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A problem-solving routine for improving hospital operations

Manimay Ghosh (Department of Operations Management and Decision Sciences, Xavier Institute of Management, Bhubaneswar, India)
Durward K Sobek II (Department of Mechanical and Industrial Engineering, Montana State University, Bozeman, MT, USA)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 13 April 2015




The purpose of this paper is to examine empirically why a systematic problem-solving routine can play an important role in the process improvement efforts of hospitals.


Data on 18 process improvement cases were collected through semi-structured interviews, reports and other documents, and artifacts associated with the cases. The data were analyzed using a grounded theory approach.


Adherence to all the steps of the problem-solving routine correlated to greater degrees of improvement across the sample. Analysis resulted in two models. The first partially explains why hospital workers tended to enact short-term solutions when faced with process-related problems; and tended not seek longer-term solutions that prevent problems from recurring. The second model highlights a set of self-reinforcing behaviors that are more likely to address problem recurrence and result in sustained process improvement.

Research limitations/implications

The study was conducted in one hospital setting.

Practical implications

Hospital managers can improve patient care and increase operational efficiency by adopting and diffusing problem-solving routines that embody three key characteristics.


This paper offers new insights on why caregivers adopt short-term approaches to problem solving. Three characteristics of an effective problem-solving routine in a healthcare setting are proposed.



The authors would like to thank the National Science Foundation for funding this research (NSF Award No. SES – 0115352). The authors would like to extend the thanks to the informants in the hospital who provided all the necessary information to write this paper, and to thank Professor Richard Howard who provided valuable suggestions that greatly improved this paper.


Ghosh, M. and Sobek II, D.K. (2015), "A problem-solving routine for improving hospital operations", Journal of Health Organization and Management, Vol. 29 No. 2, pp. 252-270.



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