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Clinical leadership and leadership models in Norwegian hospitals (completed)

Hospitals have illustratively been described as consisting of "separate worlds", reflecting conflicting dimensions between professions and top management systems. As the distance between top management and the clinical level increases in Norwegian hospitals, the role of middle managers is becoming increasingly important.


About the project

Healthcare organizations have been characterized by a decoupling and significant tension between the top management level and the clinical management level. New leadership structures have been implemented in order to bridge the gap between the different logics at these levels of the organization. A new middle management level of leaders has also emerged in most hospitals in the past 10 years. Whether the new leadership structures and middle management level have been successful at bridging the gap remains unclear.


The aim of this project is to provide a better understanding of clinical leadership and the conditions of successful bridging of logics in healthcare organizations.The project will also add new knowledge on how theories from existing leadership models can be applied to bridge the gap between management and the clinical level. The project could result in a new leadership model that is better suited to bridging the gap between top management and the clinical level.


The project will systematically assess clinical leadership models that have been applied to Norwegian hospitals and explore the new middle management levels that have been introduced. Two contrasting health trusts have been chosen for study based on knowledge of their leadership models and characteristics of their organizational structures. The project applies in-depth observation and interviews of 30 middle managers in Norwegian hospitals. Data from focus groups will be used to further validate the results. The results from these methodological approaches will be integrated into the overarching question of how middle managers are able to bridge the gap between the administrative and the clinical dimensions.


The project and its members are part of a larger research group focusing on various topics related to organization and leadership in healthcare organizations. This group includes Professor Ole Berg, Professor Halvor Nordby and Ph.D. students, Anders Havig and Vilde Bernstrøm. The members are affiliated either fully or partly to the Institute and cooperate in project groups where research and literature related to leadership and organizing within healthcare organizations are presented. Most of the group participants are also associated with the Nordic Network of Healthcare Management Research (NOHR) and the European Cooperation in the field of Scientific and Technical Research (COST). The COST network currently works towards the implementation of European research action with the goal of increasing empirical, theoretical and policy relevant knowledge about the changing role of medical professionals in healthcare management.


Spehar, Ivan & Kjekshus, Lars Erik (2012). Medical management in Norwegian hospitals. Professions and Professionalism. 2(1), pp. 42- 59

Spehar, I., Frich, J. C., & Kjekshus, L. E. (2012). Clinicians´ experiences of becoming a clinical manager: a qualitative study. BMC Health Services Research. 12: 421

Spehar, I., Frich, J. C., & Kjekshus, L.E. (2014). Clinicians in management: a qualitative study of managers' use of influence strategies in hospitals. BMC Health Services Research. 14:251

Spehar, I., Frich, J. C., & Kjekshus, L. E. (2015). Professional identity and role transitions in clinical managers. Journal of Health Organization and Management, 29(3), pp. 353 - 366.

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Published Mar. 2, 2011 4:23 PM - Last modified Feb. 17, 2020 8:53 AM