the board meetings
30th May 2011
"Dagbladet" The hospital board members declare cuts of costs
The board members in the local board elected by the main board vote this decision through. The union
representatives claim that this is not defensible with a satisfactory patient care, while the other board members argue that the reorganisation had improved the working facilities
The knowledge and information of actual numbers and cases are not mutual. The two groups are not sharing the same knowledge and information. This disagreement was just viewable as a note to the minutes by union representatives at the main board meeting.
179 and opens for a reduction of staff. 6 th June 2010 "Verdens Gang" Ceo at the University hospital quits
The CEO at XX hospital supports the employees in their view that a justifiable service is not available within the
economic limited conditions with the consequences that she leaves.
This CEO was present at the meeting in the main board few weeks earlier without communication this problem in the meeting. No members from the main board made any questions on these problems. The exchange of knowledge and information from the CEO at this hospital, and from the CEO in Healthy to the members of the main board, as well as from the main board directors to the CEO and to the local boards seem to be limited.
10th June 2011 "Verdens Gang" The minister is criticized in the Parliament for her handling of the hospital situation.
Politicians from other parties claim that the situation is out of control and that patients might suffer.
The noise "on the floor" has moved to the Parliament. Unsolved problems with the patients are discussed in the Parliament. When the formal and correct channels for information fail, important cases are moved to the political arena.
8th Sept 2011 NTB Serious failures in patient care are described in a fresh report
A fresh report shows that the patient in several areas do not get the care they should have got.
The directory of Health quality control criticises the situation. The CEO confirms her worries. At the board meeting a few days later unanimous board members leave the responsibility of these issues to the CEO. A strong trust on the CEO is thus signalled from all parties in the main board.
21st Sept 2011 NTB The minister of Health Care in Norway arranges a meeting with the board.
The minister wants the board to reduce the number of
employees and emphasises the gravity of the situation.
Remarkable that this communication of information is conducted via media. The CEO claims that the costs must be reduced, while the union representatives abet that no more reductions are possible without setting the patients in a critical situation. Serious lack of exchange of specific and general knowledge between the parties via internal
180 Subject: The University hospital uses about £ 100000 beyond the budget every day
meeting at 8 am the first day after she was back from abroad.
12th Oct 2011
NTB Healthy has
paid more than £ 40 Million to consultants during the last three years
The budget situation is critical. The hospitals are using far too much money every day. At the same time consultants are hired to describe, analyse and advice in the current situation.
The medias seem to be one of the most central information sources in the organisation. Exchange of general and specific knowledge and information via the medias is generally a serious sign of failure in communication 17th Oct 2011 NTB Political initiatives on top level to remove the top management of Healthy
The chair of the Norwegian Conservatives and the chair of the Christian Democratic claim the CEO to leave due to lack of trust between the CEO and the employees.
The minister (from the Labours) defends the CEO, assuring that improvements will be initiated. A broad lack of trust from the employees (all different groups of health care personal) to the CEO, but at the board meetings a solid trust to the CEO is announced directly as well as via the decisions they make - from the union representatives as well. Seems to be a lack of knowledge and information flow from and to the main union representatives to the employees or a reluctant attitude to conflicts.
20th Oct 2011
"Aftenposten" A letter from a worried nurse
A recently appointed nurse writes a long letter to the newspaper describing the situation into the details - as "the patients are screaming in pain because the staffs have not got time to administer pain
The situation seems to be out of control from an administrative point of view. The letter was published on the same day as a board meeting was arranged. On the agenda a case presenting the actual situation in some of the hospitals. Despite the public attention, a unanimous decision was made, expressing trust, though claiming that all aberrancies are
181 killers". "There is a lack of
wheel chairs, so we have to use the toilet chairs instead". 31st
January 2012
NTB 7 out of 9 board members were told to leave the board. New members are entering.
This is a normal election, but an unexpected high amount of the members were replaced with other persons.
The problems related to the biggest hospitals require a change in the leadership regarding the Minister of Health. The probability is high that this activity was made to re-establish the trust between the
members of the board and the employees as well as to initiate new and improved activities to improve the whole situation.
182
All the newspaper articles are available on request.
I further got the opportunity of being an observer at board meetings in the period from March
2010 till February 2012. The table below presents an overview of the meeting dates, the
duration of the meetings, the locations and a brief description of the content of every meeting.
183
Table 31: Summary of board meeting observations in Healthy
Date Time * Location General observations Consensus Comments
4th March 2010
09.00 - 15.10 Meeting Centre, Oslo The chair works for obtaining the consensus. If necessary, breaks in front of voting.
All items Two long presentations by the staff - one on the budgets and one on the health care
9th June 2010
09.00 - 15.30 Meeting Centre, Oslo Despite several long and complex cases, consensus is still present, but the union representatives had a hard time to accept in one case since the consequences for the employees were not too clear. In the end it was agreed upon a request for a report of future
consequences.
All items Two of the union representatives claimed a note on one of the items to "explain" their agreement. Two long presentations by the staff - one on patient safety and one on medical knowledge development and practice.
4th Nov 2010
09.00 - 16.30 Meeting Centre, Oslo During a long meeting the discussions were short and limited and long quotes including until 10 different points were quickly agreed upon and approved.
All items One presentation by the staff on the further development of the organisation as a whole.
16th Dec 2010
09.00 - 16.05 Meeting Centre, Oslo In one the cases - regarding cancer treatment - the union
All items, but one One presentation by the staff on a new national plan of health care
184
representatives disagreed on one out of 13 points in the decision.
17th Febr 2011
09.00 - 13.10 Meeting Centre, Oslo A short meeting without any obvious discussion or information exchanges.
All items Two presentations by staff - one on part time work and another on reputation and communication 17th Mar
2011
09.00 - 13.25 Hotel Norge, Brumundal There was an informal meeting in the board at a hotel with a dinner and seminar on board evaluation and development the night before the ordinary meeting.
All items A board evaluation , the strategic plan and future budgets were discussed in addition to the listed items.
16th June 2011
09.00 - 15.50 Meeting Centre, Oslo In an item on the University Hospital the board members really disagreed. After some discussions they agreed upon the main points and left the written version of the details in the decision to the CEO, the board chair and one of the board directors while the rest of the board members left for a break. A long note in the decision saved a consensus on almost all points
All items, but one The IKT strategy of the
organisation was presented as well as a plan for specialist health care.
14th Sept 09.00 - 13.45 Meeting Centre, Hamar There is a disagreement as well as differences in
All, but two The experiences from the hospitals on the 22nd July (terror in
185
2011 information and knowledge
on the situation regarding the largest hospitals. The union representatives disagreed and added their own notes and information in two cases on this subject.
Norway) were presented and discussed
The CEO's way of working and results were reported and discussed.
20th Oct 2011
08.00 - 13.05 Voksenåsen hotel, Oslo A meeting without any obvious disagreements or discussions. The board members were collected for a closed meeting with dinner and internal information exchange the night before.
All The strategic plan - further development and investments in the specialist health were
presented by members of the staff.
17th Nov 2011
09.00 - 15.30 Meeting Centre, Oslo The budget and general plans for 2012 were approved without discussion or general questions
All The strategy plan, the expectations of the CEO and a follow up of the board evaluations were presented.
20th Dec 2011
Absent
16 Febr 2012 09.00 - 15.05 Meeting Centre, Oslo Most of the general board members had their first meeting with a board seminar the night before. The
exchange of information and the level of communication were different. A more tune and debate was obvious, and
All The strategy plan and the project on reduction of part time work were presented.
186
communication between union representatives and ordinary board members was active during the meeting.
* Usually I had to leave the meeting an hour or more earlier, since the chair of the board closed the meetings for special cases in the end of each meeting
187
The interviews formed the third part of the data. I conducted six of them, meeting the board
chair, the CEO, two board members, one union representative and one representative from the
users. A summary of the interviews is provided in this table:
Table 32: The interviews - details
Interview Object number
Board Role Date Location Time started
Time ended
1 Board member 3rd Aug 2011 Interviewee's office
12.00 13.00
2 Board member 27th Sept 2011 IKEA - the restaurant, Oslo 14.00 15.15 3 Union representative 19th Sept 2011 Interviewee's office 11.00 12.00 4 Users' representative
16th Oct 2011 Comfort hotel, Skien - reception
18.00 19.25
5 Board chair 21st Oct 2011 Interviewee's office
13.00 14.00
6 CEO 21st Nov 2011 Interviewee's
office
12.00 13.05