Search results
21 – 30 of over 3000Thanos Papadopoulos, Zoe Radnor and Yasmin Merali
The importance of networks in effecting the outcomes of change processes is well‐established in the literature. Whilst extant literature focuses predominantly on the structural…
Abstract
Purpose
The importance of networks in effecting the outcomes of change processes is well‐established in the literature. Whilst extant literature focuses predominantly on the structural properties of networks, our purpose is to explore the dynamics of network emergence that give rise to the outcomes of process improvement interventions. Through the use of actor‐network theory (ANT), the purpose of this paper is to explore the dynamics in the implementation of a process improvement methodology in the complex organisational setting of a UK National Health Service Trust. The paper illustrates the utility of ANT in articulating the dynamic nature of networks underpinning socio‐technical change, and our analysis provides insights for the management process change initiatives.
Design/methodology/approach
This is a rich qualitative study in the Pathology Unit of a UK National Health Service Trust, using ANT as the theoretical lens for tracking the emergence and transformation of networks of individuals over the course of a management intervention to promote “Lean thinking” for process performance improvements.
Findings
ANT is useful for explicitly tracking how organisational players shift their positions and network allegiances over time, and for identifying objects and actions that are effective in engaging individuals in networks which enable transition to a Lean process. It is important to attend to the dynamics of the process of change and devise appropriate timely interventions enabling actors to shift their own positions towards a desired outcome.
Research limitations/implications
The paper makes the case for using theoretical frameworks developed outside the operations management to develop insights for designing process interventions.
Originality/value
By understanding the role of shifting networks managers can use timely interventions during the process implementation to facilitate the transition to Lean processes, e.g. using demonstrable senior leadership commitment and visual communication.
Details
Keywords
Akintola Akintoye and Ezekiel Chinyio
The UK Government has now adopted Private Finance Initiative (PFI) as a major vehicle for the delivery of additional resources to the health sector in order to achieve a greater…
Abstract
Purpose
The UK Government has now adopted Private Finance Initiative (PFI) as a major vehicle for the delivery of additional resources to the health sector in order to achieve a greater investment in healthcare facilities. The purpose of this paper is to examine the trends and risk assessment of the PFI in the healthcare sector.
Design/methodology/approach
The paper employed secondary data and interviews of key participants in two hospital PFI projects to highlight developments in healthcare PFI and the risk management of hospital projects.
Findings
The results show that the use of PFI in the provision of healthcare is increasing in terms of number, capital value and size of projects. What emerged in the healthcare PFI project was a usage of a plethora of risk management techniques, albeit to varying degrees. Experience appeared to be the prime risk assessment technique employed, while risk avoidance was first explored before pricing and allocating any residual risks. “Risk prompts”, such as using checklists and risk registers were also useful in the identification of risks. Among all participants, insurance cover and sub‐contracting appear to be the most prominent strategies employed for managing out the risks.
Originality/value
The negotiations that precede the signing of a healthcare PFI project contract had an impact on the final choice of facilities or their specifications. The two contracting parties sought a balance between an optimal allocation of risks, choice of facilities and project price. Although the risk management techniques being used are generic in nature, there is still no evidence at the moment to show that these are appropriate for PFI projects. It is important that further investigation is undertaken to assess the level of current skills in risk management techniques to deal with PFI projects and the extent to which these techniques are appropriate to tackle complex healthcare PFI projects.
Details
Keywords
Milad Yousefi and Moslem Yousefi
The complexity and interdisciplinarity of healthcare industry problems make this industry one of the attention centers of computer-based simulation studies to provide a proper…
Abstract
Purpose
The complexity and interdisciplinarity of healthcare industry problems make this industry one of the attention centers of computer-based simulation studies to provide a proper tool for interaction between decision-makers and experts. The purpose of this study is to present a metamodel-based simulation optimization in an emergency department (ED) to allocate human resources in the best way to minimize door to doctor time subject to the problem constraints which are capacity and budget.
Design/methodology/approach
To obtain the objective of this research, first the data are collected from a public hospital ED in Brazil, and then an agent-based simulation is designed and constructed. Afterwards, three machine-learning approaches, namely, adaptive neuro-fuzzy inference system (ANFIS), feed forward neural network (FNN) and recurrent neural network (RNN), are used to build an ensemble metamodel through adaptive boosting. Finally, the results from the metamodel are applied in a discrete imperialist competitive algorithm (ICA) for optimization.
Findings
Analyzing the results shows that the yellow zone section is considered as a potential bottleneck of the ED. After 100 executions of the algorithm, the results show a reduction of 24.82 per cent in the door to doctor time with a success rate of 59 per cent.
Originality/value
This study fulfils an identified need to optimize human resources in an ED with less computational time.
Details
Keywords
The purpose of this study is to explore the link between continuous improvement (CI) and dynamic actor associations through a case of lean thinking implementation in healthcare.
Abstract
Purpose
The purpose of this study is to explore the link between continuous improvement (CI) and dynamic actor associations through a case of lean thinking implementation in healthcare.
Design/methodology/approach
The paper follows the qualitative case study strategy. Data were collected by interviewing (tape‐recording) managers and staff, analysing relevant written project material, and conducting non‐participant observations.
Findings
The findings suggest that the implementation of CI depends on the emergence of a “favouring” network from the dynamic associations between heterogeneous entities. This network aims at facilitating change leadership, establishing behaviour/culture prone to CI, and constructing a behaviour non‐resistant to CI needed for creating competencies for the continuous roll‐outs of such changes. Continuous translation is the underlying mechanism for establishing the favouring network.
Originality/value
The paper addresses the literature gap regarding the role of dynamic actor associations in shaping CI in a public sector context. It does not aim at generalising the results of the case study; it informs current theory by revealing that the success of CI deployment depends on the emergence of a CI‐favouring network, which will continuously transform opposing views into accepting CI.
Details
Keywords
Abstract
Details
Keywords
The introduction of clinical audit systems is likely to provoke considerable debate in health services, located as they are at the crucial interface between clinicians and…
Abstract
The introduction of clinical audit systems is likely to provoke considerable debate in health services, located as they are at the crucial interface between clinicians and managers. The development phase of a long‐term regional project to introduce audit systems is described. The factors that facilitated the project are identified, as are the problems, some of which remain unresolved.
Details
Keywords
Pawel D. Mankiewicz and Johan Truter
The purpose of this paper is to summarise the development of a recovery-oriented and socially inclusive acute care clinical psychology service in one of the NHS Trusts based in…
Abstract
Purpose
The purpose of this paper is to summarise the development of a recovery-oriented and socially inclusive acute care clinical psychology service in one of the NHS Trusts based in East Anglia. It demonstrates the service's compliance with relevant national policies and guidelines, and addresses some of the criticisms directed at acute mental health care in recent years. Both achievements and difficulties are reflected on.
Design/methodology/approach
The paper employs an organisational development case example related to applicable clinical practice model, based on national guidelines and policies, in order to demonstrate that it is possible to develop and implement a recovery-oriented clinical psychology practice in acute inpatient mental health care. This is based on the authors, experiences as a public sector clinical psychologists specialising in complex, severe, and enduring mental health needs.
Findings
Clinical psychologists may effectively contribute to the development of psychosocially informed and recovery-based multidisciplinary attitudes towards emotional difficulties of individuals admitted to psychiatric wards.
Research limitations/implications
Future service development project of similar nature ought to implement standardised measures (e.g. ward atmosphere scales) to increase validity of findings.
Practical implications
Despite limited, and continuously decreasing, resources in the NHS it appears possible to develop and establish a successful and objectively replicable provision of recovery-based psychological services across an entire acute care mental health pathway.
Social implications
Recovery-enhancing clinical psychology interventions should not be limited to those receiving care from community-based services only. Building psychologically informed understanding of mental health needs should be employed on inpatient wards too, in order to counterbalance the dominating biomedical models of mental illness.
Originality\value
Dissemination of examples of effective psychosocial practice in acute mental health settings appears largely underrepresented.
Details
Keywords
The healthcare sector faces new financial and managerial accountability demands, along with their clinical accountability. Various studies show strong opposition by clinicians to…
Abstract
Purpose
The healthcare sector faces new financial and managerial accountability demands, along with their clinical accountability. Various studies show strong opposition by clinicians to new accountability tools, new structures and new ways of working. Less attention is paid to the innovative roles doctors can play in leading changes that use new managerial tools and techniques. The purpose of this paper is to analyse two original case studies illustrating how general practitioners (GPs) in Germany have led radical change.
Design/methodology/approach
The paper draws upon original research in Germany to present two case studies using a qualitative method, which are analysed using Glaser and Strauss' conventions of grounded theory, structured by Wenger's communities of practice framework, supporting a comprehensive literature review.
Findings
GPs are found to be able to lead radical change in healthcare delivery models and organisation using entrepreneurial talents developed in their practice businesses and to embrace modernising tools and techniques and in the process redefine their identities to include management process in addition to medical competences.
Originality/value
The paper presents two original case studies of radical change leading to an integration of healthcare services in Germany. The approach adopted by the German GPs reveals important general lessons for practitioners, as does the analytical framework employed in the paper.
Details
Keywords
This article summarises research that explored the way that policy has worked in UK mental health services over the last 20 years. It constructs a framework for analysing three…
Abstract
This article summarises research that explored the way that policy has worked in UK mental health services over the last 20 years. It constructs a framework for analysing three stages of policy making, namely: policy initiation, policy formulation and policy implementation. Three levels of policy activity are also identified; these are located at the macro, national, level; the meso, district health authority level; and the micro, provider level. A matrix is then built up that facilitates an exploration of policy activity within and between these stages and levels. The main findings of the study were that, historically, no level has held a monopoly on power or influence in the policy process, that the hitherto unsung role of the meso level has been crucial for policy success and that managers’ abilities to shape their organisation decline above the meso level. Since the Labour Government came to power in 1997, however, the macro level has begun to dominate the policy process. The ensuing “top down” approach to policy formulation is encouraging uniformity of service, but may be stifling creativity. Policy activity is becoming less than the sum of its parts.
Details
Keywords
Julie Frost and Sandra Gardiner
‘Binge drinking’ has been the subject of national concern and there are an increasing number of government initiatives to tackle it. The publicity and hyperbole that it receives…
Abstract
‘Binge drinking’ has been the subject of national concern and there are an increasing number of government initiatives to tackle it. The publicity and hyperbole that it receives has prompted the question as to whether the issue is another ‘moral panic’. The evidence is examined and the authors suggest that there are real grounds for concern.
Details