Clinical pathway efficiency for elective joint replacement surgeries: a case study

2019 ◽  
Vol 33 (3) ◽  
pp. 323-338
Author(s):  
Maude Laberge ◽  
André Côté ◽  
Angel Ruiz
Keyword(s):  
Organizational Culture ◽  
Mixed Methods ◽  
Joint Replacement ◽  
Clinical Pathway ◽  
Wait Time ◽  
System Level ◽  
Organizational Level ◽  
Significant Variable ◽  
Content Type

Purpose The purpose of this paper is to define a clinical pathway for total joint replacement (TJR) surgery, estimate the effect of delays between steps of the pathway on wait time for surgery and to identify factors contributing to more efficient operations and challenges to their implementation. Design/methodology/approach This is a case study with a mixed methods approach. The authors conducted interviews with hospital staff. Data collected in the interviews and through on-site observation were analyzed to map the TJR process and identify the steps of the care pathway. The authors extracted and analyzed data (time stamps) from 60 hospital patient records for each step in the pathway and ran a regression on the duration of the whole trajectory. Findings There were wide variations in the delays observed between the seven steps identified. The delay between Step 1 and Step 2 was the only significant variable in predicting the total wait time to surgery. In one hospital, one delay explained 50 percent of the variation. There was misalignment between findings from the qualitative data in terms of strategies implemented to increase efficiency of the clinical pathway to the quantitative data on delays between the steps. Research limitations/implications The study identified the clinical pathway from the consultation with an orthopaedic surgeon to the surgery. However, it did not go beyond the surgery. Future research could investigate the relationship between specific processes and delays between steps of the process and patient outcomes, including length of stay, mobilization and functionality in activities of daily living, as well as potential complications from surgery, readmission and the services required after the patient was discharged. Practical implications Wait times can be addressed by implementing strategies at the health system level or at the organizational level. The authors found and discuss areas where there could be efficiency gains for health care organizations. Social implications Stakeholders in care processes are diverse and they each have their preferences in how they practice (in the case of providers) and how they perceive and wish to respond adequately to patients’ needs in contexts that have different norms and approaches. The approach in this study enables a better understanding of the processes, the organizational culture and how these may affect each other. Originality/value Our mixed methods enabled a process mapping and the identification of factors that significantly affected the efficiency of the TJR surgery process. It combines methods from process engineering with health services and management research. To some extent, this study demonstrates that although managers can define and enforce processes, organizational culture and practices are harder to influence.

The promoters and the barriers for organizational culture change in a Finnish construction company

2019 ◽  
Vol 19 (4) ◽  
pp. 672-688
Author(s):  
Ville Juhani Teräväinen ◽  
Juha-Matti Junnonen
Keyword(s):  
Organizational Culture ◽  
Knowledge Management ◽  
Construction Industry ◽  
Culture Change ◽  
Holistic Approach ◽  
Organizational Level ◽  
Content Type ◽  
Construction Company ◽  
Organizational Culture Change

Purpose The construction industry has struggled with efficiency issues for decades. Organizational culture is identified as one of the biggest hindrances for the enhancement of efficiency in a highly labor-intensive sector such as construction. Based on recent academic studies, Finnish construction industry professionals would embrace clan and adhocracy culture features to achieve a better level of construction efficiency. The purpose of this paper is to investigate the promoters and the barriers for making the desired culture change happen in the case company. Design/methodology/approach The paper presents a semi-structured theme interview case study, including 12 in-depth interviews. The interviews were recorded, and later, transcribed into text, which forms the empirical data of this paper. Findings The Finnish construction industry must adopt a holistic approach to enhance its prevailing level of efficiency through the culture change. Basic learning and knowledge management processes seem to be missing from the industry and organizational levels. Better knowledge management in the case company would be the first step to start fixing this problem. Research limitations/implications Because of the nature of a case study, the research results can be generalized only with caution in the Finnish construction industry. Generalizing the findings in another country would require further studies in a different cultural environment, e.g. in another European country. Practical implications The paper includes implications for the development of the organizational culture on the Finnish construction industry level and on an organizational level. Originality/value The found influencers are discussed through Engeström’s activity model for the first time in the construction culture context.

Using action research in innovation project management: building legitimacy and organizational learning in an SME during a merger process

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Constance Elizabeth Kampf ◽  
Charlotte J. Brandt ◽  
Christopher G. Kampf
Keyword(s):  
Project Management ◽  
Organizational Learning ◽  
Action Research ◽  
Management Practices ◽  
Innovation Process ◽  
Theory And Practice ◽  
Organizational Level ◽  
Content Type ◽  
Innovation Project

PurposeThe purpose is to explore how the process of action research (AR) can support building legitimacy and organizational learning in innovation project management and portfolio practices in merger contexts.Design/methodology/approachMeta-reflection on method issues in Action Research through an action research case study with an innovation group during an organizational change process. This case demonstrates an example of an action research cycle focused on building practitioner legitimacy rather than problem-solving.FindingsKey findings include (1) demonstrating how AR can be used for building legitimacy through visualizing the innovation process, and embedding those visuals in top management practices of the organization; and (2) demonstrating how AR can work as an organizational learning tool in merger contexts.Research limitations/implicationsThis study focuses on an action research cooperation during a two-and-a-half-year period. Thus, findings offer the depth of a medium term case study. The processes of building legitimacy represent this particular case, and can be investigated in other organizational contexts to see the extent to which these issues can be generalized.Practical implicationsFor researchers, this paper offers an additional type of AR cycle to consider in their research design which can be seen as demonstrating a form of interplay between practitioner action and organizational level legitimacy. For practitioners, this paper demonstrates a connection between legitimacy and organizational learning in innovation contexts. The discussion of how visuals were co-created and used for building legitimacy for an innovation process that differs from the standard stage gate model demonstrates how engaging in AR research can contribute to developing visuals as resources for building legitimacy and organizational learning based on connections between theory and practice.Originality/valueThis case rethinks AR practice for innovation project management contexts to include legitimacy and organizational learning. This focus on legitimacy building from organizational learning and knowledge conversion contributes to our understanding of the soft side of innovation project management. Legitimacy is demonstrated to be a key concern for innovation project management practices.

scholarly journals Waiting time in public hospitals: case study of total joint replacement in Hong Kong

2018 ◽  
Vol 21 (2) ◽  
pp. 120-133 ◽  
Author(s):  
Yee-man Tsui ◽  
Ben Y.F. Fong
Keyword(s):  
Hong Kong ◽  
Waiting Time ◽  
Joint Replacement ◽  
Process Management ◽  
Emergency Services ◽  
Total Joint Replacement ◽  
Care Quality ◽  
Public Hospitals ◽  
Content Type

Purpose The purpose of this paper is to review the causes of long waiting time in Hong Kong public hospitals and to suggest solutions in the service, organisational, systems, financial and policy perspectives. Design/methodology/approach The paper is a review of waiting time of public hospital services. Total joint replacement, which is one of the elective surgeries in public hospitals, is presented as a case study. Findings The average waiting time of semi-urgent and non-urgent patients in the accident and emergency departments of public hospitals is two hours, and that of specialist outpatient (SOP) clinics is from 1 to 144 weeks. For total joint replacement, it is from 36 to 110 months. Measures like Government subsidisation programme for the replacement surgery and employing adequate physiotherapists, Chinese medicine practitioners, clinical psychologists and nurses to reduce the waiting time are suggested. Issues concerning the healthcare system of Hong Kong, such as structural reform, service delivery model, primary care, quality and process management, and policy reviews, are also discussed. Originality/value The ‬over-reliance of public services has resulted in long waiting time in public hospitals in Hong Kong, particularly in the emergency services and SOP clinics. However, the consequences of long waiting period for surgical operations, though much less discussed by the media and public, can be potentially detrimental to the patients and families, and may result in more burdens to the already stretched public hospitals‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬.

Vigilant resilience: the possibilities for renewal through preparedness

2018 ◽  
Vol 23 (2) ◽  
pp. 212-225 ◽  
Author(s):  
Elizabeth Carlson
Keyword(s):  
Public Relations ◽  
Design Methodology ◽  
Renewal Theory ◽  
Theory Building ◽  
System Level ◽  
Content Type ◽  
The Public ◽  
Energy Company ◽  
Resilience Process

Purpose Post-crisis renewal discourse (Ulmer et al., 2007) is one form of communication that stakeholders may use as they attempt to organize for resilience. The purpose of this paper propose extending Discourse of Renewal Theory to explain how it could enact a different kind of resilience than scholars typically consider. Organizational resilience strategies often focus on the recovery or prevention stages of crisis management. Under conditions of persistent threat, it would be more productive for renewal discourse to emphasize greater preparedness. Design/methodology/approach To illustrate the need for this kind of theorizing, the author analyzes a case study that follows the public relations efforts of Canadian energy company Enbridge, Inc., in the aftermath of the 2010 Kalamazoo River oil spill. Findings By the criteria of Discourse of Renewal Theory, Enbridge attempted a renewal strategy, but it failed. By other criteria, however, it succeeded: it created the opportunity for richer dialogue among stakeholders about their interdependence and their competing interests. Originality/value By considering how elements of the resilience process may vary, this paper offers resources for more nuanced theory-building and theory-testing related to organizational and system-level resilience.

How culture, leadership and engagement helped a small business survive during the pandemic

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
John F. Blattner ◽  
William P. Karmia ◽  
Thomas J. Walter
Keyword(s):  
Organizational Culture ◽  
Employee Engagement ◽  
Value Systems ◽  
Workplace Culture ◽  
Organizational Survival ◽  
Content Type ◽  
Company Culture ◽  
Organizational Culture Inventory ◽  
Business Challenges

Purpose The purpose of this case study is to investigate how a small catering company has coped with the current Covid-19 pandemic. Initial research was performed in 2014 and repeated in 2018. Given the far reaching business challenges of the pandemic, the authors examined the viability of the organization within the current climate. Design/methodology/approach Embedded organizational components of culture, leadership and engagement are explored as key elements in the sustainability of the company during the pandemic crisis. Prior research data using the organizational culture inventory is used to assess organizational culture over a four-year period. Employee data and interview analysis within company structure is used to determine how leadership and employee engagement is impacted. Culture research is examined to determine the influence of company culture upon organizational survival. Findings This paper identifies workplace culture elements that contribute to company sustainability. Embedded core value systems, strong employee engagement mechanisms and focused leadership styles were observed to be critical influences upon company survival during the pandemic. Originality/value This research would assist industry professionals and practitioners in understanding the active workplace culture mechanisms found to be effective for organizational survival during periods of crisis. Companies that adopt similar practices may acquire sustainability advantage during the pandemic.

Development of sustainable value stream mapping (SVSM) for unit part manufacturing

2019 ◽  
Vol 11 (3) ◽  
pp. 493-514 ◽  
Author(s):  
Aatish Kumar Mishra ◽  
Ayush Sharma ◽  
Moraldeepsingh Sachdeo ◽  
Jayakrishna K.
Keyword(s):  
Manufacturing Industry ◽  
Main Tool ◽  
Organizational Level ◽  
Value Stream Mapping ◽  
Simulation Approach ◽  
Content Type ◽  
Study Approach ◽  
Value Stream ◽  
Sustainable Value

Purpose The main purpose of this paper is to analyze the current state of a bonnet-manufacturing industry and to optimize the process by designing a future state map using simulation approach. Design/methodology/approach The case study approach has been proposed to highlight the applicability of value stream mapping (VSM) in an Indian bonnet manufacturing organization. The methodology used relies on formulation of VSM being the main tool used to identify the opportunities for classifying and eliminating bottlenecks with the help of various lean techniques. A contrast of present and past scenarios is highlighted to underscore the importance of using VSM with ARENA simulation. Findings Application of the proposed simulation approach has helped the organization reduce the cycle time significantly by 30 per cent over the entire production time. The average number of work-in-progress pieces has also decreased by about ten. In addition, enhancements have been seen with respect to ecological parameters, e.g. carbon footprint has been reduced to 83.7 percent across the process. Research limitations/implications The proposed approach of using a simulation-based VSM helps in reducing the time involved in traditional VSM method. This approach is also easy to implement at any organizational level. Practical implications It is believed that this paper will aid not just industrialists but also academic professionals to appreciate the role of simulation using ARENA in helping them understand how to attack the various problems faced by industries. The results of the study indicate that by applying this methodology, there will be a reduction not only in cost but also in environmental impacts. Originality/value The paper incorporates a real case study, which shows application of VSM for implementing lean principles in a bonnet-manufacturing industry. Break-even analysis presented fills the gap which previous literatures have been missing.

A cross-level model of legitimacy-driven institutional change

2020 ◽  
Vol 14 (3) ◽  
pp. 751-767
Author(s):  
Yan Guo ◽  
Liran Chen ◽  
Shih-Chieh Fang ◽  
Chen-Wei Yang
Keyword(s):  
Institutional Change ◽  
Negative Impact ◽  
Theoretical Perspective ◽  
Organizational Level ◽  
Market Forces ◽  
Historical Inquiry ◽  
Content Type ◽  
Field Level ◽  
Level Model

Purpose The purpose of this study is to develop a cross-level model of legitimacy-driven institutional change in a Chinese management context; in other words, changes that start out as legitimacy gaining processes by green enterprises but result in a shift in field-level market logic. Design/methodology/approach A case study using a historical inquiry approach and in-depth interviews has been used to qualitatively analyze the authors’ case in the Chinese photovoltaic industry. Findings The study proposes a cross-level explanation of institutional change by demonstrating how institutional change can create market forces at a field level that seemingly originate from an increase in the number of legitimated enterprises. This may negatively influence enterprises’ ongoing legitimacy gaining process for their survival at the organizational level in an institutional environment. Research limitations/implications The theoretical perspective helps improve descriptions of institutional change and develop a much-needed multi-level understanding of green enterprises in the highly institutionalized green industry. However, this case study may raise the concern of generalizability; thus, an additional survey is necessary. Practical implications As organizational field-level market forces are endorsed and transformed in the legitimacy gaining activities of green enterprises, a green enterprise manager should be aware of its negative impact on their legitimacy gaining process and ultimate survival. Originality/value The authors’ model proposes a cross-level explanation of institutional change by demonstrating how institutional change can create market forces at a field level that seemingly originate from an increase in the number of legitimated enterprises. Consequently, this may negatively influence the enterprises’ legitimacy gaining process.

Breaking through barriers: the impact of organizational culture on open government reform

2016 ◽  
Vol 10 (2) ◽  
pp. 335-350 ◽  
Author(s):  
Erna H.J.M. Ruijer ◽  
Richard F. Huff
Keyword(s):  
Organizational Culture ◽  
Theory And Practice ◽  
Open Government ◽  
Government Reform ◽  
Content Type ◽  
Use Of Technology ◽  
Practice Gap ◽  
Government Reforms ◽  
The Impact

Purpose The purpose of this paper is to examine the impact of organizational culture on open government reforms by developing a theoretical framework bridging the theory and practice gap. Design/methodology/approach An exploratory qualitative study consisting of a document analysis and a case study was conducted. Findings An open organizational culture is a precursor to effective open government. A network strategy as a facilitator for developing an open culture was used in one US federal agency, breaking across boundaries within the organization, creating greater symmetrical horizontal and vertical openness. Originality/value Much of the focus in both theory and practice has been on the use of technology as a vehicle to increase government openness. This study argues that a movement toward openness is beyond the technical. Organizational culture is a key to openness and may need to be changed. A networks strategy may be one way to facilitate a transformation to a more open culture.

Competing corporate sustainability perceptions in a global retail organization

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ulf Elg ◽  
Jens Hultman ◽  
Axel Welinder
Keyword(s):  
Corporate Sustainability ◽  
Organizational Level ◽  
Case Study Method ◽  
Communication Management ◽  
Content Type ◽  
Country Level ◽  
Strategic Issue ◽  
Retail Managers ◽  
The Uk

PurposeThe purpose is to explore the different and often contradictory perceptions individual managers have about corporate sustainability within a global retailer.Design/methodology/approachA qualitative case study method is used, including interviews and document studies. The authors study the global retailer IKEA. In total the authors have interviewed respondents on both the global level and the country level, within the sustainability organization as well as corporate, sales and communication management. The study includes managers in Sweden, the UK and Germany.FindingsThe research is based on institutional theory, focusing upon cognitive and normative aspects; the authors propose that managers may have a proactive, forceful view on sustainability or a reactive view. These need to coexist. The authors also show how global retailers can balance sustainability goals with other business considerations, as well as about the implications of the sustainability approach for the retailer's business model.Practical implicationsRetail managers need to recognize and integrate the contradictory views on sustainability that managers hold. The authors show how sustainability can be given different impact depending on the context and the strategic issue it is linked to.Originality/valueMost studies have focused on how sustainability is managed on an organizational level and how different goals can co-exist. The authors’ focus is on individual managers and their perceptions of sustainability – what it includes, how they want to manage sustainability issues, and the priority it should be given.

Flourishing in adaptive community: balancing structures and flexibilities

2018 ◽  
Vol 3 (2) ◽  
pp. 123-136 ◽  
Author(s):  
Sabre Cherkowski ◽  
Kelly Hanson ◽  
Keith Walker
Keyword(s):  
School Improvement ◽  
Well Being ◽  
System Level ◽  
Fundamental Aspect ◽  
Research Approach ◽  
Organizational Research ◽  
Content Type ◽  
Research And Practice ◽  
Research Activities

Purpose This paper documents findings from a qualitative research project on flourishing in schools using a positive organizational research approach. The purpose of this paper is to uncover and bring to description educators’ experiences of the conditions, forces and influencing factors for flourishing in their context. The main objectives were to inform research and practice in school improvement from a positive perspective, provide knowledge and practice about noticing and growing well-being for educators and to encourage an attention on individual and collective well-being as an organizational imperative. Design/methodology/approach To gain a rich description of what it means for educators to feel a sense of flourishing in their work, the researchers used qualitative, case study methods and appreciative research activities. For the case study reported on in this paper, data were collected through open-ended, appreciative, focus group conversations and researcher observations in the participants’ classrooms. Conversations were recorded and transcribed. The researchers analyzed the transcripts using an iterative process of coding, categorizing and abstracting data. Findings Participants grew their adaptive communities through balancing structures (collaboration, purpose, administrator support) with flexibilities (synergy, creativity, tinkering, friendships) for adaptation and co-creation. Well-being was connected with feeling collegial support, care, shared meaning and engagement and where positive relationships were central in their work. These relational conditions seemed to contribute to building a social container that promoted flourishing. This led to innovation as teachers worked together in ways that promoted their learning and growth as a group, and increased their sense of vitality in their work. The researchers found that the principal plays a vital role in fostering, encouraging and sustaining conditions for teachers to cultivate adaptive community. Research limitations/implications While small in scale and not generalizable across contexts, this research offers particular examples of what is working well for these teachers. Insights from these examples are intended to be generative, potentially resonating with and inspiring others to examine the possible benefits and potentials that may come from a positive approach to research and practice in school improvement in their own contexts. Engaging in positive organizational research in schools led to new insights on the work of teaching, learning and leading in schools. The researchers suggest that this positive, appreciative and generative perspective offers potentials and benefits for new understandings on school improvement. Practical implications The findings from this case study indicate that more attention is needed to supporting educators to cultivate the conditions necessary to experience rich and meaningful relationships within which they will thrive, grow and innovate in their teaching. At a system level, the authors argue for a re-orientation of schools toward well-being and a more holistic and human-development perspective on schooling. Social implications Currently and internationally, schooling is under re-design as the authors learn more about the need to organize the schools in ways that encourage the kinds of teaching and learning necessary to prepare young people for an increasingly unpredictable future. The findings from this study highlight the importance of attending to teacher well-being as a fundamental aspect of encouraging the kind of teaching needed for the kinds of learning desired in schools across all contexts. Originality/value This case study provides the findings that illustrate the potential and benefits of research on school organizations from a positive organizational perspective. Additionally, this study is a reminder of the systemic nature of all living systems, such as schools, and the associated need to ensure well-being for all members of the learning community.

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