Purpose: Previous studies show that the hospital environment and the behavior of health care personnel may predict patients’ perceptions of care quality. The aim of the study was to explore changes in perceived care quality from the patients’ perspective (QPP) when hospital services are relocated from an old to a new high-tech hospital and to describe what is important for patients in the high-tech hospital. Patients and methods: A comparative cross-sectional design was used. The questionnaire QPP, which is based on a theoretical model of the quality of care comprising four quality dimensions, was used. Data were collected in 2015 (old hospital) and 2016 (new hospital), with 253 and 324 respondents, respectively, by consecutive sampling. Comparative statistics was used to test differences between patients’ care quality perceptions (perceived reality [PR] and subjective importance [SI]) (P≤0.05). Results: The patients rated PR of all four quality dimensions (the care organization’s physical-technical conditions and sociocultural approach and the caregivers’ medical-technical competence and identity-oriented approach) higher in the new hospital. However, only the two quality dimensions concerning the care organization were rated significantly more highly. On an item level, five of the 27 items scored significantly higher on patients’ SI than on patients’ PR of the care in the new hospital, indicating a quality deficiency from the patients’ perspective. This comprised receiving effective pain relief, receiving examination and treatment within an acceptable waiting time, receiving useful information on self-care, receiving useful information on which doctors were responsible for their medical care, and having a comfortable bed. Conclusion: The increase in care QPP was associated with improved environmental conditions, and no significant improvement in care quality was associated with the health care personnel. The results indicate that being in a high-tech environment does not improve patients’ perceptions of care quality provided by health care personnel. The results gave valuable information for quality improvement in clinical practice, based on the patients’ perspective.

The term ‘restriction of output’ is a basic category in research on resistance and organizational misbehaviour and it has many synonyms, but seems to lack antonyms. The term means, of course, that employees do less work than they are expected to by management. The opposite behaviour is in the management literature regarded as organization citizenship behaviour, a term with several synonyms as well as antonyms. This article argues that ‘expansion of output’ can be a form of organizational misbehaviour and an antonym to restriction of output. The study bases its argument on empirical findings from the public sector: workers doing more than they are expected to do in order to resist management control. A typology of different kinds of expansion of output is suggested.

Purpose: First-line nurse managers are frequently torn between conflicting demands from management and employees, and previous research suggests that nurse managers use a variety of responses to cope with these demands. The purpose of this paper is to explore the influence of social support on nurse managers’ responses to role-conflict. Design/methodology/approach: Two focused ethnographic studies involving participant observation and interviews with seven first-line nurse managers were completed. One study included first-line nurse managers from four units in two municipalities (2005), while the second included three first-line nurse managers from a hospital in Norway (2015-2016). Findings: Three types of responses were identified: the embracing managerialism career, the emphasising managerialism career and the emphasising professionalism career. Emphasising managerialism was associated with role distance from the role of nurse, whereas emphasising professionalism involved role distance from the managerial role. Originality/value: This study provides insights into first-line nurse managers’ responses to role conflict, by identifying the mechanisms involved and an opportunity to develop a theoretical framework for future studies among nurse managers.

Opplevelsen av ensomhet øker med alderen og en svekket helsetilstand. Av den grunn kan man anta en større forekomst av ensomme blant brukere av hjemmesykepleie enn ellers i befolkningen. Hovedhensikten med studien var å beskrive forekomsten av ensomhet blant brukere av hjemmesykepleien, og undersøke i hvilken grad sosiale nettverk og kvaliteten på pleien bidrar til å påvirke brukerens opplevelse av ensomhet. Studien hadde et tverrsnittdesign og resulterte i 118 brukeres svar på et spørreskjema som blant annet omfattet spørsmål knyttet til opplevelsen av ensomhet, Anderssons Sosiale Nettverkskontaktskjema og Wilde-Larssons instrument for måling av kvalitet på pleien (KUPP). Hovedfunnene viste at 19,5 prosent av brukerne ofte eller alltid opplevde ensomhet, og at brukernes helsetilstand og bostatus hadde en statistisk signifikant sammenheng med denne opplevelsen. I tillegg fant man at god kvalitet på relasjonene mellom brukerne og aktørene i deres sosiale nettverk, og en opplevelse av god kvalitet på pleien, førte til en statistisk signifikant reduksjon i opplevd ensomhet. The experience of loneliness increases with age and with reduced health condition. Therefore, it may be assumed that it is a greater incidence of loneliness among patients in home care nursing than in the general population. The aim of this study was to assess the prevalence of perceived loneliness among patients in home care nursing, and to explore the potential predictors of perceived loneliness as the patients’ social network and the quality of nursing care. A cross-sectional design was used and 118 patients answered a questionnaire which included questions related to the experience of loneliness, Andersson Social Network Contact Form and Wilde-Larsson instrument for measuring quality of care (QPP). The main findings showed that 19.5 percent of the patients often or always experienced loneliness, and the patients’ health condition and residential status had a statistically significant impact on the experienced loneliness. A statistically significant reduction in perceived loneliness was found when the relationship between the patient and the social network was good, and the patient experienced high quality of nursing care.

Purpose: Previous studies indicate that the introduction of information and communication technology (ICT) in health care organizations impairs health care professional’s working conditions and diminishes job discretion. Most of these studies, however, were designed to explore the influence of ICT exclusively on a single group of health care professionals and thereby did not consider the influence of the same technology on other groups of health care professionals. The aim of this article is to explore the influence of a fully integrated ICT system on both doctors and registered nurses within the same working environment: a high-tech hospital. Methods: This is a cross-sectional study conducted in a high-tech Norwegian hospital. Data were collected in 2016. In total, 264 registered nurses and 172 doctors responded to a questionnaire on their working conditions and experiences with ICT in clinical work. Descriptive statistics, compare means, cross-tables, Chi-square and bivariate correlation analysis were used to analyze the data. Statistical significance was set at p < 0.05. Results: The findings revealed differences in doctors’ and registered nurses’ working conditions. Registered nurses reported a statistically significant higher workload and better job content than doctors. There was no difference in job discretion between doctors and registered nurses. Both occupational groups experienced that the ICT system impairs patient contact and the quality of health services. We found statistically significant correlations between registered nurses’ and doctors’ experiences with ICT in clinical work and working conditions, whereof the strongest correlation was related to job discretion in clinical work. Conclusion: This study concludes that the impact of ICT on doctors’ and registered nurses’ working conditions in a hospital depends on the experiences of ICT in clinical work. In consequence, it is recommended to involve doctors and registered nurses in the implementation of ICT in hospitals.