Health Policy 90 (2009) 166–174 Contents lists available at ScienceDirect Health Policy journal homepage: www.elsevier.com/locate/healthpol Necessary organizational changes according to Burke–Litwin model in the head nurses system of management in healthcare and social welfare institutions—The Slovenia experience Bojana Filej a , Brigita Skela-Saviˇ c b , Visnja H. Vicic c , Narcis Hudorovic d,* a Faculty of Health Sciences, University of Maribor, Slovenia b College of Nursing Jesenice, Slovenia c Accredited College of Business and Management, Zapresic, Croatia d University Department of Surgery, University Hospital “Sestre milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia article info Keywords: Head nurse Agenda for change Management system Burke–Litwin model Organizational changes abstract Objective: To discover which changes should be implemented in the system of head nursing management in Slovenian healthcare institutions and social welfare institutions. Methods: The questionnaire was distributed to 155 head nurses of Slovenian hospitals, pri- mary healthcare centres and social welfare institutions. The Burke–Litwin organizational change model has been used to look at which changes have to be implemented in the management system of head nurses. Results: In hospitals head nurses have greater independent competence for planning profes- sional training of nursing employees (p < .022) and are also more independent when it comes to selecting employees when it comes to new job openings (M = 4.20, S.D. = .83, p < .004). According to the Burke–Litwin organizational change model, the elements to which changes should be introduced include “external environment” for primary healthcare centres and social welfare institutions, and “system (policies and procedures)” for primary healthcare centres. Conclusions: According to results of our study, changes are needed in leadership and man- agement of nursing in primary healthcare centres. In social welfare institutions changes are only required in leadership. Organizational changes are not necessary for any element of the Burke–Litwin model for hospitals. © 2008 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Slovenia has been a member of the European Union since 2004. There are 24 public, non-profit hospi- tals in Slovenia on the secondary level, and there are 59 primary healthcare centres and 72 social welfare institutions—homes for the elderly (nursing homes) on the primary level. In all these institutions nursing is part of * Corresponding author. Tel.: +385 1 46 40 774; fax: +385 1 37 68 292. E-mail address: narcis.hudorovic@zg.htnet.hr (N. Hudorovic). management, being guided by the head nurse of the insti- tution. A short overview shows that in Slovenia the function of healthcare management is not developing well. Direc- tors of healthcare institutions need not have any special know-how on healthcare or social management in order to assume that position. The knowledge in this area is not a value in the system [1]. In Slovenia, the first postgraduate program for healthcare and social management developed as late as 2007. There are some research results which focus mainly on hospital management, but these results are nev- ertheless important for our research from the nursing point 0168-8510/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2008.09.013