scholarly journals Framing the difficulties resulting from implementing a Participatory Management Model in a public hospital

2012 ◽  
Vol 20 (6) ◽  
pp. 1142-1151 ◽  
Author(s):  
Andrea Bernardes ◽  
Greta Cummings ◽  
Yolanda Dora Martinez Évora ◽  
Carmen Silvia Gabriel
Keyword(s):  
Decision Making ◽  
Public Hospital ◽  
Communication Process ◽  
Management Model ◽  
Participatory Management ◽  
Bolman And Deal ◽  
Job Descriptions ◽  
Team Members ◽  
Decentralized Decision Making ◽  
Innovative Management

OBJECTIVE: This study aims to address difficulties reported by the nursing team during the process of changing the management model in a public hospital in Brazil. METHODS: This qualitative study used thematic content analysis as proposed by Bardin, and data were analyzed using the theoretical framework of Bolman and Deal. RESULTS: The vertical implementation of Participatory Management contradicted its underlying philosophy and thereby negatively influenced employee acceptance of the change. The decentralized structure of the Participatory Management Model was implemented but shared decision-making was only partially utilized. Despite facilitation of the communication process within the unit, more significant difficulties arose from lack of communication inter-unit. Values and principals need to be shared by teams, however, that will happens only if managers restructure accountabilities changing job descriptions of all team members. CONCLUSION: Innovative management models that depart from the premise of decentralized decision-making and increased communication encourage accountability, increased motivation and satisfaction, and contribute to improving the quality of care. The contribution of the study is that it describes the complexity of implementing an innovative management model, examines dissent and intentionally acknowledges the difficulties faced by employees in the organization.

scholarly journals Decision-making of the nursing team after the revitalization of a decentralized management model

2014 ◽  
Vol 23 (2) ◽  
pp. 286-293 ◽  
Author(s):  
Karen Yukari Hayashida ◽  
Andrea Bernardes ◽  
Vanessa Gomes Maziero ◽  
Carmen Silvia Gabriel
Keyword(s):  
Decision Making ◽  
Public Hospital ◽  
Participant Observation ◽  
Management Model ◽  
Participatory Management ◽  
Structured Interviews ◽  
Daily Work ◽  
Decentralized Management ◽  
Qualified Work

This study's objective was to identify changes in decision-making arising from the revitalization of the participatory management model and how these changes impacted the daily work of the nursing staff, as well as to identify potential difficulties. This qualitative case study was conducted in a public hospital in the State of São Paulo, Brazil. Participant observation and semi-structured interviews were conducted with 23 nursing workers and the Health Technical Assistant. We used thematic content analysis for data analysis. The revitalization of the management model was not comprehensive because many professionals were oblivious to the process. Shared actions did not occur and adherence to the model was hampered because the workers were not fully informed of the assumptions concerning this management model. For the implementation of this model to be effective, teamwork and the inclusion of all the stakeholders should be reviewed in order to achieve more cooperative and qualified work.

scholarly journals Collective and decentralized management model in public hospitals: perspective of the nursing team

2011 ◽  
Vol 19 (4) ◽  
pp. 1003-1010 ◽  
Author(s):  
Andrea Bernardes ◽  
Luiz Carlos de Oliveira Cecilio ◽  
Yolanda Dora Martinez Évora ◽  
Carmen Silvia Gabriel ◽  
Mariana Bernardes de Carvalho
Keyword(s):  
Public Hospital ◽  
Public Hospitals ◽  
Management Model ◽  
Thematic Content Analysis ◽  
Collective Management ◽  
Innovative Management ◽  
Decentralized Management ◽  
The City

This research aims to present the implementation of the collective and decentralized management model in functional units of a public hospital in the city of Ribeirão Preto, state of São Paulo, according to the view of the nursing staff and the health technical assistant. This historical and organizational case study used qualitative thematic content analysis proposed by Bardin for data analysis. The institution started the decentralization of its administrative structure in 1999, through collective management, which permitted several internal improvements, with positive repercussion for the care delivered to users. The top-down implementation of the process seems to have jeopardized workers adherence, although collective management has intensified communication and the sharing of power and decision. The study shows that there is still much work to be done to concretize this innovative management proposal, despite the advances regarding the quality of care.

Mutable Mobiles: Charting the Cartography of Banarasi Toymakers

Design Issues ◽  
2017 ◽  
Vol 33 (2) ◽  
pp. 43-57
Author(s):  
Koumudi Patil ◽  
Uday Athavankar
Keyword(s):  
Decision Making ◽  
Distributed Cognition ◽  
Time And Space ◽  
Design Decisions ◽  
Team Members ◽  
The Earth ◽  
Decentralized Decision Making ◽  
The Future ◽  
Over Time

From the perspective of design, Latour's cycles of inscriptions and mobility promises to be of significance to the future exploration of self-organizing tendencies, as well as distributed cognition in decentralized decision making between heterogeneous team members scattered across time and space. Of particular relevance is the role of the artefact in the absence or lack of communication as an object- to-think-with, as well as to negotiate design decisions over time and space. Artefacts, as in this study- Banarasi toys, acting as probes not only accumulate design decisions, but also inscribe the worldview of the members on themselves. Their mutability and mobility endows on them the promising role of gathering members and eventually an entire community around them. On completion of the cycles, they become a microcosm of the worldview, similar to Latour's map encapsulating the earth.

Collaborative Action Research In Academic Administration

2019 ◽  
Vol 8 (3) ◽  
pp. 227-252
Author(s):  
Bradley C. Thompson
Keyword(s):  
Decision Making ◽  
Action Research ◽  
Collaborative Action Research ◽  
Team Members ◽  
Academic Administration ◽  
Leadership Culture ◽  
Collaborative Action ◽  
Working Together ◽  
Upper Level ◽  
Action Process

This research involved a study exploring the changes in an academic institution expressed through decision-making in a shifting leadership culture. Prior to the study, the school was heavily entrenched in authoritarian and centralized decision-making, but as upper-level administrators were exposed to the concept of collaborative action research, they began making decisions through a reflection and action process. Changing assumptions and attitudes were observed and recorded through interviews at the end of the research period. The research team engaged in sixteen weekly cycles of reflection and action based on an agenda they mutually agreed to and through an analysis of post-research interviews, weekly planning meetings, discussions, and reflection and action cycles. Findings revealed experiences centering around the issues of:  The nature of collaboration- it created discomfort, it created a sense of teamwork, it created difficulty.  The change of environment in the process- team members began to respect each other more, and the process became more enjoyable.  The freedom and change in the process- freedom to voice opinions and to actively listen, the use of experience to lead elsewhere in the school.  How issues of power are better understood by working together- the former process was less collaborative, politics will always be part of the process. As a result of this study, members have started using this decision-making methodology in other areas of administration.

scholarly journals Impact of pre-dialysis nephrology care engagement and decision-making on provider and patient action toward permanent vascular access

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Vanessa Grubbs ◽  
Bernard G. Jaar ◽  
Kerri L. Cavanaugh ◽  
Patti L. Ephraim ◽  
Jessica M. Ameling ◽  
...  
Keyword(s):  
Decision Making ◽  
Public Hospital ◽  
Veterans Administration ◽  
Engagement In Care ◽  
Vascular Surgeon ◽  
Patient Level ◽  
Nephrology Care ◽  
Record Review ◽  
Retrospective Medical Record Review

Abstract Background While catheters are often thought the result of emergency hemodialysis (HD) initiation among patients with little or no pre-dialysis nephrology care, the role of patient level of engagement in care and modality decision-making have not been fully explored. Methods This is a retrospective medical record review of adults (age 18–89 years) who received care in academically affiliated private practice, public hospital, or Veterans Administration settings prior to initiating HD with a catheter between 10/1/2011 and 9/30/2012. Primary predictors were level of patient engagement in nephrology care within 6 months of HD initiation and timing of modality decision-making. Primary outcomes were provider action (referral) and any patient action (evaluation by a vascular surgeon, vein mapping or vascular surgery) toward [arteriovenous fistula or graft, (AVF/AVG)] creation. Results Among 92 incident HD patients, 66% (n = 61) initiated HD via catheter, of whom 34% (n = 21) had ideal engagement in care but 42% (n = 25) had no documented decision. Providers referred 48% (n = 29) of patients for AVF/AVG, of whom 72% (n = 21) took any action. Ideal engagement in care predicted provider action (adjusted OR 13.7 [95% CI 1.08, 175.1], p = 0.04), but no level of engagement in care predicted patient action (p > 0.3). Compared to patients with no documented decision, those with documented decisions within 3, 3–12, or more than 12 months before initiating dialysis were more likely to have provider action toward AVF/AVG (adjusted OR [95% CI]: 9.0 [1.4,55.6], p = 0.2, 37.6 [3.3423.4] p = 0.003, and 4.8 [0.8, 30.6], p = 0.1, respectively); and patient action (adjusted OR [95% CI]: 18.7 [2.3, 149.0], p = 0.006, 20.4 [2.6, 160.0], p = 0.004, and 6.2 [0.9, 44.0], p = 0.07, respectively). Conclusions Timing of patient modality decision-making, but not level of engagement in pre-dialysis nephrology care, was predictive of patient and provider action toward AVF/AVG Interventions addressing patients’ psychological preparation for dialysis are needed.

scholarly journals The Process and Impact of Stakeholder Engagement in Developing a Pediatric Intensive Care Unit Communication and Decision-Making Intervention

2016 ◽  
Vol 3 (4) ◽  
pp. 108-118 ◽  
Author(s):  
Kelly N Michelson ◽  
Joel Frader ◽  
Lauren Sorce ◽  
Marla L Clayman ◽  
Stephen D Persell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Stakeholder Engagement ◽  
Pediatric Intensive Care ◽  
Healthcare Team ◽  
Team Members ◽  
Core Elements ◽  
Stakeholder Input

Stakeholder-developed interventions are needed to support pediatric intensive care unit (PICU) communication and decision-making. Few publications delineate methods and outcomes of stakeholder engagement in research. We describe the process and impact of stakeholder engagement on developing a PICU communication and decision-making support intervention. We also describe the resultant intervention. Stakeholders included parents of PICU patients, healthcare team members (HTMs), and research experts. Through a year-long iterative process, we involved 96 stakeholders in 25 meetings and 26 focus groups or interviews. Stakeholders adapted an adult navigator model by identifying core intervention elements and then determining how to operationalize those core elements in pediatrics. The stakeholder input led to PICU-specific refinements, such as supporting transitions after PICU discharge and including ancillary tools. The resultant intervention includes navigator involvement with parents and HTMs and navigator-guided use of ancillary tools. Subsequent research will test the feasibility and efficacy of our intervention.

Sign in / Sign up

Export Citation Format

Share Document