How Costing and Funding Systems Create Institutional Tensions Between Management and Medical Personnel in The Public Health Care Sector

2021 ◽  
Author(s):  
◽  
Caroline Thirsk
Keyword(s):  
Public Health ◽  
Institutional Theory ◽  
Medical Staff ◽  
Medical Personnel ◽  
Structured Interview ◽  
Public Health Care ◽  
Internal Conflict ◽  
Future Research ◽  
Use Of Resources ◽  
Starting Point

<p>This research examines the conflicting relationship between management and medical personnel in the New Zealand Public Health Sector with regard to costing and funding systems. Due to the lack of research into small DHBs, this research focuses on small hospitals as they face unique circumstances not experienced by larger hospitals, to discover potential areas where costing and funding systems cause conflict, the reasons for this conflict and to provide possible solutions to prevent or mitigate this conflict. The method employed is a qualitative exploratory case study of one DHB utilizing a two phased semi-structured interview approach. A total of 10 interviews were conducted and analysed.  Three main areas from which conflict arises were identified: the costing system within the case hospital, the Population-based funding system and Inter-district flows. Each area is investigated from the perspectives of management and medical staff, using Institutional Theory and the concept of legitimacy. The institutional theory lens is used to identify and separate the interviewees into three groups based on their competing institutions. Each group’s answers were then compared to find reasons as to why there was conflict.  Three core reasons for the conflict were identified: ineffective communication, lack of trust in management and the costing and funding systems themselves. Much of the tension is because of misconceptions, limited knowledge and poor communication leading medical personnel to feel that management does not respect their opinions and management to believe that medical personnel are unwilling to cooperate with them. This research also determined that the institution of management that focuses on costs and economic use of resources and the institution of medical personnel which is patient focused, are necessary to the operation of a public hospital. Though it can be a difficult to balance, the ideal situation would be for these institutions to work in harmony and perhaps eventually merge. Suggestions are given for reducing internal conflict between management and medical personnel and it is hoped this research offers a starting point for future research into improving both the costing and funding systems and the internal relationships between management and medical staff.</p>

scholarly journals How Costing and Funding Systems Create Institutional Tensions Between Management and Medical Personnel in The Public Health Care Sector

2021 ◽  
Author(s):  
◽  
Caroline Thirsk
Keyword(s):  
Public Health ◽  
Institutional Theory ◽  
Medical Staff ◽  
Medical Personnel ◽  
Structured Interview ◽  
Public Health Care ◽  
Internal Conflict ◽  
Future Research ◽  
Use Of Resources ◽  
Starting Point

<p>This research examines the conflicting relationship between management and medical personnel in the New Zealand Public Health Sector with regard to costing and funding systems. Due to the lack of research into small DHBs, this research focuses on small hospitals as they face unique circumstances not experienced by larger hospitals, to discover potential areas where costing and funding systems cause conflict, the reasons for this conflict and to provide possible solutions to prevent or mitigate this conflict. The method employed is a qualitative exploratory case study of one DHB utilizing a two phased semi-structured interview approach. A total of 10 interviews were conducted and analysed.  Three main areas from which conflict arises were identified: the costing system within the case hospital, the Population-based funding system and Inter-district flows. Each area is investigated from the perspectives of management and medical staff, using Institutional Theory and the concept of legitimacy. The institutional theory lens is used to identify and separate the interviewees into three groups based on their competing institutions. Each group’s answers were then compared to find reasons as to why there was conflict.  Three core reasons for the conflict were identified: ineffective communication, lack of trust in management and the costing and funding systems themselves. Much of the tension is because of misconceptions, limited knowledge and poor communication leading medical personnel to feel that management does not respect their opinions and management to believe that medical personnel are unwilling to cooperate with them. This research also determined that the institution of management that focuses on costs and economic use of resources and the institution of medical personnel which is patient focused, are necessary to the operation of a public hospital. Though it can be a difficult to balance, the ideal situation would be for these institutions to work in harmony and perhaps eventually merge. Suggestions are given for reducing internal conflict between management and medical personnel and it is hoped this research offers a starting point for future research into improving both the costing and funding systems and the internal relationships between management and medical staff.</p>

Institutional Theory and E-Government Research

2008 ◽  
pp. 349-360 ◽  
Author(s):  
Shahidul Hassan ◽  
J. Ramon Gil-Garcia
Keyword(s):  
Information Systems ◽  
Institutional Theory ◽  
Information Technologies ◽  
Future Research ◽  
Fourth Section ◽  
Current State ◽  
Starting Point ◽  
Recent Developments ◽  
Good Starting Point ◽  
Government Research

Recent developments in institutional theory are highly promising for the study of e-government. Scholars in various disciplines, such as economics (North, 1999; Rutherford, 1999), sociology (Brinton & Nee, 1998), and political science (March & Olsen, 1989; Peters, 2001), have used institutional approaches to understand diverse social and organizational phenomena. Insights gained from these studies can be valuable for guiding research in e-government. In fact, there are some initial efforts in information systems and e-government research that have applied institutional theory and proved useful in generating new insights about how information technologies are adopted (Teo, Wei, & Benbasat, 2003; Tingling & Parent, 2002), designed and developed (Butler, 2003; Klein, 2000; Laudon, 1985), implemented (Robey & Holmstrom, 2001), and used (Fountain, 2001) in organizations. In this chapter, we provide a brief overview of some of these initial studies to highlight the usefulness of institutional theory in e-government research. We also suggest some opportunities for future research in e-government using institutional theory. This chapter does not capture all the essential theoretical and empirical issues related to using institutional theory in information systems and e-government research. Instead, it is a brief review and a good starting point to explore the potential of institutional theory. We hope that e-government scholars find it interesting and useful. The chapter is organized in five sections, including this introduction. The second section provides a brief overview of institutional theory in various disciplinary traditions, with an emphasis on institutional theory in sociology. Then the chapter identifies various patterns of the use of institutional theory in information systems and e-government research. Based on our analysis of the current state of the art, the fourth section suggests some opportunities for future research. Finally, the fifth section provides some final comments.

Context matters: enablers and barriers to knowledge sharing in Australian public sector ICT projects

2020 ◽  
Vol 24 (8) ◽  
pp. 1921-1941
Author(s):  
Yakub Karagoz ◽  
Naomi Whiteside ◽  
Axel Korthaus
Keyword(s):  
Public Sector ◽  
Knowledge Sharing ◽  
Single Case ◽  
Structured Interview ◽  
Current Theory ◽  
Future Research ◽  
Content Type ◽  
The Public ◽  
Project Environment ◽  
Starting Point

Purpose This paper aims to extend the theory relating to knowledge sharing barriers and enablers in the public sector information and communication technology (ICT) project context. Design/methodology/approach A case study method was used whereby project managers from each of the seven departments of the Victorian Public Sector in Australia were interviewed about their knowledge sharing practice. A semi-structured interview instrument based on Riege’s (2005) barrier framework was used to explore the barriers to knowledge sharing that they experienced as part of their work. Findings The study found that many of Riege’s (2005) barriers did not apply in the public sector ICT project environment, demonstrating that context matters. In addition, five enablers were identified, resulting in a new model of enablers and barriers to knowledge sharing in public sector ICT projects. Research limitations/implications This study focuses on a single case, the Victorian Public Sector, and consequently the results are not generalisable. Future research should explore the applicability of the model in other public sector ICT project contexts. Practical implications The study highlights the relationship between knowledge sharing and the project manager and the role it plays in project delivery. The model presented provides a starting point for public sector practitioners to develop their knowledge sharing practice, potentially enhancing project outcomes in the process. Originality/value This study examines barriers to knowledge sharing in an under-researched context, that of the public sector ICT project environment. It builds on current theory and provides insights for practitioners in the public sector.

scholarly journals Nursing Voices during COVID-19: An Analysis of Canadian Media Coverage

Aporia ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 109-113
Author(s):  
Marilou Gagnon ◽  
Amélie Perron
Keyword(s):  
Public Health ◽  
Health Care ◽  
Severe Acute Respiratory Syndrome ◽  
Media Coverage ◽  
Lessons Learned ◽  
Public Health Care ◽  
News Stories ◽  
Starting Point ◽  
The Media

While it is generally recognized that nurses and nursing issues are underrepresented in the media, the contrary is also true during major public health care crises like Ebola and SARS (Severe Acute Respiratory Syndrome). We see this phenomenon unfolding in the midst of the current COVID-19 pandemic with nurses and nursing issues receiving extensive media coverage in Canada and internationally. To gain more insights into this media coverage, we analyzed the content of Canadian news stories published in both English and French during the first five months of the COVID-19 pandemic. This paper presents the findings of our analysis and identifies important lessons learned. We believe that our findings serve as an important starting point for understanding nurses’ agency and the media savviness they displayed during the first months of the pandemic.

Comprehensive On-site Medical and Public Health Training for Local Medical Practitioners in a Refugee Setting

2013 ◽  
Vol 7 (1) ◽  
pp. 82-88 ◽  
Author(s):  
Ramin Asgary ◽  
Karen Jacobson
Keyword(s):  
Public Health ◽  
Clinical Decision Making ◽  
Health Workers ◽  
Medical Personnel ◽  
Clinical Decision ◽  
Medical Providers ◽  
Medical Practitioners ◽  
Use Of Resources ◽  
Public Health Training ◽  
Site Training

AbstractObjectivesIn refugee settings, local medical personnel manage a broad range of health problems but commonly lack proper skills and training, which contributes to inefficient use of resources. To fill that gap, we designed, implemented, and evaluated a curriculum for a comprehensive on-site training for medical providers.MethodsThe comprehensive teaching curriculum provided ongoing on-site training for medical providers (4 physicians, 7 medical officers, 15 nurses and nurse aids, and 30 community health workers) in a sub-Saharan refugee camp. The curriculum included didactic sessions, inpatient and outpatient practice-based teaching, and case-based discussions, which included clinical topics, refugee public health, and organizational skills. The usefulness and efficacy of the training were evaluated through pretraining and posttraining tests, anonymous self-assessment surveys, focus group discussions, and direct clinical observation.ResultsPhysicians had a 50% (95% CI 17%-82%; range, 25%-75%) improvement in knowledge and skills. They rated the quality and usefulness of lectures 4.75 and practice-based teaching 5.0 on a 5-point scale (1=poor to 5=excellent). Evaluation of medical officers’ knowledge revealed improvements in (1) overall test scores (52% [SD 8%] to 80% [SD 5%]; P < .0001); (2) pediatric infectious diseases (44% [SD 9%] to 79% [SD 7%]; P < .001); and (3) noninfectious diseases (57% [SD 16%] to 81% [SD 10%] P < .01). Main barriers to effective learning were lack of training prioritization, time constraints, and limited ancillary support.ConclusionsA long-term, ongoing training curriculum for medical providers initiated by aid agencies but integrated into horizontal peer-to-peer education is feasible and effective in refugee settings. Such programs need prioritizing, practice and system-based personnel training, and a comprehensive curriculum to improve clinical decision making.(Disaster Med Public Health Preparedness. 2013;7:82-88)

scholarly journals Changing perspectives of public health in India: the growing role of health economics

2020 ◽  
Vol 4 ◽  
pp. 14
Author(s):  
Nutan Shashi Tigga ◽  
Vikash R. Keshri
Keyword(s):  
Public Health ◽  
Health Economics ◽  
Private Sector ◽  
Care Delivery ◽  
Public Health Care ◽  
Regulatory Control ◽  
Future Research ◽  
Indian Government ◽  
The Government

Health economics is a sub-discipline of economics that has significant relevance to public health. The academic discipline of health economics has not evolved in India till now. Since India became independent country, the public health practice in India has revolved largely around public health systems; the private health system has functioned in parallel with negligible regulatory control by the government. The recent launch of a large health insurance program by the Indian government has opened the door of public resources for the private sector in health. It is envisaged that a substantial portion of public money will be diverted to the private sector with little regulation. This situation will potentially change the landscape of public health care delivery in the country.  With this change, the role of health economists is bound to increase, given the increased demand for economic evaluation. Ironically, there is a complete dearth of educational institutions offering specialised training in health economics in India. To fulfil this demand-supply gap, there is an urgent need to introduce the discipline of health economics at master’s level within existing university economics departments and schools of public health. Building on this foundation, academic research degrees in health economics can be evolved to fulfil future research gaps.

Right to health and access to health-care services for refugees in Turkey

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
N. Ela Gokalp Aras ◽  
Sertan Kabadayi ◽  
Emir Ozeren ◽  
Erhan Aydin
Keyword(s):  
Public Health ◽  
Health Care ◽  
Institutional Theory ◽  
Access To Health Care ◽  
Health Care Services ◽  
Public Health Care ◽  
Content Type ◽  
Care Services ◽  
Access To Health ◽  
The Impact

Purpose This paper aims to provide a comprehensive understanding of factors that contribute to refugees’ exclusion from health-care services. More specifically, using institutional theory, this paper identifies regulative pillar-, normative pillar- and cultural/cognitive pillar-related challenges that result in refugees having limited or no access to health-care services. Design/methodology/approach The paper draws on both secondary research and empirical insights from two qualitative fieldwork studies totaling 37 semi-structured meso-level interviews, observations and focus groups in three Turkish cities (Izmir, Ankara and Edirne), as well as a total of 42 micro-level, semi-structured interviews with refugees and migrants in one large city (Izmir) in Turkey. Findings This study reveals that systematically stratified legal statuses result in different levels of access to public health-care services for migrants, asylum seekers or refugees based on their fragmented protection statuses. The findings suggest access to health-care is differentiated not only between local citizens and refugees but also among the refugees and migrants based on their legal status as shaped by their country of origin. Originality/value While the role of macro challenges such as laws and government regulations in shaping policies about refugees have been examined in other fields, the impact of such factors on refugee services and well-being has been largely ignored in service literature in general, as well as transformative service research literature in particular. This study is one of the first attempts by explicitly including macro-level factors to contribute to the discussion on the refugees’ access to public health-care services in a host country by relying on the institutional theory by providing a holistic understanding of cognitive, normative and regulative factors in understanding service exclusion problem.

scholarly journals Evolución de la gestión en la administración pública hospitalaria: Un estudio de caso de un hospital de segundo nivel en México (The evolution of public health care management: A case study of a second level hospital in Mexico)

2019 ◽  
Vol 15 (30) ◽  
Author(s):  
José Alfredo Sánchez Aldape ◽  
Arturo Briseño García ◽  
Mónica Lorena Sánchez Limón
Keyword(s):  
Public Health ◽  
Management Practices ◽  
Local Population ◽  
Public Health Care ◽  
Control Panel ◽  
Structured Interviews ◽  
Integral Control ◽  
Medical Specialties ◽  
Use Of Resources

Abstract. This paper analyses the management of Hospital General in Cd. Victoria, Tamaulipas, México, a decentralized public institute from the State Government that started operations on 1985. The first services offered to the local population was medical consultation, core medical specialties, emergency services, hospitalization, and intensive care unit. Within the hospital activities, both administrative and medical the management continuously looked for best practices that allowed it to reach its goals and fulfill its mission. Current literature provides a diversity of strategic tools and models that create value to public health processes making a more efficient use of resources. With this context, this research takes an exploratory case study approach using semi-structured interviews having as key informants the hospital managers since its foundation, allowing explanations on the evolution of the implemented management practices. This paper infers the need to incorporate actions that contribute to a comprehensive and structured professional management.Key words: hospital, integral control panel, strategic management 

scholarly journals Health Care Crowds: Collective Intelligence in Public Health

2017 ◽  
Author(s):  
John Prpić
Keyword(s):  
Public Health ◽  
Health Care ◽  
Collective Intelligence ◽  
Public Health Care ◽  
Future Research ◽  
Exploratory Research ◽  
University Of Michigan ◽  
Health Maintenance ◽  
Early Results ◽  
Care Health

For what purposes are crowds being implemented in health care? Which crowdsourcing methods are being used? This work begins to answer these questions by reporting the early results of a systematic literature review of 110 pieces of relevant research. The results of this exploratory research in progress reveals that collective intelligence outcomes are being generated in three broad categories of public health care; health promotion, health research, and health maintenance, using all three known forms of crowdsourcing. Stemming from this fundamental analysis, some potential implications of the research are discussed and useful future research is outlined.Prpić, J., (2015). Health Care Crowds: Collective Intelligence in Public Health. Collective Intelligence 2015. Center for the Study of Complex Systems, University of Michigan.

Sign in / Sign up

Export Citation Format

Share Document