Leading Quality and Safety on the Frontline – A Case Study of Department Leaders in Nursing Homes

Figures & data

Figure 1 Organization of the municipality according to the chairmanship model. The political steering line is shaded blue, while the rest of the organization chart represents the administration. The leadership levels relevant to this study are shaded green. The red shaded level represents the top-leaders in the municipality, while the yellow shaded level represents the middle leaders.

Table 1 Characteristics of Municipalities and Data Collection

Municipality	Urban/rural	Citizens	Number of nursing homes in the municipality	Number of participating nursing homes	Interviews
1	Urban	42,000	6	5	5
2	Urban	72,000	10	4	6
3	Rural	2000	1	1	1
4	Rural	2000	1	1	1
5	Urban	61,000	5	3	3

Table 2 Examples of the Content Analysis Process Theme 2. Relational Capacity

Meaning unit	Condensed meaning unit	Code
I have really good support from my leader I must say. Personally, I think it’s good, but she has not always time for all	Good support from leader, but not always time.	Relationship with nursing home leader
I feel like I am alone with this. We have HSE meetings, and we do have arenas where we meet as a group, but I feel that it is my responsibility to have control over what happens in my department.	Feel alone, my responsibility.	Collaboration with other leaders

Table 3 Examples of Content Analysis theme 2. Relational Capacity

Theme 2	Category	Subcategory	Code
Relational capacity	Interactions	Relations to leaders	Understanding from leader Relationship with nursing home leader
		Relations with employees	Does the relationship affect work
		Cooperation	Transfer from hospital Interaction between municipality and hospital Interdisciplinary collaboration Cooperation with next of kin Collaboration with other leaders
	Engagement	Proud of the job	Meaningful work Pride Good reporting culture
		Reporting culture	Causes of poor reporting culture
		Diversity in the employee group	Ethnicity Female-dominated industry Male caregiver

Figure 2 The four themes of how department leaders in nursing homes manage the dual responsibility of HSE and QPS, the barriers and enablers, using a human factors perspective.

Figure 3 Frontline leaders position in the municipalities, with responsibilities, considerations and influencing factors in a human factors perspective.