Using systems thinking to support clinical system transformation

2016 ◽  
Vol 30 (3) ◽  
pp. 302-323 ◽  
Author(s):  
Allan Best ◽  
Alex Berland ◽  
Carol Herbert ◽  
Jennifer Bitz ◽  
Marlies W van Dijk ◽  
...  
Keyword(s):  
Health System ◽  
Complex Adaptive Systems ◽  
Clinical Guidelines ◽  
Large Scale ◽  
Guideline Implementation ◽  
Clear Understanding ◽  
Care Providers ◽  
System Transformation ◽  
Content Type

Purpose – The British Columbia Ministry of Health’s Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC’s health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings. Design/methodology/approach – Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey. Findings – The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system. Research limitations/implications – The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels – policy, management and practice – about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue. Practical implications – Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing change fatigue; ensuring adequate resources; providing consistent communication especially for front-line care providers; and supporting local teams to demonstrate the clinical value of the guidelines to their colleagues. Originality/value – Bringing a complex systems perspective to clinical guideline implementation resulted in a clear understanding of the challenges involved in LSC.

A network of networks

2017 ◽  
Vol 31 (2) ◽  
pp. 223-236 ◽  
Author(s):  
Rick Iedema ◽  
Raj Verma ◽  
Sonia Wutzke ◽  
Nigel Lyons ◽  
Brian McCaughan
Keyword(s):  
Health Service ◽  
Health System ◽  
Network Governance ◽  
System Reform ◽  
System Transformation ◽  
Content Type ◽  
Multiple Networks ◽  
Network Of Networks

Purpose To further our insight into the role of networks in health system reform, the purpose of this paper is to investigate how one agency, the NSW Agency for Clinical Innovation (ACI), and the multiple networks and enabling resources that it encompasses, govern, manage and extend the potential of networks for healthcare practice improvement. Design/methodology/approach This is a case study investigation which took place over ten months through the first author’s participation in network activities and discussions with the agency’s staff about their main objectives, challenges and achievements, and with selected services around the state of New South Wales to understand the agency’s implementation and large system transformation activities. Findings The paper demonstrates that ACI accommodates multiple networks whose oversight structures, self-organisation and systems change approaches combined in dynamic ways, effectively yield a diversity of network governances. Further, ACI bears out a paradox of “centralised decentralisation”, co-locating agents of innovation with networks of implementation and evaluation expertise. This arrangement strengthens and legitimates the role of the strategic hybrid – the healthcare professional in pursuit of change and improvement, and enhances their influence and impact on the wider system. Research limitations/implications While focussing the case study on one agency only, this study is unique as it highlights inter-network connections. Contributing to the literature on network governance, this paper identifies ACI as a “network of networks” through which resources, expectations and stakeholder dynamics are dynamically and flexibly mediated and enhanced. Practical implications The co-location of and dynamic interaction among clinical networks may create synergies among networks, nurture “strategic hybrids”, and enhance the impact of network activities on health system reform. Social implications Network governance requires more from network members than participation in a single network, as it involves health service professionals and consumers in a multi-network dynamic. This dynamic requires deliberations and collaborations to be flexible, and it increasingly positions members as “strategic hybrids” – people who have moved on from singular taken-as-given stances and identities, towards hybrid positionings and flexible perspectives. Originality/value This paper is novel in that it identifies a critical feature of health service reform and large system transformation: network governance is empowered through the dynamic co-location of and collaboration among healthcare networks, particularly when complemented with “enabler” teams of people specialising in programme implementation and evaluation.

How “The Three Rules” guide strategy and investment decisions at Deloitte Consulting LLP

2015 ◽  
Vol 43 (3) ◽  
pp. 7-14 ◽  
Author(s):  
Jim Moffatt
Keyword(s):  
Design Methodology ◽  
Large Scale ◽  
Investment Decisions ◽  
Decision Makers ◽  
Research Project ◽  
Content Type ◽  
First Case ◽  
Practical Implications ◽  
Thought Leadership

Purpose – This case example looks at how Deloitte Consulting applies the Three Rules synthesized by Michael Raynor and Mumtaz Ahmed based on their large-scale research project that identified patterns in the way exceptional companies think. Design/methodology/approach – The Three Rules concept is a key piece of Deloitte Consulting’s thought leadership program. So how are the three rules helping the organization perform? Now that research has shown how exceptional companies think, CEO Jim Moffatt could address the question, “Does Deloitte think like an exceptional company?” Findings – Deloitte has had success with an approach that promotes a bias towards non-price value over price and revenue over costs. Practical implications – It’s critical that all decision makers in an organization understand how decisions that are consistent with the three rules have contributed to past success as well as how they can apply the rules to difficult challenges they face today. Originality/value – This is the first case study written from a CEO’s perspective that looks at how the Three Rules approach of Michael Raynor and Mumtaz Ahmed can foster a firm’s growth and exceptional performance.

scholarly journals Supply chain resilience in a developing country context: a case study on the interconnectedness of threats, strategies and outcomes

2017 ◽  
Vol 22 (6) ◽  
pp. 486-505 ◽  
Author(s):  
Benjamin Tukamuhabwa ◽  
Mark Stevenson ◽  
Jerry Busby
Keyword(s):  
Supply Chain ◽  
Developing Country ◽  
Large Scale ◽  
Empirical Studies ◽  
Small Scale ◽  
Supply Network ◽  
Catastrophic Events ◽  
Content Type ◽  
Supply Chain Resilience

Purpose In few prior empirical studies on supply chain resilience (SCRES), the focus has been on the developed world. Yet, organisations in developing countries constitute a significant part of global supply chains and have also experienced the disastrous effects of supply chain failures. The purpose of this paper is therefore to empirically investigate SCRES in a developing country context and to show that this also provides theoretical insights into the nature of what is meant by resilience. Design/methodology/approach Using a case study approach, a supply network of 20 manufacturing firms in Uganda is analysed based on a total of 45 interviews. Findings The perceived threats to SCRES in this context are mainly small-scale, chronic disruptive events rather than discrete, large-scale catastrophic events typically emphasised in the literature. The data reveal how threats of disruption, resilience strategies and outcomes are inter-related in complex, coupled and non-linear ways. These interrelationships are explained by the political, cultural and territorial embeddedness of the supply network in a developing country. Further, this embeddedness contributes to the phenomenon of supply chain risk migration, whereby an attempt to mitigate one threat produces another threat and/or shifts the threat to another point in the supply network. Practical implications Managers should be aware, for example, of potential risk migration from one threat to another when crafting strategies to build SCRES. Equally, the potential for risk migration across the supply network means managers should look at the supply chain holistically because actors along the chain are so interconnected. Originality/value The paper goes beyond the extant literature by highlighting how SCRES is not only about responding to specific, isolated threats but about the continuous management of risk migration. It demonstrates that resilience requires both an understanding of the interconnectedness of threats, strategies and outcomes and an understanding of the embeddedness of the supply network. Finally, this study’s focus on the context of a developing country reveals that resilience should be equally concerned both with smaller in scale, chronic disruptions and with occasional, large-scale catastrophic events.

Networks as systems

2018 ◽  
Vol 32 (1) ◽  
pp. 9-24 ◽  
Author(s):  
Allan Best ◽  
Alex Berland ◽  
Trisha Greenhalgh ◽  
Ivy L. Bourgeault ◽  
Jessie E. Saul ◽  
...  
Keyword(s):  
Network Theory ◽  
Large Scale ◽  
Human Resources For Health ◽  
Flexible Structures ◽  
Communication Strategy ◽  
Global Network ◽  
World Health ◽  
Content Type ◽  
Large Complex

Purpose The purpose of this paper is to present a case study of the World Health Organization’s Global Healthcare Workforce Alliance (GHWA). Based on a commissioned evaluation of GHWA, it applies network theory and key concepts from systems thinking to explore network emergence, effectiveness, and evolution to over a ten-year period. The research was designed to provide high-level strategic guidance for further evolution of global governance in human resources for health (HRH). Design/methodology/approach Methods included a review of published literature on HRH governance and current practice in the field and an in-depth case study whose main data sources were relevant GHWA background documents and key informant interviews with GHWA leaders, staff, and stakeholders. Sampling was purposive and at a senior level, focusing on board members, executive directors, funders, and academics. Data were analyzed thematically with reference to systems theory and Shiffman’s theory of network development. Findings Five key lessons emerged: effective management and leadership are critical; networks need to balance “tight” and “loose” approaches to their structure and processes; an active communication strategy is key to create and maintain support; the goals, priorities, and membership must be carefully focused; and the network needs to support shared measurement of progress on agreed-upon goals. Shiffman’s middle-range network theory is a useful tool when guided by the principles of complex systems that illuminate dynamic situations and shifting interests as global alliances evolve. Research limitations/implications This study was implemented at the end of the ten-year funding cycle. A more continuous evaluation throughout the term would have provided richer understanding of issues. Experience and perspectives at the country level were not assessed. Practical implications Design and management of large, complex networks requires ongoing attention to key issues like leadership, and flexible structures and processes to accommodate the dynamic reality of these networks. Originality/value This case study builds on growing interest in the role of networks to foster large-scale change. The particular value rests on the longitudinal perspective on the evolution of a large, complex global network, and the use of theory to guide understanding.

A practical integrated solution into enterprise application: a large-scale quality control system development case study

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Vahid Hajipour ◽  
Hamidreza Amouzegar ◽  
Sajjad Jalali
Keyword(s):  
Quality Control ◽  
Enterprise Resource Planning ◽  
Large Scale ◽  
Resource Planning ◽  
Qualitative Assessment ◽  
Primary Concern ◽  
Content Type ◽  
Business Units ◽  
Functional Units

PurposeEnterprise resource planning (ERP) offers a streamlined system architecture to feed businesses with beneficial information in the current intense global competition. The primary concern of ERP is how to integrate different functional units to facilitate a unified flow of information. This paper aims at providing a non-trivial practice of integrating the quality control (QC) system into the core ERP processes of a real large-scaled case study.Design/methodology/approachTo satisfy the purpose of the current study, a large-scale steel making holding, inclusive of 27 business units being dispersed over a wide area, has been targeted. In our research methodology, a sample of four business units is selected as the pilot cases to be investigated at first. The output results of such investigations are further extended to the other units. In light of the investigation, the existing QC working conditions of the pilot cases are assessed through the As-Is model. The To-Be models are derived based on the best practices and the integration scope is then bordered.FindingsThe findings show that the integrated QC solution has enabled the following features: the smooth interconnection between QC and other functional units like purchase and manufacturing, the ease of generating real-time performance report of QC unit, the sack of tracing the quality of any available item in the system and the root-cause of defects, and the straightforwardness of the qualitative assessment of the suppliers.Research limitations/implicationsThere is almost no similar practice for designing a large-sized integrated system from scratch in the target region associated with our case study while the off-the-shelf products are prohibitively expensive.Practical implicationsThis paper includes implications for providing a standard practice on integrating a substantial module of ERP down to the smallest detail.Originality/valueThe value of the current paper is associated with fulfilling a critical research gap in the context of studying the QC integration into an enterprise solution. In fact, despite the importance of the QC module and its plethora of interconnection with other functional units, the literature review shows a centric lack of considering such integration in a real case study, particularly the large-scale one. Further, this paper works as a valuable study in the literature owing to not only focusing on the design and development of an integrated QC solution but also considering the deployment facet of such a practice.

The public’s trust and information brokers in health care, public health and research

2019 ◽  
Vol 33 (7/8) ◽  
pp. 929-948 ◽  
Author(s):  
Jodyn Platt ◽  
Minakshi Raj ◽  
Sharon L.R. Kardia
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health System ◽  
Information Sharing ◽  
Health Information ◽  
Health Care Providers ◽  
Care Providers ◽  
Content Type ◽  
The Public ◽  
Information Brokers

Purpose Nations such as the USA are investing in technologies such as electronic health records in order to collect, store and transfer information across boundaries of health care, public health and research. Health information brokers such as health care providers, public health departments and university researchers function as “access points” to manage relationships between the public and the health system. The relationship between the public and health information brokers is influenced by trust; and this relationship may predict the trust that the public has in the health system as a whole, which has implications for public trust in the system, and consequently, legitimacy of involved institutions, under circumstances of health information data sharing in the future. This paper aims to discuss these issues. Design/methodology/approach In this study, the authors aimed to examine characteristics of trustors (i.e. the public) that predict trust in health information brokers; and further, to identify the factors that influence trust in brokers that also predict system trust. The authors developed a survey that was administered to US respondents in 2014 using GfK’s nationally representative sample, with a final sample of 1,011 participants and conducted ordinary least squares regression for data analyses. Findings Results suggest that health care providers are the most trusted information brokers of those examined. Beliefs about medical deceptive behavior were negatively associated with trust in each of the information brokers examined; however, psychosocial factors were significantly associated with trust in brokers, suggesting that individual attitudes and beliefs are influential on trust in brokers. Positive views of information sharing and the expectation of benefits of information sharing for health outcomes and health care quality are associated with system trust. Originality/value This study suggests that demonstrating the benefits and value of information sharing could be beneficial for building public trust in the health system; however, trust in brokers of information are variable across the public; that is, knowledge, attitudes and beliefs are associated with the level of trust different individuals have in various health information brokers – suggesting that the need for a personalized approach to building trust.

scholarly journals Modelling change and cultural safety: A case study in northern British Columbia health system transformation

2018 ◽  
Vol 32 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Margo Greenwood
Keyword(s):  
Health System ◽  
Indigenous Peoples ◽  
Cultural Safety ◽  
System Transformation ◽  
Health System Change ◽  
Health Authorities ◽  
The Relationship ◽  
Canadian Healthcare System ◽  
Canadian Healthcare

The relationship that Indigenous Peoples have to the Canadian healthcare system makes the system’s weaknesses and complexities obvious. The long-standing lack of consideration to the historical and contemporary realities of Indigenous Peoples has resulted in miscommunication, misunderstanding, mistrust and racism. Health leaders, including health authorities, across the province are thus challenged to ensure that culturally safe environments are available and culturally safe practices are being used. This article begins with an overview of contemporary social political contexts in which Indigenous individual and collective realities are situated. Following is a conceptual discussion focused on health system change and the experiences of Indigenous Peoples. Change at structural, systemic and individual levels is the focus of the change model presented in this article. Throughout this exploration, examples of concrete actions currently underway in a health authority are offered. The article concludes with visions for future change.

Schedule delays in engineering, procurement, and construction petrochemical projects in Vietnam

2014 ◽  
Vol 8 (1) ◽  
pp. 3-26 ◽  
Author(s):  
Linh Hong Pham ◽  
Harimurti Hadikusumo
Keyword(s):  
Business Process ◽  
Large Scale ◽  
Business Models ◽  
Case Analysis ◽  
Clear Understanding ◽  
Content Type ◽  
Purposive Sampling ◽  
Root Cause ◽  
Schedule Delay ◽  
Cross Case Analysis

Purpose – Petrochemical projects play a very important role in the economic development of Vietnam. For the past ten years, many large-scale petrochemical plants have been developed using the engineering, procurement and construction (EPC) project delivery system for completing the project faster. However, many projects have suffered from schedule delays. In order to solve the delay problem, a clear understanding of the EPC business model and its delays problems are studied in this research. A qualitative research method by using case study on selected EPC projects was adopted. This paper aims to define the current business models used in the Vietnamese petrochemical industry and explores the root cause of delays. Design/methodology/approach – The research methodology used in this study is multiple case studies by purposive sampling on EPC projects. This is chosen due to the limited number of EPC projects in petrochemical in Vietnam and to obtain schedule delay factors from both delayed and on-time projects. In this purposive sampling, the researcher decided on what needs to know and sets out to find the people who can and are willing to share their information. From each project, project manager and project engineer were interviewed to understand the delay factors in their EPC projects. Data from the interview were analyzed by using “pattern coding” described by Miles and Huberman. Then, cross-case analysis was used to identify the common and unique factors occurring in each case. By comparing the three cases, the authors can identify the delay factors in EPC petrochemical in Vietnam. Findings – By interviewing the management level officers in three cases and performing exploratory work on the secondary data, it was observed that the local and foreign contractors of EPC projects in Vietnam have generally similar business process. Then, the codes were grounded based on the EPC business process, and subjected to the cross-case analysis. The root cause of problems in each phase was provided. Originality/value – The paper fulfills an identified root cause of EPC projects in Vietnam.

Cathay & Southwest: flying the flag of good practice in airline mergers

2015 ◽  
Vol 31 (8) ◽  
pp. 20-22 ◽  
Author(s):  
Reetesh Sharma ◽  
Mark Thomas
Keyword(s):  
Airline Industry ◽  
Large Scale ◽  
Good Practice ◽  
Aviation Industry ◽  
Content Type ◽  
Key Stakeholders ◽  
The Usa ◽  
Airline Mergers ◽  
Southwest Airlines

Purpose – This article highlights the essential factors to be considered for successful mergers and acquisitions (M & As) in the aviation industry. The article draws insights from the successful deals between Morris and Southwest Airlines as well as Cathay Pacific and Dragonair. Design/methodology/approach – The article is a case study of two successful mergers in the airline industry, one in the USA and one in Asia. Findings – M & As in the airline industry are loaded with difficulties. These include problems of brand identification, opposition from key stakeholders and the need of forming one coherent organisational culture. However, this does not mean that they are impossible. Two large-scale mergers have shown that successful mergers can occur in the industry. Originality/value – This article gives examples of two successful M & A deals from the aviation industry and shows the important factors to achieve this.

The leading small group: an institutional innovation for PPP projects in China

2019 ◽  
Vol 9 (2) ◽  
pp. 291-301 ◽  
Author(s):  
Yajian Zhang ◽  
Willie Tan
Keyword(s):  
Small Group ◽  
Large Scale ◽  
Good Governance ◽  
Secondary Data ◽  
Coordination Mechanism ◽  
Waste To Energy ◽  
Public Agencies ◽  
Content Type ◽  
High Level

Purpose It is widely recognized that large-scale public–private partnership (PPP) projects require an effective coordination mechanism among various stakeholders throughout the project life cycle. The purpose of this paper is to provide an insight into how this may be achieved through the leading small group (LSG), which is a distinctive informal Chinese institution for coordination among various public agencies. Design/methodology/approach An in-depth case study using secondary data and five in-depth interviews with two staff members from the developer and three government officials involved is used to probe into how the LSG functions during the various development phases of the Yangzhou Teda Waste-to-Energy project. Findings The main finding is that, conditional on its capacity, the LSG coordinated various public agencies to promote fast project implementation and ensure its smooth operation by making high-level decisions, facilitating quick permits and approvals, and mitigating the risks. However, formalization and participation from other stakeholders are needed to ensure good governance. Research limitations/implications Because it is an exploratory case study, the findings cannot be readily generalized. Further research can be done to compare the performance of LSGs in different Chinese cities and PPP projects. Practical implications It is supposed that this paper can provide implications of designing effective coordination mechanisms for managing large-scale PPP projects. Originality/value This paper provides an account of the LSG as a distinctive Chinese coordination mechanism that has been rarely studied.

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