The balance between professional autonomy and organizational obligations in resilient management of specialized health care: A Norwegian document study

Abstract

Background: Adverse events in hospitals may jeopardize the safety of patients. Failure in professional autonomy, organizational learning or in the contact between these two factors may explain the occurrence of injurious incidents in hospitals.

Objective: To study reasons for failure in contact between professional autonomy and organizational learning in resilient management of specialized health care through document analysis.

Methods: A total of 20 reports from the Norwegian Board of Health Supervision were evaluated by a retrospective in-depth document analysis. In the analysis of adverse events, we applied the Braut model to identify function or failure of 1. Professional autonomy, 2. Organizational learning and 3. Contact between professional autonomy and organizational learning.

Results: Multivariable regression analysis showed that failure in organizational learning was the only explanatory variable for failure in contact between doctors and nurses autonomy and organizational learning. Failure in organizational learning had the strongest effect on failure in contact between doctors and nurse's autonomy and organizational learning (B = 1.69; 95% CI = 0.45 to 2.92). Failure in professional autonomy showed no significant effect on this contact.

Conclusions: Failure in organizational learning is associated with failure in contact between professional autonomy and organizational learning. Failure in professional autonomy did not influence this contact.

Keywords: Norway; Norwegian Board of Health Supervision; Professional autonomy; hospital; organizational learning; resilience management; specialized health care.