title: Quality, efficiency and integrity: value squeezes in management of hospital wards.
abstract: OBJECTIVE
  The aim of this study was to explore and describe the value squeezes experienced by ward managers in connection with quality management in hospital wards. The study focused on integrity pressure and coping strategies to deal with such pressure.
  
  
  BACKGROUND
  Nurses in the role of ward managers have a key function in the field of quality improvement. These managers are also responsible for the efficient running of their wards and thus face tensions between demands for both quality and efficiency.
  
  
  METHODS
  Data were collected through interviews conducted with 10 ward managers from six Norwegian hospitals. The data were analysed using both content and template analysis.
  
  
  RESULTS
  Ward managers felt squeezed between conflicting values associated with demands for both quality and efficiency. These tensions resulted in pressure on integrity for the managers as well as their nursing colleagues. Three different management strategies were used to cope with such pressure: quality conscious, efficiency adjusting and hybrid.
  
  
  CONCLUSIONS
  A hybrid strategy appeared to be the best, both for the ward managers and the hospital organisations, despite the fragmentation associated with this strategy.
  
  
  CONCLUSIONS
  Hybrid management may be beneficial for coping with pressure on integrity, although more empirical research is needed.
authors.affiliation: Aalesund University College, Aalesund, Norway.
authors.forename: Arne
authors.initials: A
authors.lastname: Orvik
authors.forename: Sølvi Røsvik
authors.initials: SR
authors.lastname: Vågen
authors.forename: Susanna Bihari
authors.initials: SB
authors.lastname: Axelsson
authors.forename: Runo
authors.initials: R
authors.lastname: Axelsson
mesh_terms: D001291:Attitude of Health Personnel; D004526:Efficiency; D006801:Humans; D009664:Norway; D009718:Nurse Administrators / Q000941:ethics*; D036301:Qualitative Research; D058996:Quality Improvement / Q000191:economics; D011787:Quality of Health Care / Q000191:economics* / Q000592:standards*
keywords: integrity; organisational health; quality deviation; value squeezes; ward management