Virkeligheden bag ledelsesinformation – dokumentation med mening? : Et casestudie af polariseret ”Sensemaking” i kommunal ældrepleje

Abstract

Problemstilling Projektets udgangspunkt er, at kommunerne som følge af de økonomifokuserede ledelses- og styringsmodeller og af sparekrav både efterspørger - men også sætter spørgsmålstegn ved ledelsesinformationen fra deres elektroniske omsorgsjournaler (EOJ). Spørgsmålene er rettet mod udtrækkenes validitet og årsager til, at ledelsesinformationsbehovet ikke kan dækkes fyldestgørende. Tilgangen til projektet har været søgende og ikke mindst undersøgende, fordi litteraturen ikke kunne bekræfte vores aktuelle antagelse om en generel problematisk ledelsesinformation. Billedet af problemfeltets virkelighed er derfor opnået dels ved et interview med KL og dels en landsdækkende spørgeskemaundersøgelse til én IT- koordinator i hver af landets 98 kommuner. Undersøgelsen bekræftede med en svarpro-cent på 88,8 % vores antagelse om kommu-nernes problematiske ledelsesinformation. 50,7 % af respondenterne svarede, at ledel-sesinformationen var meget problematisk eller problematisk. Baggrund Projektet undersøger en af de potentielle årsager til den problematiske ledelsesinformation, som IT-koordinatorerne pegede på, nemlig at dele af dokumentationen ikke giver mening, og disse dele derfor ikke dokumenteres. Nationale instanser og andre toneangivende aktører lancerer løbende tiltag, der skal forbedre ledelsesinformationen, og de understreger også betydningen af meningsfuld do-kumentation. Ingen definerer dog klart, hvad ”mening” er, hvorledes meningsfuld doku-mentation afdækkes og ej heller, hvad der skal til for at give dokumentationen mening. Fokus i undersøgelsen er derfor på meningsdannelsen i forhold til at dokumentere og til dokumentation, dvs. datainput og dataoutput. Metode Mening afdækkes gennem kvalitative inter-views, hvor Laddering-metoden anvendes som hjælp til at fremkalde respondenternes værdier gennem teorien om Means-End Chain (MEC), og præsenteres derefter grafisk i kognitive kort. Rammen for analysen af de empiriske data er teori om Sensemaking, og suppleres med teori om translation af organisationskoncepter for at belyse sygeplejerskers og controlleres polariserede meningsdannelse. Resultat Sammenholdes de to faggruppers værdier ses, at de er meget forskellige, og teorien om translation kan dels underbygge og føre for-skelligheden tilbage til overgangen til NPM, som medførte et altoverskyggende fokus på økonomiens logik og begreber. Denne logik tager ikke højde for kompleksiteten og for-skelligheden i den offentlige sektor. Konklusion Det er muligt via MEC-metoden, Laddering-teknik, kognitive kort og Sensemaking at defi-nere, hvad der giver mening i forbindelse med data og dokumentation for henholdsvis sygeplejersker og controllere i kommunal ældrepleje. Der er klare forskelle på, hvad der giver mening for de to faggrupper. Forskellene er, at det for controlleren er data til afregning og ledelsesinformation, der giver mening - og for sygeplejersker er det faglige data, der anvendes inden for egen gruppe, som giver mening, og dermed kan ses som en af årsagerne til den problematiske ledelsesinformation i kommunerne.

Thesis Municipalities in Denmark are demanding obtainment of management information from their electronic care records (ECR) at an increasing rate, but at the same time they generally question the management information that can be obtained. This skepticism is partly related to whether the information is in fact valid, and partly to why it does not adequately cover the need for information. Our approach to this project has therefore been searching, and not least exploratory, mainly because searching through the literature on the subject did not lead to clarification of the current problems that we wished to investigate. Illumination of this problem in order to achieve a genuine and realistic view of the actual situation has therefore been achieved through an interview with KL (Municipalities’ Associa-tion) and through a nationwide survey – the latter including an electronic survey to all 98 municipalities, represented by one IT-coordinator from each municipality. With a response rate of 88, 8 % our assumptions about problematic management informa-tion were confirmed. In fact, 50, 7 % of the responding IT-coordinators confirmed that man-agement information was indeed problematic or very problematic. Background This project investigates into one of the potential causes behind the problematic manage-ment information – one result shows that 55 % of the respondents fully agree or agree that the documentation seems pointless to the employees, who in turn do not document any-thing. Both national agencies and other operators stress the importance of the documenta-tion being perceived as meaningful, although no one defines what meaningful really is or how it is to be investigated into. We want to bring attention to the process of sense making in relation to documentation, i.e. data input and data output. Method Meaningfulness is uncovered through qualitative interviews, in which the Laddering method is used to guide and aid respondents reveal their values through the theory of Means-End Chain (MEC), and is then presented graphically in cognitive cards. The theoretical framework in which the analysis of the empirical data is placed is the theory of Sensemaking, which is supplemented by the theory of translation of organizational concepts in order to illuminate both nurses’ and controllers’ polarized sensemaking. Results Comparing the values of the two occupational groups, it is obvious that they are very differ-ent, and the theory of translation can partly explain the difference in regards to the imple-mentation of NPM (New Public Management) which led to a pervasive focus on the logic of economy. This logic does not take into account the complexity and diversity of the Public Sector. Conclusion It is possible through the MEC method, the Laddering technique, cognitive cards and Sensemaking to define meaningfulness in relations to data and documentation for both nurses and controllers in public elder care municipal elderly care. The differences between the two occupational groups are substantial. To the controller data for billing and management information is what makes sense. To the nurses it is domain specific data, which is used within her own group that makes sense to her – which is one of the main clues as to why management information is problematic. This can be one of the main causes of the problems with management information.

A master programme thesis from Aalborg University

Virkeligheden bag ledelsesinformation – dokumentation med mening? : Et casestudie af polariseret ”Sensemaking” i kommunal ældrepleje

[The reality behind management information - documentation that makes sense? : A case study of polarized “Sensemaking” in public home care]