Ivan Spehar

• Phillipson, Juliette Catherine; Fenwick, Mary; Spehar, Ivan & Lyons, Oscar (2026). Developing leaders, strengthening systems: evaluation of a multidisciplinary healthcare leadership programme. Leadership in Health Services. ISSN 1751-1879. p. 17–17. doi: 10.1108/lhs-12-2025-0210. Full text in Research Archive Show summary

  Purpose Evaluations of healthcare leadership development programmes often rely on short-term self-report and rarely examine organisational impact. This study aims to evaluate four cohorts of the multidisciplinary emerging leaders programme (ELP), using a theory-informed mixed-methods design with longitudinal follow-up across all four Kirkpatrick levels (reaction, learning, behaviour and results). Design/methodology/approach The programme consisted of seven or eight full-day workshops and included team quality improvement (QI) projects as the experiential learning element. Ninety-four participants from multidisciplinary backgrounds within Oxford University Hospitals NHS Foundation Trust completed the programme. Qualitative data included 39 reflective essays and 21 semi-structured interviews conducted 3–4 years post-programme. These data were analysed using Braun and Clarke’s approach to thematic analysis. Quantitative data included workshop ratings, pre/post affective commitment scale (ACS), turnover intention scale (TIS-6) and an adapted medical leadership competency framework questionnaire (MLCFQ). 86 (91%) completed pre- and 72 (77%) completed post-programme questionnaires, resulting in 55 (58%) paired questionnaires. Results were compared using Wilcoxon signed-rank tests, adjusted for multiple comparisons. Findings Participants reported improvements in leadership knowledge, confidence and emotional intelligence. There were significant improvements across all MLCFQ domains (median change + 0.6 to + 0.9; adjusted p < 0.005 for each). Participants reported application of QI tools, stakeholder engagement, conflict management and distributed leadership. The ACS and TIS-6 showed no significant pre/post changes. Participants described sustained service improvements and system contributions, including redesigned patient pathways, team processes, externally funded innovations and initiatives that maintained service continuity. Originality/value This study demonstrates an evolving and sustained impact of the ELP, with outcomes extending beyond individual capability gains to behavioural change and organisational benefits.

• Fossberg, Bettina Caroline; Frich, Jan C & Spehar, Ivan (2025). Norwegian district medical officers’ experiences during Covid-19: a qualitative study. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948251394900. Full text in Research Archive Show summary

  Background/aims: Municipalities in Norway are required to have a district medical officer (DMO) as chief medical advisor and leader of infection control and prevention work. There is great variation between municipalities in how the role is enacted and organized. Before the Covid-19 pandemic many DMOs felt their role to be unclear and invisible in the organization. This study aimed to explore DMOs’ experiences during the Covid-19 pandemic and how organizational context mediated these experiences. Methods: We conducted a qualitative study, generating data from three focus groups involving 17 DMOs from three different regions in Norway. Data were analysed using systematic text condensation. Results: All DMOs, regardless of municipal size, position size or infection rate, reported feeling overwhelmed by the responsibility during the pandemic. Their organizational outset, number of tasks, number of enquiries and uncertain foundation for decisions contributed to this experience. Organizational characteristics that promoted DMOs’ coping were resource allocation, teamwork, and professional and social support. Conclusions: Our results suggest that municipalities can enhance their crisis management of future infection control crises by establishing an organizational structure around DMOs that facilitates networking, and by developing plans for task delegation and creation of teams to support and alleviate DMOs during a crisis.

• Varga, Andreea Isabela; Spehar, Ivan; Veggeland, Frode & Skirbekk, Helge (2025). Factors influencing trust among colleagues in hospital settings: a systematic review. BMC Health Services Research. 25(2025). doi: 10.1186/s12913-024-12159-6. Full text in Research Archive Show summary

  Background Many studies show positive results of collegial trust in the workplace, e.g. performance, innovation and collaboration. However, no systematic review on collegial trust in hospital settings exists. This study aimed to provide the missing overview of factors that positively and negatively influence this trust relationship between healthcare providers. Methods Ten information sources (Web of Science, Embase, MEDLINE, APA PsycInfo, CINAHL, Scopus, EconLit, Taylor & Francis Online, SAGE Journals and Springer Link) were searched from database inception up until October 21st, 2022. Empirical studies included were written in English, undertaken in a hospital or similar setting, and addressed collegial trust relationships between healthcare professionals, without date restrictions. Studies were excluded if they only explored trust between healthcare professionals on different hierarchical levels. Theoretical studies, systematic reviews, conceptually unclear papers and anecdotal case studies were also excluded. Records were independently screened for eligibility by at least two researchers. A narrative synthesis technique was adopted to explore and discuss the influencing factors of trust between colleagues identified across both quantitative and qualitative studies. This method was chosen given the inclusion of studies with different research designs and the unsuitability of the data for a meta-analysis or meta-ethnography. Risk of bias was assessed independently by at least two researchers using four critical appraisal tools. Results Eight thousand two hundred sixty-eight studies were screened and 11 studies were included. Seven were qualitative and four were quantitative. Themes identified were professional competence, elements of communication, such as tacit knowledge sharing, and ethical conduct, such as honesty, confidentiality and accountability. Moreover, trust among colleagues was seen to thrive in work environments characterised by psychological safety. The results of the quality assessment show that most studies were of an acceptable quality, with some associated risk of bias. One of the limitations was represented by the lack of a definition for trust in some studies, and some inconsistency for those studies that did define trust. Conclusions Professionalism, communication and ethics were seen as the most important factors enhancing trust. However, these concepts were defined differently in the studies. Trial registration PROSPERO; CRD42023433021.

• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Show all 10 contributors for this article] (2024). Local management of the COVID-19 pandemic in Norway: a longitudinal interview study of municipality chief medical officers. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(1), p. 214–224. doi: 10.1080/02813432.2023.2301562. Full text in Research Archive Show summary

  Objective - To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses.<p> <p>Design - Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data.<p> <p>Results - Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality.<p> <p>Conclusions - The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience.

• Varga, Andreea Isabela; Spehar, Ivan; Veggeland, Frode & Skirbekk, Helge (2023). Factors influencing trust among colleagues in a hospital setting: a systematic review. PROSPERO International prospectie register of systematic reviews. Full text in Research Archive
• Varga, Andreea Isabela; Spehar, Ivan & Skirbekk, Helge (2023). Trustworthy management in hospital settings: a systematic review. BMC Health Services Research. 23. doi: 10.1186/s12913-023-09610-5. Full text in Research Archive Show summary

  Background Trustful relationships play a vital role in successful organisations and well-functioning hospitals. While the trust relationship between patients and providers has been widely studied, trust relations between healthcare professionals and their supervisors have not been emphasised. A systematic literature review was conducted to map and provide an overview of the characteristics of trustworthy management in a hospital setting. Methods We searched Web of Science, Embase, MEDLINE, APA PsycInfo, CINAHL, Scopus, EconLit, Taylor & Francis Online, SAGE Journals and Springer Link from database inception up until Aug 9, 2021. Empirical studies written in English undertaken in a hospital or similar setting and addressed trust relationships between healthcare professionals and their supervisors were included, without date restrictions. Records were independently screened for eligibility by two researchers. One researcher extracted the data and another one checked the correctness. A narrative approach, which involves textual and tabular summaries of findings, was undertaken in synthesising and analysing the data. Risk of bias was assessed independently by two researchers using two critical appraisal tools. Most of the included studies were assessed as acceptable, with some associated risk of bias. Results Of 7414 records identified, 18 were included. 12 were quantitative papers and 6 were qualitative. The findings were conceptualised in two categories that were associated with trust in management, namely leadership behaviours and organisational factors. Most studies (n = 15) explored the former, while the rest (n = 3) additionally explored the latter. Leadership behaviours most commonly associated with employee’s trust in their supervisors include (a) different facets of ethical leadership, such as integrity, moral leadership and fairness; (b) caring for employee’s well-being conceptualised as benevolence, supportiveness and showing concern and (c) the manager’s availability measured as being accessible and approachable. Additionally, four studies found that leaders’ competence were related to perceptions of trust. Empowering work environments were most commonly associated with trust in management. Conclusions Ethical leadership, caring for employees’ well-being, manager’s availability, competence and an empowering work environment are characteristics associated with trustworthy management. Future research could explore the interplay between leadership behaviours and organisational factors in eliciting trust in management.

• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria Lyche; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Show all 10 contributors for this article] (2022). Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: a longitudinal interview study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. doi: 10.1080/02813432.2022.2142796. Full text in Research Archive Show summary

  Objective: When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change.<p> <p>Design: Longitudinal qualitative interview study with two interview rounds. The first round of interviews was conducted from September–December 2020, the second round from January–April 2021. In the first interview round, we performed eight semi-structured interviews with GPs from eight municipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutive interviews were performed 2–4 months apart. To analyze the data, we used thematic analysis. <p>Results: The COVID-19 pandemic required GPs to balance several concerns, such as continuity of care and their own professional efforts. Several GPs experienced challenges in the collaboration with the municipality and in relation to defining their own professional position. Guided by The Norwegian Association of General practitioners, The Norwegian College of General Practice and collegial support, they found viable solutions and ended up with a feeling of having adapted to a new normal. <p>Conclusions: Although our study demonstrates that the GPs adapted to the changing conditions, the current municipal health care models are not ideal. There is a need for clarification of responsibilities between GPs and the municipality to facilitate a more coordinated future pandemic response.

• Høye, Sigurd; Brænd, Anja Maria & Spehar, Ivan (2020). Quality improvement and antimicrobial stewardship in general practice – the role of the municipality chief medical officer. A qualitative study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 38(3), p. 352–359. doi: 10.1080/02813432.2020.1794400. Full text in Research Archive Show summary

  Aims This study aimed to explore the conditions for the Municipal Chief Medical Officers’ (MCMOs) involvement in quality improvement in general practice, specifically concerning antibiotic prescribing practices. Methods This qualitative study consisted of semi-structured in-depth telephone interviews and group interviews with MCMOs (n = 12). The interview guide aimed to explore the MCMOs’ views on their role and responsibilities regarding the quality of care in general practice. The data were analysed using systematic text condensation. Results Three main themes were identified: 1) the relationship between the municipality and the general practitioner (GP), with the MCMO acting as an intermediary, 2) influencing the GPs’ work and 3) antibiotic use and infection control. The MCMOs perceived themselves as liaisons between the municipalities and the GPs. They emphasized building trust, showing respect and sharing common values in their interactions with the GPs, upholding the GPs’ professional autonomy. Working for quality improvement was considered a priority; however, MCMOs expressed a need for external support to establish a permanent quality improvement framework. The informants were positive about engaging in improving antibiotic prescribing practices because this combined the municipality’s responsibilities for quality improvement and communicable disease control. Conclusions The MCMOs considered themselves as well-suited agents for quality improvement in general practice, as liaisons between the municipalities and the GPs. Quality improvement in general practice would benefit from a clearer structure in terms of the MCMOs’ roles and responsibilities. Within communicable diseases control, the MCMOs have a clear mandate, which places antimicrobial stewardship initiatives in a favourable position amongst other areas of quality improvement.

• Frich, Jan C & Spehar, Ivan (2018). Physician leadership development: towards multidisciplinary programs? BMJ Leader. 2, p. 91–94. doi: 10.1136/leader-2018-000070. Full text in Research Archive Show summary

  Background: The format and content of leadership development programmes for physicians is a theme for discussion in the literature. Objectives: The aim of this study is to explore healthcare executives’ perspectives on physician leadership development, focusing on perceived benefits and negative effects associated with multidisciplinary programmes. Methods: We did a qualitative study based on data from semistructured interviews with 16 healthcare executives in US healthcare systems. Results: We found that one group perceived programmes targeting one profession as advantageous, promoting openness and professional relationships among peers. Other executives argued that multidisciplinary programmes could add value because they could bridge professional boundaries, strengthen networks and build leadership capacity throughout an organisation. Costs, timing, organisational culture and a lack of knowledge about how to run multidisciplinary programmes were challenges our informants associated with multidisciplinary leadership development programmes. Conclusion: This study identifies topics and challenges that can inform organisational policies and decisions about leadership development activities.

• Vassbotn, Ane Drougge; Sjøvik, Hege; Tjerbo, Trond; Frich, Jan C & Spehar, Ivan (2018). General practitioners' perspectives on care coordination in primary health care: A qualitative study. International Journal of Care Coordination. ISSN 2053-4345. 21(4), p. 153–159. doi: 10.1177/2053434518816792. Full text in Research Archive Show summary

  Introduction To explore Norwegian general practitioners’ experiences with care coordination in primary health care. Methods Qualitative study using data from five focus groups with 32 general practitioners in Norway. We analysed the data using systematic text condensation, a descriptive and explorative method for thematic cross-case analysis of qualitative data. Results The general practitioners had different notions of care pathways. They expressed a wish and an obligation to be involved in planning and coordination of primary health-care services, but they experienced organisational and financial barriers that limited their involvement and contribution. General practitioners reported lack of information about and few opportunities for involvement in formal coordination initiatives, and they missed informal arenas for dialogue with other primary health-care professionals. They argued that the general practitioner’s role as coordinator should be recognised by other parties and that they needed financial compensation for contributions and attendance in meetings with the municipality. Discussion General practitioners need informal arenas for dialogue with other primary health-care professionals and access to relevant information to promote coordinated care. There might be an untapped potential for improving patient care involving general practitioners more in planning and coordinating services at the system level. Financial compensation of general practitioners contribution may promote increased involvement by general practitioners.

• Frich, Jan C; Sjøvik, Hege & Spehar, Ivan (2017). Leder- og ledelsesutvikling i helsevesenet – en oversikt. Michael. ISSN 1893-9651. 14, p. 168–176. Full text in Research Archive Show summary

  Artikkelen omhandler tilnærminger til leder- og ledelsesutvikling i helsevesenet. Vi vil definere begrepene lederutvikling og ledelsesutvikling, peke på betydningen av å tydeliggjøre forventet læringsutbytte, presentere ulike typer tiltak og aktiviteter, diskutere styrker og svakheter ved interne og eksterne program, før vi gjør rede for kunnskapsstatus om effekter av lederutvikling. I litteraturen er det vanlig å skille mellom tiltak og aktiviteter rettet inn mot å utvikle enkeltindivider (lederutvikling) versus grupper eller organisasjoner (ledelsesutvikling). Tiltak og aktiviteter kan inndeles i fem kategorier: Utviklende relasjoner, utviklende oppgaver, tilbakemelding, formelle program og egenutviklingsaktiviteter. Det er dokumentert at leder- og ledelsesutvikling er assosiert med positive resultater, men det er behov for mer forskning om hvilke typer program, tiltak og aktiviteter som er hensiktsmessige.

• Spehar, Ivan; Sjøvik, Hege; Karevold, Knut Ivar; Rosvold, Elin Olaug & Frich, Jan C (2017). General practitioners' views on leadership roles and challenges in primary health care: a qualitative study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 35(1), p. 105–110. doi: 10.1080/02813432.2017.1288819. Full text in Research Archive Show summary

  Objective: To explore general practitioners’ (GPs) views on leadership roles and leadership challenges in general practice and primary health care. Design: We conducted focus groups (FGs) with 17 GPs. Setting: Norwegian primary health care. Subjects: 17 GPs who attended a 5 d course on leadership in primary health care. Results: Our study suggests that the GPs experience a need for more preparation and formal training for the leadership role, and that they experienced tensions between the clinical and leadership role. GPs recognized the need to take on leadership roles in primary care, but their lack of leadership training and credentials, and the way in which their practices were organized and financed were barriers towards their involvement. Conclusions: GPs experience tensions between the clinical and leadership role and note a lack of leadership training and awareness. There is a need for a more structured educational and career path for GPs, in which doctors are offered training and preparation in advance.

• Spehar, Ivan; Jacques, Forest & Stenseng, Frode (2016). Passion for Work, Job Satisfaction, and the Mediating Role of Belongingness. Scandinavian Journal of Organizational Psychology. 8(1), p. 5–14. Full text in Research Archive
• Spehar, Ivan; Frich, Jan C & Kjekshus, Lars Erik (2015). Professional identity and role transitions in clinical managers. Journal of Health Organisation and Management. ISSN 1477-7266. 29(3), p. 353–366. doi: 10.1108/JHOM-03-2013-0047. Full text in Research Archive
• Spehar, Ivan; Frich, Jan C & Kjekshus, Lars Erik (2014). Clinicians in management: a qualitative study of managers' use of influence strategies in hospitals. BMC Health Services Research. 14(251). doi: 10.1186/1472-6963-14-251. Full text in Research Archive Show summary

  Background Combining a professional and managerial role can be challenging for doctors and nurses. We aimed to explore influence strategies used by doctors and nurses who are managers in hospitals with a model of unitary and profession neutral management at all levels. Methods We did a study based on data from interviews and observations of 30 managers with a clinical background in Norwegian hospitals. Results Managers with a nursing background argued that medical doctors could more easily gain support for their views. Nurses reported deliberately not disclosing their professional background, and could use a doctor as their agent to achieve a strategic advantage. Doctors believed that they had to use their power as experts to influence peers. Doctors attempted to be medical role models, while nurses spoke of being a role model in more general terms. Managers who were not able to influence the system directly found informal workarounds. We did not identify horizontal strategies in the observations and accounts given by the managers in our study. Conclusions Managers’ professional background may be both a resource and constraint, and also determine the influence strategies they use. Professional roles and influence strategies should be a theme in leadership development programs for health professionals.

• Spehar, Ivan; Frich, Jan C & Kjekshus, Lars Erik (2012). Clinicians' experiences of becoming a clinical manager: a qualitative study. BMC Health Services Research. 12(421). doi: 10.1186/1472-6963-12-421. Full text in Research Archive Show summary

  Background There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals' decisions to engage in management. The aim of this study is to explore clinicians' journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. Methods We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. Results We found that there were three phases in clinicians' journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants' experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management "on the fly". Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Conclusions Path dependency and social pressure seems to influence clinicians' decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary support functions are available locally, especially for early stage clinician managers.

• Spehar, Ivan & Kjekshus, Lars Erik (2012). Medical management in Norwegian hospitals. Professions and Professionalism. 2(1), p. 42–59. doi: 10.7577/pp.v2i1.178. Full text in Research Archive

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• Spehar, Ivan (2024). Nyttig om helseledelse (bokanmeldelse). Michael. ISSN 1893-9651. 21, p. 348–349. Full text in Research Archive
• Hasanic, Alan; Lyons, Oscar; Nayak, Rounaq & Spehar, Ivan (2024). IMPACT: how to design & deliver a leadership development programme for senior healthcare leaders. BMJ Leader. 8:A1. doi: 10.1136/leader-2024-FMLM.1. Full text in Research Archive
• Frich, Jan C & Spehar, Ivan (2023). Gir lederutdanning bedre ledere? Full text in Research Archive
• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Show all 10 contributors for this article] (2022). Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: A longitudinal interview study. Full text in Research Archive
• Rød, Sigrid; Faiz, Kashif Waqar & Spehar, Ivan (2018). Hva motiverer sykehusleger? 138(16), p. 1514–1516. doi: 10.4045/tidsskr.18.0545. Full text in Research Archive
• Spehar, Ivan (2018). Engaging clinicians in management: role transitions and identity. Full text in Research Archive
• Frich, Jan C & Spehar, Ivan (2018). Ledelsesutvikling for leger. 138(15), p. 1418–1419. doi: 10.4045/tidsskr.18.0645. Full text in Research Archive
• Spehar, Ivan; Klev, Nils Kristian; Rokstad, Kirsten Skinlo; Rosvold, Elin Olaug & Frich, Jan C (2017). Ledelseskurs for leger i primærhelsetjenesten. Utposten. ISSN 0800-5680. 46(6), p. 42–43. Full text in Research Archive
• Spehar, Ivan (2016). Ledelse i norske helseforetak: Betraktninger om ledelsesutvikling i helsevesenet basert på en avhandling om ledelse i norske helseforetak. Sykepleien Ledelse. 4(1). Full text in Research Archive
• Spehar, Ivan (2016). Gjør det vondt for leger å bli ledere? Overlegen. ISSN 1503-2663. p. 14–15. Full text in Research Archive
• Spehar, Ivan (2015). Kompetanse alene er ikke nok - Noen refleksjoner rundt lederutvikling og rekruttering, basert på studier av klinikeres motivasjon for og opplevelse av å bli ledere i spesialisthelsetjenesten. Full text in Research Archive
• Spehar, Ivan & Larsson, Martin (2012). Undervisningen må endres. Full text in Research Archive
• Spehar, Ivan & Ng, Mei Ying (2010). Hjelpeløse på markedet (papirutgave). p. 50–51. Full text in Research Archive Show summary

  Kronikkforfatterne foreslår at forventninger til å mislykkes på det norske arbeidsmarkedet kan være en viktig årsak til at mange innvandrere står utenfor jobb. Tiltak for å øke innvandreres mestringstro blir presentert som en mulig løsning for økt deltakelse i arbeidslivet.

• Spehar, Ivan (2010). Mind the gap: exploring the challenges related to clinical leadership (poster presentation). Full text in Research Archive
• Spehar, Ivan (2009). Jobblidenskapens skyggeside. Full text in Research Archive Show summary

  En lidenskapelig interesse for jobben kan fremme arbeidstakerens jobbtilfredshet. En tvangspreget form for lidenskap kan derimot medføre negative konsekvenser for både den ansatte og bedriften. I verste fall kan den ansatte drive seg selv til utbrenthet, godt hjulpet av en bedriftskultur som oppfordrer til overtidsarbeid.

• Spehar, Ivan (2016). Evaluering av piloten i Ledermobiliseringsprogrammet i regi av Nasjonal ledelsesutvikling. Rapport mars 2016. Universitetet i Oslo. Full text in Research Archive
• Spehar, Ivan (2015). Leadership in Norwegian hospitals: a qualitative study of clinical managers´ pathways, identities, and influence strategies. Universitetet i Oslo. Full text in Research Archive Show summary

  Clinicians have a central role in the design, implementation, and improvement of care, and they exercise a key role in treatment decisions with implications for overall budgets. Increasing expectations to health care, increased costs and a growing number of older patients with complex diseases have raised public awareness towards effectiveness and quality of care. Several authors and commentators have pointed to the need to involve doctors in management in order to control resource use and costs. There has consequently been an increased interest in recruiting clinicians to management positions in health care. The overall aim of this study is to uncover conditions for successful engagement of clinicians in management. The thesis consists of three articles that seek to explore clinicians´ journeys into management and their experiences of becoming a clinical manager (paper I); how their professional background influences their identity and transition into a manager role (paper II); and how their professional background influences the strategies that they use to exert influence in hospitals (paper III). The thesis is based on observations and interviews with 30 clinicians in two different health trusts in Norway. While the main interest was on doctors, nurses were also included in the study to provide a contrasting lens for analyzing and interpreting the findings. We found that the career paths of clinical managers were characterized by coincidences and peer pressure to take the position as manager, rather than deliberate choices (paper I). A common experience among participants was insufficient preparation for the required tasks for their new position. Clinicians told that they had to learn management “on the fly”, and experienced frustrations related to administrative work and challenges delegating work effectively. Doctors also experienced difficulties in reconciling the role as health professional with the role as manager (paper II). They maintained a professional identity and reported to find meaning and satisfaction from clinical work. The thesis also highlights some of the institutionalized rules and norms in hospitals, namely the perception that power relies on professional expertise and that clinical managers were more likely to draw on expert power than on formal position power (paper III). The managers´ professional background was both a resource and a constraint in this context; while nurses were mostly restrained from acting within an expert base, doctors believed that they had to draw on expert power to influence peers. Participants who were not able to influence higherlevel managers sought to find informal workarounds. The thesis suggests that theories on role and identity increase the understanding of how clinicians experience and perform the manager role and that psychological needs for autonomy, competence and relatedness might be instrumental in effective identity building and role transition. Clinical managers who do not experience need satisfaction in their managerial role might become frustrated and instead seek satisfaction in the clinical and research aspects of their role. Decision makers and top managers should acknowledge the social structure that exists in hospitals and the limitations facing managers with different backgrounds, before implementing new management models and responsibilities. Clinicians entering management need training and preparation at an early stage, rather than having to learn important skills after becoming managers. Management programs should also acknowledge the sense of meaning and purpose imbedded in the professional role, and the sense of loss involved when clinicians enter into managerial positions.

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