Facilitating system-wide organizational change in health care

2015 ◽  
Vol 7 (1) ◽  
pp. 72-89 ◽  
Author(s):  
Anna Westerlund ◽  
Rickard Garvare ◽  
Elisabet Höög ◽  
Monica Elisabeth Nyström
Keyword(s):  
Health Care ◽  
Organizational Change ◽  
Organizational Development ◽  
Current Knowledge ◽  
Health Care Organization ◽  
Care Organization ◽  
Longitudinal Case Study ◽  
Content Type ◽  
Roles And Responsibilities ◽  
Combining Data

Purpose – The purpose of this paper was to investigate the role of an intra-organizational change facilitating function (CFF) in relation to a multi-level development initiative in a health care organization. Involved actors’ views on factors in need of attention and how the CFF related to these factors were studied. Design/methodology/approach – A longitudinal case study design was used, combining data from questionnaires, process diaries and interviews with employees at the CFF, managers and clinic staff. Findings – Factors on micro, meso and macro levels, crucial to attend to, were highlighted by respondents at staff and managerial levels. The CFF related to some of these factors by acting upon them, or by developing plans to handle them, while other factors were unattended to. The CFF activities also had indirect influence on other factors. The CFF role and responsibilities were not clearly defined beforehand, and a need to clarify a division of roles and responsibilities is highlighted. Research limitations/implications – Our study contributes to current knowledge on facilitation of change by relating it to an organizational dimension of implementation. Practical implications – The description of important factors to handle during a large organizational change process and issues a CFF can encounter may aid others involved in designing and managing large organizational development initiatives. Originality/value – The study elaborates on less studied functions and roles of an intra-organizational CFF in relation to factors of vital importance for organizational change and development in health-care organizations.

“Stuck in the middle” first-line healthcare managers’ responsibilities and needs of support when applying Lean

2020 ◽  
Vol 12 (2) ◽  
pp. 173-186
Author(s):  
Therese Kahm ◽  
Pernilla Ingelsson
Keyword(s):  
Health Care ◽  
Health Care Organization ◽  
Shared Responsibility ◽  
Care Organization ◽  
First Line ◽  
Line Managers ◽  
Content Type ◽  
Lean Principles ◽  
Organizational Issues ◽  
The Relationship

Purpose The purpose of this paper is to present the supportive conditions that the first-line health-care managers claim that they need from their own managers and what they experience as their own roles and responsibilities in relation to their coworkers when applying Lean principles and practices. Design/methodology/approach A survey with a Web-based questionnaire was designed and used in a Swedish health-care organization two years after the initiation of Lean to investigate the managers’ views on their role, conditions and ability to create change according to Lean. The result from two of the questions will be presented where one focuses on the relationship to the first-line managers’ own manager and the second on the relationship to their coworkers. Findings The results show that to initiate improvement, work based on Lean first-line managers ask for own managers who are assured about Lean, include them in discussions and ask for follow-ups and results about Lean. Concerning first-line managers’ relation to their coworkers they experience themselves as responsible for leading toward creating a culture where problems and mistakes are viewed as possibilities to improve, for encouraging that new work procedures are tested and for creating commitment and inspiration in relation to their coworkers. Originality/value The questions can be used separately or as part of an entire questionnaire before and along the Lean process to highlight organizational issues such as shared responsibility and supportive relations when developing health care.

Structure of health-care dyad leadership: an organization’s experience

2018 ◽  
Vol 31 (2) ◽  
pp. 238-253 ◽  
Author(s):  
Anurag Saxena ◽  
Maura Davies ◽  
Don Philippon
Keyword(s):  
Health Care ◽  
Leadership Development ◽  
Health Care Organization ◽  
Middle Level ◽  
Care Organization ◽  
Mutual Relationship ◽  
Joint Decision ◽  
Content Type ◽  
Management Domain ◽  
Formal Leadership

Purpose This study aims to explore the structural aspects (roles, responsibilities and reporting) of dyad leadership in one health-care organization (HCO). Design/methodology/approach The perceptions of 32 leaders (17 physician leaders and 15 dyad co-leaders) in formal leadership positions (six first-level with formal authority limited to teams or divisions, 23 middle-level with wider departmental or program responsibility and three senior-level with institution-wide authority) were obtained through focus groups and surveys. In addition, five senior leaders were interviewed. Descriptive statistics was used for quantitative data, and qualitative data were analyzed for themes by coding and categorization. Findings There are a large number of shared responsibilities in the hybrid model, as most activities in HCOs bridge administrative and professional spheres. These span the leadership (e.g. global performance and quality improvement) and management (e.g. human resources, budgets and education delivery) domains. The individual responsibilities, except for staff and physician engagement are in the management domain (e.g. operations and patient care). Both partners are responsible for joint decision-making, projecting a united front and joint reporting through a quadrat format. The mutual relationship and joint accountability are key characteristics and are critical to addressing potential conflicts and contradictions and achieving coherence. Practical implications Clarity of role will assist development of standardized job descriptions and required competencies, recruitment and leadership development. Originality/value This is an original empirical study presenting an integrated view of dyad leaders and senior leadership, meaningful expansion of shared responsibilities including academic functions and developing mutual relationship and emphasizing the central role of stability generating management functions.

Enhancing organizational health literacy in a rural Missouri clinic: a qualitative case study

2019 ◽  
Vol 32 (5) ◽  
pp. 788-804 ◽  
Author(s):  
Ricardo Wray ◽  
Nancy Weaver ◽  
Prajakta Adsul ◽  
Kanak Gautam ◽  
Keri Jupka ◽  
...  
Keyword(s):  
Organizational Change ◽  
Health Literacy ◽  
Literacy Practices ◽  
Health Care Organization ◽  
Qualitative Interviews ◽  
Management Strategies ◽  
Organizational Health ◽  
Health Clinic ◽  
Care Organization ◽  
Content Type

Purpose The purpose of this paper is to evaluate a collaborative effort between a health care organization and academic institution to strengthen organizational health literacy. Design/methodology/approach The intervention took place at a rural, federally qualified health clinic in Missouri between May 2009 and April 2011. Qualitative interviews of key informants were conducted before (n=35) and after (n=23) the intervention to examine program implementation and success in effecting organizational change. Findings Intervention activities helped establish a comprehensive understanding of health literacy. The project achieved moderate, fundamental and sustainable organizational change. The program successfully integrated health literacy practices into clinic systems and garnered leadership and organizational commitment, helped the workforce improve interpersonal communication and embedded practices making health education materials more accessible. Originality/value The study points to programmatic, conceptual and methodological challenges that must be addressed for organizations to improve health literacy practices, and suggests change management strategies to advance organizational health literacy.

Quality improvement in large healthcare organizations

2016 ◽  
Vol 30 (1) ◽  
pp. 133-153 ◽  
Author(s):  
Elisabet Höög ◽  
Jack Lysholm ◽  
Rickard Garvare ◽  
Lars Weinehall ◽  
Monica Elisabeth Nyström
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Care Quality ◽  
Health Care Systems ◽  
Care Quality ◽  
Care Organization ◽  
Longitudinal Case Study ◽  
Systematic Analysis ◽  
Content Type

Purpose – The purpose of this paper is to investigate the obstacles and challenges associated with organizational monitoring and follow-up (M & F) processes related to health care quality improvement (QI) and development. Design/methodology/approach – A longitudinal case study of a large health care organization during a system-wide QI intervention. Content analysis was conducted of repeated interviews with key actors and archival data collected over a period of four years. Findings – The demand for improved M & F strategies, and what and how to monitor were described by the respondents. Obstacles and challenges for achieving M & F strategies that enables system-wide and coherent development were found in three areas: monitoring, processing, and feedback and communication. Also overarching challenges were found. Practical implications – A model of important aspects of M & F systems is presented that can be used for analysis and planning and contribute to shared cognition of such systems. Approaches for systematic analysis and follow-up of identified problems have to be developed and fully incorporated in the organization’s measurement systems. A systematic M & F needs analytic and process-oriented competence, and this study highlights the potential in an organizational function with capacity and mandate for such tasks. Originality/value – Most health care systems are flooded with a vast amount of registers, records, and measurements. A key issue is how such data can be processed and refined to reflect the needs and the development process of the health care system and how rich data can be used for improvement purposes. This study presents key organizational actor’s view on important factors to consider when building a coherent organizational M & F strategy.

scholarly journals Building perspective awareness as a workplace practice

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Pia Andersson ◽  
Lotta Dellve ◽  
Gunnar Gillberg ◽  
Hans Lindgren
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Health Care Organization ◽  
Work Organization ◽  
Implementation Process ◽  
Care Organization ◽  
Content Type ◽  
Dialogue Model ◽  
Organizational Conditions ◽  
The Right

Purpose The present study aims to describe the implementation of a facilitated dialogue model intended to improve communication across professional logics and knowledge boundaries in two units of a large health-care organization in Sweden. Design/methodology/approach This is a mixed-methods study with interviews, field observations and follow- up questionnaires that were conducted during the implementation process. Findings The conclusion drawn in this study is that it is possible to change and improve the dialogue between health-care professionals with the help of a tailored, facilitated dialogue model. The authors found that different professional logics can indeed meet and share perspectives if the right conditions are provided. Moreover, an improved dialogue between different professional groups may contribute to work satisfaction, engagement, social cohesion and communication between professionals. Practical implications This study shows that the right organizational conditions, such as support from managers, must exist if the model’s inherent possibilities are to be used. Inhouse facilitation may be a sustainable model for facilitated workplace dialogue when its implementation is supported by the overall organization. Originality/value The contribution is an empirically based analysis of a new form of model for mediating perspectives within an organization with distinct professional roles. This study shows how, under the right conditions, the model can contribute to a perspective awareness and thus a more mature work organization.

Knowledge creation practices at organizational boundaries: the role of ICT in sickle-cell care for tribal communities

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Vinayak Ram Tripathi ◽  
Manish Popli ◽  
Swati Ghulyani ◽  
Shrey Desai ◽  
Ajai Gaur
Keyword(s):  
Health Care ◽  
Sickle Cell ◽  
Knowledge Creation ◽  
Genetic Disorder ◽  
Health Care Organization ◽  
Care Organization ◽  
Front Line ◽  
Organizational Boundaries ◽  
Content Type ◽  
Tribal Communities

Purpose This paper aims to examine the role of information and communication technology (ICT) in the knowledge creation practices adopted by a health care organization. The organization is delivering care to patients of a genetic disorder, called the sickle cell, in tribal communities. The paper identifies how ICT intermediates knowledge creation practices across the organizational boundaries wherein tribal patients, front-line counselors and expert physicians interact, which then produces context-specific, evidence-based medicine (EBM). Design/methodology/approach The knowledge-in-practice approach is adopted to conduct an ethnographic study of sickle cell care practices in a non-profit health care organization in Western India. The analysis focuses on ICT-mediated interactional practices among the physicians, front-line counselors, tribal patients and their families, for more than a year-long observation. These are supplemented with informal and formal interviews, archival records and vignettes based on several episodes to explicate the key knowledge creation practices. Findings Technology-mediated informative interactions at organizational boundaries can bridge socio-linguistic and interpretive barriers between actors, while also providing a generative structure that leads to the creation of longitudinal clinical evidence about a rare genetic disorder. Three specific ICT-entwined knowledge creation practices emerge, namely, knowing the community, increasing interactional engagement and constructing gradients of socio-clinical history. These practices generate organization-wide knowledge about the social and clinical dimensions of the genetic disorder. The findings are presented through vignettes and a novel conceptual framework. Research limitations/implications This study identifies various useful knowledge creation practices in health care delivery for resource-constrained emerging economy contexts. Further, the study suggests that the involvement of local front-line actors and ICT can become important resources in the delivery of health care in these settings. Originality/value A novel framework is developed which demonstrates knowledge creation at organizational boundaries wherein the actors use ICT-based practices for effective delivery of health care. The proposed framework may be used by health care organizations in similar contexts providing care to marginalized communities.

Modelling the leadership characteristics for organizational readiness: a context of lean implementation in healthcare

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rojalin Patri ◽  
M. Suresh ◽  
Rajiv Prasad
Keyword(s):  
Health Care ◽  
Health Care Organization ◽  
Team Building ◽  
Organizational Readiness ◽  
Leadership Characteristics ◽  
Care Organization ◽  
Lean Implementation ◽  
Content Type ◽  
Lean Practices ◽  
Expert Interview

Purpose The purpose of this study is to identify the leadership characteristics that make a health-care organization ready for lean implementation, analyse the interdependence among them and determine the rank of each characteristic based on their influence in the overall phenomenon. Design/methodology/approach The leadership characteristics were identified through a review followed by an expert interview. Then, total interpretive structural modelling (TISM) was used to analyse the interdependence and determine the rank, driving power and dependence of each characteristic. Findings The results suggest that modesty is the most crucial leadership characteristic that makes a health-care organization ready for the successful incorporation of lean practices. Apart from that, attributes such as transparency, accountability, a leader’s ability to empower the employees and communication play a significant role in making the change management programme impactful and effective. A leader’s team building capacity was found to be the dependent characteristic and was ranked the last in the overall phenomenon. Research limitations/implications Though this study throws light on various leadership dispositions that prepare a health-care organization to become a lean, it is still not an exhaustive exploration to be generalized. Because the leadership characteristics required for successful lean implementation may vary from one organization to the other depending on the purpose, intensity and priority of the implementation programme, these parameters along with the complexity of the scenario would determine what other leadership characteristics need to be included in the model to make it more robust and holistic. Originality/value The novelty of the study lies in capturing the leadership characteristics for organizational readiness in the health-care sector and using the TISM approach to identify the critical characteristics in the context of lean implementation in hospitals.

Employee career development and turnover: a moderated mediation model

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ryan L. Kasdorf ◽  
Alper Kayaalp
Keyword(s):  
Job Satisfaction ◽  
Health Care ◽  
Career Development ◽  
Health Care Organization ◽  
Intent To Stay ◽  
Care Organization ◽  
Data Set ◽  
Content Type ◽  
Large Sample ◽  
Positive Effects

Purpose Responding to calls for further research, the primary aim of the current study is to examine the employee perceptions of development (EPD) and intent to stay process with potential intervening variables (i.e. job satisfaction and supervisor support) to expand our understanding of how employees will respond to such perceptions. Design/methodology/approach A large sample (n = 687) of survey responses from a health-care organization was analyzed. The data set is from an employee experience survey that was distributed to employees after one year of employment. As one of the largest change initiatives in its history, the organization was in the process of merging with another large health-care organization. Findings The results indicated that there is a direct and positive relationship between EPD and intent to stay, and that job satisfaction mediated this relationship. These findings provide further evidence that employee development is an effective intervention to reduce turnover and increase job satisfaction. Originality/value The current study contributed to the existing literature by providing additional evidence for the positive effects of employee career development perceptions on job satisfaction and intent to stay by examining a large sample in an organizational setting.

Significance of scientific evidence in organizing care processes

2016 ◽  
Vol 30 (4) ◽  
pp. 597-612 ◽  
Author(s):  
Henna Hasson ◽  
Staffan Blomberg ◽  
Anna Dunér ◽  
Anneli Sarvimäki
Keyword(s):  
Health Care ◽  
Ad Hoc ◽  
Social Care ◽  
Scientific Evidence ◽  
Health Care Organization ◽  
Controlled Study ◽  
Care Organization ◽  
Content Type ◽  
Health And Social Care ◽  
Care Practices

Purpose – The purpose of this paper is to analyze how staff and managers in health and social care organizations use scientific evidence when making decisions about the organization of care practices. Design/methodology/approach – Document analysis and repeated interviews (2008-2010) with staff (n=39) and managers (n=26) in health and social care organizations. The respondents were involved in a randomized controlled study about testing a continuum of care model for older people. Findings – Scientific evidence had no practical function in the social care organization, while it was a prioritized source of information in the health care organization. This meant that the decision making regarding care practices was different in these organizations. Social care tended to rely on ad hoc practice-based information and political decisions when organizing care, while health care to some extent also relied in an unreflected manner on the scientific knowledge. Originality/value – The study illustrates several difficulties that might occur when managers and staff try to consider scientific evidence when making complicated decisions about care practices.

scholarly journals Assessing the leanness of a supply chain using multi-grade fuzzy logic: a health-care case study

2019 ◽  
Vol 10 (1) ◽  
pp. 81-105 ◽  
Author(s):  
Abdulaziz Marzouq Almutairi ◽  
Konstantinos Salonitis ◽  
Ahmed Al-Ashaab
Keyword(s):  
Health Care ◽  
Fuzzy Logic ◽  
Supply Chain ◽  
Conceptual Model ◽  
Health Care Organization ◽  
Future Research ◽  
Care Organization ◽  
Content Type ◽  
Lean Principles

Purpose Numerous and diverse organizations have implemented lean principles and practices, which concentrate on improving the efficiency of business processes by reducing cost, waste, consumptions and effort. However, previous assessments have not focused on the leanness of the supply chain in a health-care setting. This paper aims to introduce a method for assessing the successful implementation of lean principles and tools in a supply chain. Furthermore, this paper validates the method in a health-care organization. Design/methodology/approach This paper starts with an extensive literature review on assessing leanness and using multi-grade fuzzy logic. Then, a conceptual model was developed to measure leanness. The conceptual model was validated by discussing the initial version with select academic experts, especially those who deal with leanness in health-care organizations. After responding to the experts’ valuable comments, the health-care organization that is the focus of this case study was chosen based on two criteria. The first criterion was the organization’s ability to participate in the study, and the second was the organization’s commitment to implementing lean principles. These criteria were important to ensure the organization had the necessary foundation for implementing change initiatives such as lean process improvements. Next, a multi-grade (multi-attributes) fuzzy logic was used for leanness measurement. A leanness index was calculated, and the results were validated using experts from the case study organization. Finally, the weaker areas of the organization’s processes were identified to point the way for further improvements. Findings The assessment indicated that the case study organization is not lean. The organization’s weaker attributes were identified, and improvements have been suggested. Research limitations/implications This study focused on a single health-care organization, which was selected from a limited pool of potential organizations, namely, organizations which are accredited by both the Saudi Central Board for Accreditation of Healthcare Institutions and the Joint Commission International. The scope of future research should be extended to multi-case studies to enhance the findings presented in this paper. This paper’s findings can be used to help decision-makers at health-care providers to implement lean thinking in supply chain processes. Practical implications This research may be interest to practicing supply chain managers, as it proposes what enablers, factors and attributes should be emphasized in lean implementation. The proposed model can work as an assessment tool to identify the gap between the present level of leanness and the desired leanness state so the health-care organization can identify what can be improved. This model enables decision-makers in hospital supply chain to take suitable actions for improving lean implementation level. Originality/value This study makes an original contribution to the body of research concerning lean principles; the study developed a conceptual model for leanness assessment that can be applied to the supply chain of health-care organizations. Indeed, the conceptual model is likely to be useful for assessing leanness outside of the health-care field, which suggests avenues for future research.

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