Creating a healthcare variant CYNEFIN framework to improve leadership and urgent decision-making in times of crisis

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Paul James Lane ◽  
Robyn Clay-Williams ◽  
Andrew Johnson ◽  
Vidula Garde ◽  
Leah Barrett-Beck

Purpose The complex and occasionally chaotic nature of health care has been previously described in the literature, as has the broadening recognition that different management approaches are required for different types of problems rather than a “one size fits all” approach. The CYNEFIN framework from Snowden outlines a consistent cognitive approach that offers the leader and leadership team an ability to urgently apply the correct actions to a given situation. This paper proposes a variant CYNEFIN approach for healthcare. Design/methodology/approach Consistent and accurate decision-making within health care is the hallmark of an effective and pragmatic leader and leadership team. An awareness of how one’s cognitive biases and heuristics may adversely impact on this cognitive process is paramount, as is an understanding of the calibration between fast and slow thinking. Findings The authors propose a variant CYNEFIN approach for health care of “act-probe-sense-respond” to resolve complex and time-critical emergency scenarios, using the differing contexts of a cardiac arrest and an evolving crisis management problem as examples. The variant serves as a pragmatic sense-making framework for the health-care leader and leadership team that can be adopted for many time-critical crisis situations. Originality/value The variant serves as a pragmatic sense-making framework for the health-care leader that can be adopted for many crisis situations.

2017 ◽  
Vol 22 (3) ◽  
pp. 214-232 ◽  
Author(s):  
Lilisbeth Perestelo-Perez ◽  
Amado Rivero-Santana ◽  
Yolanda Alvarez-Perez ◽  
Yaara Zisman-Ilani ◽  
Emma Kaminskiy ◽  
...  

Purpose Shared decision making (SDM) is a model of health care in which patients are involved in the decision-making process about their treatment, considering their preferences and concerns in a deliberative process with the health care provider. Many existing instruments assess the antecedents, process, or the outcomes of SDM. The purpose of this paper is to identify the SDM-related measures applied in a mental health context. Design/methodology/approach The authors performed a systematic review in several electronic databases from 1990 to October 2016. Studies that assessed quantitatively one or more constructs related to SDM (antecedents, process, and outcomes) in the field of mental health were included. Findings The authors included 87 studies that applied 48 measures on distinct SDM constructs. A large majority of them have been developed in the field of physical diseases and adapted or directly applied in the mental health context. The most evaluated construct is the SDM process in consultation, mainly by patients’ self-report but also by external observer measures, followed by the patients’ preferences for involvement in decision making. The most applied instrument was the Autonomy Preference Index, followed by the Observing Patient Involvement in Decision Making (OPTION) and the Control Preferences Scale (CPS). The psychometric validation in mental health samples of the instruments identified is scarce. Research limitations/implications The bibliographic search is comprehensive, but could not be completely exhaustive. Effort should be invested in the development of new SDM for mental health tools that will reflect the complexity and specific features of mental health care. Originality/value The authors highlight several limitations and challenges for the measurement of SDM in mental health care.


Facilities ◽  
2019 ◽  
Vol 37 (7/8) ◽  
pp. 415-434 ◽  
Author(s):  
Nadeeshani Wanigarathna ◽  
Keith Jones ◽  
Adrian Bell ◽  
Georgios Kapogiannis

Purpose This paper aims to investigate how digital capabilities associated with building information modelling (BIM) can integrate a wide range of information to improve built asset management (BAM) decision-making during the in-use phase of hospital buildings. Design/methodology/approach A comprehensive document analysis and a participatory case study was undertaken with a regional NHS hospital to review the type of information that can be used to better inform BAM decision-making to develop a conceptual framework to improve information use during the health-care BAM process, test how the conceptual framework can be applied within a BAM division of a health-care organisation and develop a cloud-based BIM application. Findings BIM has the potential to facilitate better informed BAM decision-making by integrating a wide range of information related to the physical condition of built assets, resources available for BAM and the built asset’s contribution to health-care provision within an organisation. However, interdepartmental information sharing requires a significant level of time and cost investment and changes to information gathering and storing practices within the whole organisation. Originality/value This research demonstrated that the implementation of BIM during the in-use phase of hospital buildings is different to that in the design and construction phases. At the in-use phase, BIM needs to integrate and communicate information within and between the estates, facilities division and other departments of the organisation. This poses a significant change management task for the organisation’s information management systems. Thus, a strategically driven top-down organisational approach is needed to implement BIM for the in-use phase of hospital buildings.


2015 ◽  
Vol 35 (10) ◽  
pp. 1408-1436 ◽  
Author(s):  
Elena Revilla ◽  
Desirée Knoppen

Purpose – There are two major objectives in the research. First, the authors investigate the impact of knowledge integration in terms of joint decision-making and joint sense-making, on relational performance, including operational efficiency and innovation. Second, the authors examine the key antecedents that might facilitate knowledge integration: strategic supply management and trust. The paper aims to discuss these issues. Design/methodology/approach – This paper expands and tests theory drawing upon survey data from 133 buyer-supplier relationships (BSRs). The authors employed a two-step process of analysis to evaluate first the measurement model and then the structural model. The measurement model test built upon confirmatory factor analysis, while the structural model quality test built upon path analysis. Findings – The results suggest that both integrative mechanisms, joint decision making and joint sense making, affect performance although in different ways. This study also finds that while trust has multiple significant influences and consequently must be viewed as an organizing principle, strategic supply management is required to jointly understand the dynamic and complex context but not to jointly make ongoing decisions. Research limitations/implications – Three limitations: first, this study was cross-sectional rather than longitudinal. Second, in line with accepted practice, the authors surveyed only one side of the relationship. The suppliers’ viewpoint is thus not fully taken into account. Third, another potential limitation of the study is that the sample stems from just one country and its size does not distinguish subgroups in the analysis of the path model. Practical implications – Managers should be advised that: first, a trusting partnership built on knowledge integration is a hard order, especially with a new, unknown supplier in a low-cost country, where intellectual property protection is less obvious; second, strategic supply management may not improve cost or operational performance, but in its absence, it is unlikely that a supplier has insight into the exact needs of its buyer and thus, may not add considerable value to their customers; third, building a dynamic knowledge integration capability (valuable, rare, and difficult to imitate) takes time, as does creating reliable learning mechanisms. Joint teams, visit partners’ workplace, early involve suppliers in developing new products or selection of supplier with high-learning capabilities may help to create a knowledge integration capability. Social implications – The authors suggest that companies should move from an arm-length relationship and turn their supplier relationships into a tool for innovating faster while cutting cost. In order to do this, joint sense-making and joint decision should be seen as institutionalized inter-firm routines rather than ad hoc activities. Thus, the authors recommend managers to proactively build certain knowledge-based capabilities that hinges heavily upon a strategic stance toward supply management and trustful relationships with selected suppliers. Originality/value – The major intent of this research is to expand understanding of knowledge integration by building a more testable, complex model around its creation. While previous research relied on a configuration approach to explore the relationship between knowledge integration and performance, the authors evaluate causal relationships at the level of the formative dimensions rather than higher order knowledge integration, as this has proven to be a superior analytical method. Second, although supply chain scholars have expressed great interest in trust, an in-depth examination of prior studies in knowledge integration indicate that trust has been analyzed alone. In contrast, the study empirically examines the simultaneous effect of trust and strategic supply management in BSRs.


2020 ◽  
Vol 75 (3) ◽  
pp. 559-574 ◽  
Author(s):  
Ahmed Kamassi ◽  
Noor Hazilah Abd Manaf ◽  
Azura Omar

Purpose This paper aims to address and identify the major stakeholders in the medical tourism industry, based on their participation in medical tourism activities and their support for medical tourism development. Design/methodology/approach This paper systematically reviews the content of medical tourism studies from literature to identify key stakeholders and address the roles they play in the medical tourism industry. Findings This study shows that the key stakeholders in the medical tourism industry are eight, namely, medical tourists, health-care providers, government agencies, facilitators, accreditation and credentialing bodies, health-care marketers, insurance providers and infrastructure and facilities. These stakeholders strongly influence medical tourists’ decision-making process in seeking medical treatment abroad. Besides, a successful medical tourism development depends greatly on the excellent partnership between all stakeholders. Practical implications This paper sheds light on the crucial role of these stakeholders that can be an important consideration in medical tourists’ decision-making process and industry growth. The study can facilitate policymakers in designing and developing policies to improve medical tourism practices. Originality/value This paper expands the knowledge about medical tourism literature by identifying and explaining the significant role of each stakeholder in the industry. The results of this paper are quite revealing to all practitioners in terms of the potential strategies and medical tourism growth. The study establishes a foundation for future medical tourism research in the rapidly growing industry.


2017 ◽  
Vol 14 (5) ◽  
pp. 467-472 ◽  
Author(s):  
Mohammad M. Hamasha ◽  
George Rumbe

Purpose Emergency departments (ED) are faced with the challenge of capacity planning that caused by the high demand for patients and limited resources. Consequently, inadequate resources lead to increased delays, impacts on the quality of care and increase the health-care costs. Such circumstances necessitate utilizing operational research modules, such as the Markov decision process (MDP) to enable better decision-making. The purpose of this paper is to demonstrate the applicability and usage of MDP on ED. Design/methodology/approach The adoption of MDP provides invaluable insights into system operations based on the different system states (e.g. very busy to unoccupied) to ensure optimal assigning of resources and reduced costs. In this paper, a descriptive health system model based on the MDP is presented, and a numerical example is illustrated to elaborate its appropriateness in optimal policy decision determination. Findings Faced with numerous decisions, hospital managers have to ensure that the appropriate technique is used to minimize any undesired outcomes. MDP has been shown to be a robust approach which provides support to the critical decision-making processes. Additionally, MDP also provides insights on the associated costs which enable the hospital managers to efficiently allocate resources ensuring quality health care and increased throughput while minimizing costs. Originality/value Applying MDP in the ED is a unique and good starting. MDP is powerful tool helps in making a decision in the critical situations, and the ED needs such tool.


2021 ◽  
Vol 35 (9) ◽  
pp. 245-264
Author(s):  
Roy Liff ◽  
Ewa Wikström

PurposeThe purpose of this paper is to investigate and theoretically explain how line managers and lower-status experts work together in public health-care organizations. Hence, this study explores how lower-status experts influence line managers' decision-making and task prioritizing in order to guide staff experts' cooperation and performance improvements.Design/methodology/approachThe authors used a qualitative method for data collection and analysis of the experts' and line managers' explanations about their cooperation. A theoretical approach of experts' identity positioning, in terms of differences and similarities, was used in analyzing the interaction between managers and experts.FindingsThis study shows that similarities and differences in positioning acts exist simultaneously. Similarity is constructed by way of strategic and professional alignment with the line managers' core tasks. Differences stem from the distinction between knowledge-grounded skills and professional attributes such as language, analytical tools, and jargon. Lower-status experts need to leave their entrenched positions and match the professional status of line managers in both knowledge aspirations and appearance to reach a respected approach of experts' identity positioning.Originality/valueUnlike many previous studies, this study demonstrates that similarities and differences in positioning acts exist simultaneously.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rosalind Lau ◽  
Anastasia Hutchinson

Purpose Over the past 15 years, mental health organisations have taken steps to move towards providing services that are more recovery-oriented. This review was undertaken to explore what is known about service users’ experience of services that have introduced a recovery-oriented approach to service provision. There is limited research evaluating consumers’ lived experiences of recovery-orientated care; a scoping review was chosen to provide an overview of the available research in this area (Munn et al., 2018). The purpose of this review was to summarize and synthesize current qualitative research exploring consumers’ experience of recovery orientated mental health care provision. Design/methodology/approach This scoping review was undertaken as outlined by Arksey and O'Malley (2005). The five steps consisted identifying the research question; searching for relevant studies; selecting the studies; charting the studies; and collating, summarising and reporting the findings. Findings Three key themes emerged from this review: translation of recovery policy to practice; ward environment; and recovery principles with five subthemes: engagement; not being listened to; shared decision-making; informational needs; and supportive and collaborative relationships. The themes and subthemes identified in each of the 18 studies are presented in Table 3. Research limitations/implications This review highlights the different degree to which service users have received recovery-oriented recovery care. In the majority of cases, most service users reported few opportunities for nursing engagement, poor communication, inadequate information provision, a lack of collaborative care and mostly negative experiences of the ward environment. Because of the limited studies on mental health service users’ lived experiences of a recovery-oriented service, more clinical studies are needed and in different cultural contexts. Practical implications On hindsight, the authors should have included service users in this review process as consumer inclusion is progressively emphasised in mental health educational and research activities. This review highlights that not all studies have involved service users or consumers in their research activity. Social implications Service users need relevant information in a timely manner to participate in decision-making regarding their treatment and care. This review found that either no information was provided to the service users or it was provided in a limited and fragmented manner. This review also found inpatients reported limited opportunities to have meaningful participation in decision-making about their care. These findings have important social implications, as greater consumer engagement in the design and delivery of mental health services will increase community trust in the care provided. This in turn has the potential to facilitate greater community engagement in preventative mental health care. Originality/value This is the first review to systematically synthesis consumers perspectives on the extent to which service providers are achieving the goal of implementing recovery-orientated practice into their service provision. Despite important policy changes, the findings of this review demonstrate that more work is needed to truly operationalise and translate these principles into practice.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Vaidik Bhatt ◽  
Samyadip Chakraborty

Purpose The purpose of the study was to empirically validate the linkages between IoT adoption and how it overarched influenced the patient care service engagement. This contributes to the body of knowledge and helps hospital managers to understand the relationship and relevance of IoT adoption; otherwise healthcare sector are late movers towards technology adoption. This gives a nuanced framework towards establishing empirically validated framework which will motivate healthcare services providers to be motivated to adopt and implement IoT enabled care delivery. The physician patient interaction and alignment during decision making will foster positive word of mouth, superior care service and reduce extra overheads for healthcare providers without compromise or rather with increment in service delivery proposition. Design/methodology/approach The study theoretically and empirically describes that with the adoption of internet of things (IoT) devices in health care, better services can be provided to patients by using partial least square – structure equation modelling-based robust technique and explains the better understanding of the health-care process with the help of information pervasiveness, physician-patient orientation and improved patient and physician involvement in the decision-making process. Findings This study shows that wearable IoT device adoption in health-care service delivery opens new opportunities and disrupts the conventional and traditional way of health-care service delivery by empowering the patient to take part in decision-making and enhancing their engagement in health-care service delivery. Research limitations/implications The study might influence by generalizability. Perception-based cross-examination knowledge from the patient’s perspective. It is likely that patients who use these devices will grow accustomed to using them and become more capable of using them. Thus, time-series tests have not been used to catch enhanced skills. New patients’ experiences will be altered over time. Regardless, non-response bias and traditional process bias received excessive interest. Practical implications The study aims at unravelling how the adoption of IoT enabled practices and usage of IoT devices bolsters the available data points in the context of healthcare especially with respect to patient care delivery. The study conceptualizes and empirically validates how the usage of IoT interface enabled technology enables better patient treatment and caregiver participation. The study puts forth a nuanced understanding regarding how pervasively available ubiquitous care information fosters shared decision making. This study further emphasizes that importance of ensuring a reliable computing environment devoid of privacy and security risks. The study attempts at Emphasizing empirically how the enhanced information pervasiveness catapults the patient-provider interactions, through health data exchange. Highlighting the importance of search feature in cloud storage and recovery mechanisms. The study not only fulfills the overarching linkage between enhanced service engagement with IoT adoption, it provides a mental map and ready to refer framework for hospital and healthcare experts to refer to, which prescribes thar care providers must build new methods aimed at empowerment of patients to participate and take more inclusive role. This unique confluence between patients and physicians will unravel the sync; helping not only avoid costly decision errors, but also improve patient care delivery environment. Patients should be permitted to participate in decision-making,inspire patients to be participatory. Originality/value The study efforts to empirically investigate and discover the link between how wearable sensor-based IoT enhances health-care service engagement is underway. Using primary data this linkage validation allows the community and readers at large to gain a nuanced understanding of how superior interaction is enabled by a digital-health-care process with the help of IoT-enabled information pervasiveness, physician-patient orientation and empowered involvement.


2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Justin Okoli

Design/Methodology/Approach This review examines the role of intuition as a cognitive tool to better manage complex crises. The paper draws on a case study in the aviation industry, the Hudson river incident, to advance the potency and value of intuitive expertise in crisis situations. Purpose Crisis managers operating in safety critical domains are often faced with difficult and exceptional conditions that may challenge their expertise and cause them to rely more heavily on their experiential knowledge. This review therefore provides insights into intuitive thinking and demonstrates its importance in crisis decision-making. Findings Evidence suggests that intuition arguably offers a better cognitive option to decision-makers in high staked and time-pressured crisis situations. The Hudson River case study further highlights why organizations should aim to train their personnel to become better intuitive thinkers. Originality/value This review challenges conventional classical decision theory, outlining its limitations in typical fast paced crises environments. The paper instead positions intuition as a scientific construct that holds important value for crisis managers in extreme conditions.


2014 ◽  
Vol 27 (1) ◽  
pp. 5-19 ◽  
Author(s):  
Iestyn Williams ◽  
Daisy Phillips ◽  
Charles Nicholson ◽  
Heather Shearer

Purpose – The purpose of this paper is to describe and evaluate a novel approach to citizen engagement in health priority setting carried out in the context of Primary Care Trust (PCT) commissioning in the English National Health Service. Design/methodology/approach – Four deliberative events were held with 139 citizens taking part in total. Events design incorporated elements of the Twenty-first Century Town Meeting and the World Café, and involved specially-designed dice games. Evaluation surveys reporting quantitative and qualitative participant responses were combined with follow-up interviews with both PCT staff and members of the public. An evaluation framework based on previous literature was employed. Findings – The evaluation demonstrates high levels of enjoyment, learning and deliberative engagement. However, concerns were expressed over the leading nature of the voting questions and, in a small minority of responses, the simplified scenarios used in dice games. The engagement exercises also appeared to have minimal impact on subsequent Primary Care Trust resource allocation, confirming a wider concern about the influence of public participation on policy decision making. The public engagement activities had considerable educative and political benefits and overall the evaluation indicates that the specific deliberative tools developed for the exercise facilitated a high level of discussion. Originality/value – This paper helps to fill the gap in empirical evaluations of deliberative approaches to citizen involvement in health care priority setting. It reports on a novel approach and considers a range of implications for future research and practice. The study raises important questions over the role of public engagement in driving priority setting decision making.


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