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As part of a national plan to govern professional and organizational development in Norwegian specialist healthcare, the country’s hospital clinics are tasked with constructing development plans. Using the development plan as a case, the paper analyzes how managers navigate and legitimize the planning process among central actors and deals with the contingency of decisions in such strategy work.

This study applies a qualitative research design using a case study method. The material consists of public documents, observations and single interviews, covering the process of constructing a development plan at the clinical level.

The findings suggest that the development plan was shaped through a multilevel translation process consisting of different contending rationalities. At the clinical level, the management had difficulties in legitimizing the process. The underlying tension between top-down and bottom-up steering challenged involvement and made it difficult to manage the contingency of decisions.

The findings are relevant to public sector managers working on strategy documents and policymakers identifying challenges that might hinder the fulfillment of political intentions.

This paper draws on a case from Norway; however, the findings are of general interest. The study contributes to the academic discussion on how to consider both the health authorities’ perspective and the organizational perspective to understand the manager’s role in handling the contingency of decisions and managing paradoxes in the decision-making process.

During the 1990s, Italian healthcare organisations (HOs) underwent a process of corporatisation, and the most innovative HOs introduced the balanced scorecard (BSC) to address the need for broader accountability. Currently, there is a limited understanding of the dynamics and outcomes of such a process. Therefore, this study aims to explore whether the BSC is still considered an effective performance management tool and analyse the factors driving and hindering its evolution and endurance in public and non-profit HOs.

We conducted a retrospective longitudinal analysis of two pioneering cases in the adoption of the BSC: one in a public hospital and the other in a non-profit hospital. Data collection relied on accessing institutional documents and reports from the early 2000s to the present, as well as conducting semi-structured interviews with the internal sponsors of the BSC.

We found evidence of three main categories of factors that trigger or hinder the adoption and development of the BSC: (1) the role of the internal sponsor and professionals’ commitment; (2) information technology and the controller’s technological skills; and (3) the relationship between the management and professionalism logics during the implementation process. At the same time, there is no evidence to suggest that specific technical features of the BSC influence its endurance.

The paper contributes to the debate on the key factors for implementing and sustaining multidimensional control systems in professional organisations. It emphasises the importance of knowledge-based assets and distinctive internal capabilities for the success of the business. The implications of the BSC legacy are discussed, along with future developments of multidimensional control tools aimed at supporting strategy execution.

A large number of studies indicate that coercive forms of organizational control and performance management in health care services often backfire and initiate dysfunctional consequences. The purpose of this article is to discuss new approaches to performance management in health care services when the purpose is to support innovative changes in the delivery of services.

The article represents cross-boundary work as the theoretical and empirical material used to discuss and reconsider performance management comes from several relevant research disciplines, including systematic reviews of audit and feedback interventions in health care and extant theories of human motivation and organizational control.

An enabling approach to performance management in health care services can potentially contribute to innovative changes. Key design elements to operationalize such an approach are a formative and learning-oriented use of performance measures, an appeal to self- and social-approval mechanisms when providing feedback and support for local goals and action plans that fit specific conditions and challenges.

The article suggests how to operationalize an enabling approach to performance management in health care services. The framework is consistent with new governance and managerial approaches emerging in public sector organizations more generally, supporting a higher degree of professional autonomy and the use of nonfinancial incentives.

The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

In this paper, the authors examine the strategies used to reduce labour costs in three public hospitals in South Africa, which were effective and why. In the democratic era, after the revelations of large-scale corruption, the authors ask whether their case studies provide lessons for how public service institutions might re-make themselves, under circumstances of austerity.

A comparative qualitative case study approach, collecting data using a combination of interviews with managers, focus group discussions and interviews with shop stewards and staff was used.

Management in two hospitals relied on their financial power, divisions between unions and employees' loyalty. They lacked the insight to manage different actors, and their efforts to outsource services and draw on the Extended Public Works Program failed. They failed to support staff when working beyond their scope of practice, reducing employees' willingness to take on extra responsibilities. In the remaining hospital, while previous management had been removed due to protests by the unions, the new CEO provided stability and union–management relations were collaborative. Her legitimate power enabled unions and management to agree on appropriate cost cutting strategies.

Finding an appropriate balance between the new reality of reduced financial resources and the needs of staff and patients, requires competent unions and management, transparency and trust to develop legitimate power; managing in an authoritarian manner, without legitimate power, reduces organisational capacity. Ensuring a fair and orderly process to replace ineffective management is key, while South Africa grows cohorts of competent managers and builds managerial experience.

Healthcare providers are under pressure due to increasing and more complex demands for services. Increased pressure on budgets and human resources adds to an ever-growing problem set. Competent leaders are in demand to ensure effective and well-performing healthcare organisations that deliver balanced results and high-quality services. Researchers have made significant efforts to identify and define determining competencies for healthcare leadership. Broad terms such as competence are, however, inherently at risk of becoming too generic to add analytical value. The purpose of this study is to suggest a holistic framework for understanding healthcare leadership competence, that can be crucial for operationalising important healthcare leadership competencies for researchers, decision-makers as well as practitioners.

In the present study, a critical interpretive synthesis (CIS) was conducted to analyse competency descriptions for healthcare leaders. The descriptions were retrieved from peer reviewed empirical studies published between 2010 and 2022 that aimed to identify healthcare services leadership competencies. Grounded theory was utilised to code the data and inductively develop new categories of healthcare leadership competencies. The categorisation was then analysed to suggest a holistic framework for healthcare leadership competence.

Forty-one papers were included in the review. Coding and analysing the competence descriptions resulted in 12 healthcare leadership competence categories: (1) character, (2) interpersonal relations, (3) leadership, (4) professionalism, (5) soft HRM, (6) management, (7) organisational knowledge, (8) technology, (9) knowledge of the healthcare environment, (10) change and innovation, (11) knowledge transformation and (12) boundary spanning. Based on this result, a holistic framework for understanding and analysing healthcare services leadership competencies was suggested. This framework suggests that the 12 categories of healthcare leadership competencies include a range of knowledge, skills and abilities that can be understood across the dimension personal – and technical, and organisational internal and – external competencies.

This literature review was conducted with the results of searching only two electronic databases. Because of this, there is a chance that there exist empirical studies that could have added to the development of the competence categories or could have contradicted some of the descriptions used in this analysis that were assessed as quite harmonised. A CIS also opens for a broader search, including the grey literature, books, policy documents and so on, but this study was limited to peer-reviewed empirical studies. This limitation could also have affected the result, as complex phenomenon such as competence might have been disclosed in greater details in, for example, books.

The holistic framework for healthcare leadership competences offers a common understanding of a “fuzzy” concept such as competence and can be used to identify specific competency needs in healthcare organisations, to develop strategic competency plans and educational programmes for healthcare leaders.

This study reveals a lack of consensus regarding the use and understanding of the concept of competence, and that key competencies addressed in the included papers are described vastly different in terms of what knowledge, skills and abilities they entail. This challenges the operationalisation of healthcare services leadership competencies. The proposed framework for healthcare services leadership competencies offers a common understanding of work-related competencies and a possibility to analyse key leadership competencies based on a holistic framework.

In modern societies, consumer well-being is dependent on choices regarding complex services, such as investments, health care, insurance and lending. However, evaluating costs of such services is often difficult for consumers due to a combination of limited cognitive resources and complexity of the service. The purpose of this study is to empirically examine to what extent three specific consequences of complexity influence consumer tendencies to make mistakes when evaluating the costs (or price) of complex services.

Three studies were conducted (survey: n = 153, experiment: n = 332 and conjoint analysis: n = 225), all focusing on how consumers evaluate costs in the complex mutual fund setting.

The authors find that consumers struggle with estimating and using cost information in decision-making in the complex services setting. Consumers of complex services frequently underestimate the costs over the long-term, may see costs as a signal of service quality and are susceptible to influence from presentation formats when evaluating costs.

The study investigates mutual funds, which is one example of a complex service. In order to get a full picture of how consumers deal with costs in complex setting, future research needs to expand this focus to other types of complex services.

The results have implications for both marketers of complex services and policymakers. For marketers, this paper highlights that competing with a low-cost strategy may be difficult in the complex services setting as consumers may lack the ability to actually evaluate what they pay over the long term. For policymakers, increased simplification of prices may be an attractive option. However, it is important that this simplification is done in a way that increases the possibility to compare prices.

As complexity influences several aspects of decision-making, an understanding of how consumers evaluate costs in complex settings is dependent on taking a multidimensional research approach. This paper makes a novel contribution to the literature on pricing by showing that consumers struggle with multiple aspects when evaluating costs in complex contexts. Understanding these effects is important to policy, as well as to research on the cognitive value of simplicity that is currently gaining traction in marketing research.

This paper demystifies the fluid workforce phenomenon increasingly discussed in the circles of organizational innovators and explores the characteristic aspects of the fluid workforce in the healthcare sector.

We analyze the concept and provide a generic review of definitions of a fluid workforce in relation to other similar concepts established in the academic and practitioner literature, contextualize the fluid workforce phenomenon in healthcare and distinguish relevant drivers and categories of fluid workers in this sector. We also discuss the implications of a fluid workforce for healthcare organizations, drawing on the health labor market and human resource management (HRM) practices frameworks.

The fluid workforce in healthcare is not new. Today’s main novelties are related to the wide diversity of types of fluid workforce that have emerged, the expanding scale of diffusion of the fluid workforce and the emergence of digital technologies to support HRM decisions. While a fluid workforce may provide solutions to address mismatches in the supply and demand of health workers, it can also worsen working conditions, increase dual practice and have implications for existing HRM practices.

We disentangle a novel term for the public sector, healthcare and HRM literature. We discern similarities and distinctions, presenting a framework for managing and analyzing this workforce at organizational and labor market levels in the healthcare sector. Acknowledging the challenges in estimating the existing fluid workforce labor market size, we offer practical methodologies to empirically estimate its prevalence within the healthcare industry and build an agenda for future research.

The paper investigates how the engagement of a group of actors (the volunteers), previously unexplored in service ecosystems literature, contributes to generating new co-creation activities and well-being outcomes in the healthcare service ecosystem (HSE). Moreover, the study analyses how the provision and integration of volunteers’ resources help to explain the HSE self-adjustment favouring the re-humanisation of service.

The article zooms in on the volunteers’ activities in an HSE. A qualitative approach is adopted, and an empirical investigation is grounded in data gathered from Kids Kicking Cancer (KKC) Italia, a volunteer association operating in the paediatric oncology ward of Italian hospitals. Data are collected and triangulated through in-depth interviews, volunteers’ diaries and observations. The analysis is conducted by adopting an interpretative thematic analysis technique.

The study provides a conceptual framework explaining how volunteers’ value co-creation activities influence the HSE’s self-adjustment by leading to a re-humanisation of services. The paper also contributes to the state of knowledge by identifying seven categories of volunteers’ value co-creation activities, two of which are completely new in the literature (co-responsibility and empowerment).

The paper contributes to the service research literature by identifying empirically grounded value co-creation activities extending the understanding of self-adjustment and re-humanisation of the service ecosystem.