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1 – 10 of over 1000Jacinta Nzinga, Gerry McGivern and Mike English
The purpose of this paper is to explore the way “hybrid” clinical managers in Kenyan public hospitals interpret and enact hybrid clinical managerial roles in complex healthcare…
Abstract
Purpose
The purpose of this paper is to explore the way “hybrid” clinical managers in Kenyan public hospitals interpret and enact hybrid clinical managerial roles in complex healthcare settings affected by professional, managerial and practical norms.
Design/methodology/approach
The authors conducted a case study of two Kenyan district hospitals, involving repeated interviews with eight mid-level clinical managers complemented by interviews with 51 frontline workers and 6 senior managers, and 480 h of ethnographic field observations. The authors analysed and theorised data by combining inductive and deductive approaches in an iterative cycle.
Findings
Kenyan hybrid clinical managers were unprepared for managerial roles and mostly reluctant to do them. Therefore, hybrids’ understandings and enactment of their roles was determined by strong professional norms, official hospital management norms (perceived to be dysfunctional and unsupportive) and local practical norms developed in response to this context. To navigate the tensions between managerial and clinical roles in the absence of management skills and effective structures, hybrids drew meaning from clinical roles, navigating tensions using prevailing routines and unofficial practical norms.
Practical implications
Understanding hybrids’ interpretation and enactment of their roles is shaped by context and social norms and this is vital in determining the future development of health system’s leadership and governance. Thus, healthcare reforms or efforts aimed towards increasing compliance of public servants have little influence on behaviour of key actors because they fail to address or acknowledge the norms affecting behaviours in practice. The authors suggest that a key skill for clinical managers in managers in low- and middle-income country (LMIC) is learning how to read, navigate and when opportune use local practical norms to improve service delivery when possible and to help them operate in these new roles.
Originality/value
The authors believe that this paper is the first to empirically examine and discuss hybrid clinical healthcare in the LMICs context. The authors make a novel theoretical contribution by describing the important role of practical norms in LMIC healthcare contexts, alongside managerial and professional norms, and ways in which these provide hybrids with considerable agency which has not been previously discussed in the relevant literature.
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Thomas W. Wainwright and David McDonald
Health services continue to face economic and capacity challenges. Quality improvement (QI) methods that can improve clinical care processes are therefore needed. However, the…
Abstract
Purpose
Health services continue to face economic and capacity challenges. Quality improvement (QI) methods that can improve clinical care processes are therefore needed. However, the successful use of current QI methods within hospital settings remains a challenge. There is considerable scope for improvement of elective clinical pathways, such as hip and knee replacement, and so the use and study of QI methods in such settings is warranted.
Design/methodology/approach
A model to manage variability was adapted for use as a QI method and deployed to improve a hip and knee replacement surgical pathway. A prospective observational study, with a mixed-methods sequential explanatory design (quantitative emphasised) that consisted of two distinct phases, was used to assess its effectiveness.
Findings
Following the use of the novel QI method and the subsequent changes to care processes, the length of hospital stay was reduced by 18%. However, the interventions to improve care process highlighted by the QI method were not fully implemented. The qualitative data revealed that staff thought the new QI method (the model to manage variability) was simple, effective, offered advantages over other QI methods and had highlighted the correct changes to make. However, they felt that contextual factors around leadership, staffing and organisational issues had prevented changes being implemented and a greater improvement being made.
Originality/value
The quality of QI reporting in surgery has previously been highlighted as poor and lacking in prospective and comprehensively reported mixed-methods evaluations. This study therefore not only describes and presents the results of using a novel QI method but also provides new insights in regard to important contextual factors that may influence the success of QI methods and efforts.
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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…
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Practical implications
The findings are relevant to public sector managers working on strategy documents and policymakers identifying challenges that might hinder the fulfillment of political intentions.
Originality/value
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.
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Sara Korlén, Anna Essén, Peter Lindgren, Isis Amer-Wahlin and Ulrica von Thiele Schwarz
Policy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby…
Abstract
Purpose
Policy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby incentives are filtered through organizations to influence staff motivation, and the key role of managers is often overlooked. The purpose of this paper is to explore the strategies managers use as intermediaries between financial incentives and the individual motivation of staff. The authors use empirical data from a local case in Swedish specialized care.
Design/methodology/approach
The authors conducted an exploratory qualitative case study of a patient-choice reform, including financial incentives, in specialized orthopedics in Sweden. In total, 17 interviews were conducted with professionals in managerial positions, representing six healthcare providers. A hypo-deductive, thematic approach was used to analyze the data.
Findings
The results show that managers applied alignment strategies to make the incentive model motivating for staff. The managers’ strategies are characterized by attempts to align external rewards with professional values based on their contextual and practical knowledge. Managers occasionally overruled the financial logic of the model to safeguard patient needs and expressed an interest in having a closer dialogue with policy makers about improvements.
Originality/value
Externally imposed incentives do not automatically motivate healthcare staff. Managers in healthcare play key roles as intermediaries by aligning external rewards with professional values. Managers’ multiple perspectives on healthcare practices and professional culture can also be utilized to improve policy and as a source of knowledge in partnership with policy makers.
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Chiara Oppi, Cristiana Cattaneo and Giovanna Galizzi
Further investigation is needed of network effectiveness in healthcare and how it is influenced by unpredictable events like COVID-19. Based on Provan and Milward’s (2001…
Abstract
Purpose
Further investigation is needed of network effectiveness in healthcare and how it is influenced by unpredictable events like COVID-19. Based on Provan and Milward’s (2001) framework, this study investigates the effectiveness criteria of healthcare networks and their potential contribution to network effectiveness during the pandemic’s challenges.
Design/methodology/approach
This research employs an explanatory case study in a local area of Italy’s Lombardy Region and analyzes network effectiveness at the network level based on network member perceptions.
Findings
Network effectiveness refers to the network’s ability to address patient needs, guaranteeing services through network members' coordinated efforts and a central coordinator that facilitates their interaction. Members’ capacity to strengthen their roles played a crucial part in sustaining network effectiveness when COVID-19 revised other members’ priorities and threatened achievement of network goals.
Practical implications
This study’s findings equip healthcare managers and policymakers with knowledge about network effectiveness criteria at the network level, offering suggestions for managerial practices and network design to address exogenous shocks.
Originality/value
This study identifies factors that influence network effectiveness criteria and provides insight into how network members can contribute to sustaining effectiveness during crises.
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Petra Apell and Patrik Hidefjäll
Quantifying the performance level of surgeons with digital virtual reality (VR) simulators can help ensure that quality requirements in healthcare are met. In order to better…
Abstract
Purpose
Quantifying the performance level of surgeons with digital virtual reality (VR) simulators can help ensure that quality requirements in healthcare are met. In order to better understand integration amongst quality principles, practices and technologies in the adoption and diffusion of VR simulators, the authors applied a technological innovation system (TIS) framework. The purpose of this study is to understand how the adoption and diffusion of VR surgical simulators in a Swedish healthcare context is influenced by various system factors.
Design/methodology/approach
In this study, single-case holistic design based on innovation system theory was used to analyse the adoption of digital quality technologies related to surgical performance in Swedish hospitals. The case employs a mixed methods approach triangulating data longitudinally from published documents and expert interviews.
Findings
Adoption of digital technologies regarding surgical performance is restricted by system factors relating to inconsistent normative and regulatory requirements for quantified performance criteria to judge surgical expertise. Addressing these systems' weaknesses with evidence-based training programmes can have a significant impact on the further development of the innovation system and can ultimately affect healthcare reliability and quality.
Originality/value
This paper explores quality management (QM) challenges in the context of digital transformation in healthcare. The paper attempts to fill the gap for TIS studies in a healthcare context and highlight the role of innovation function strength along the value chain and in relation to technology cycles to increase the understanding of adoption of digital technologies relating to surgical performance.
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Russell Mannion, Frederick Hassan Konteh and Rowena Jacobs
This study aims to compare and contrast the core organisational processes across high and low performing mental health providers in the English National Health Service (NHS).
Abstract
Purpose
This study aims to compare and contrast the core organisational processes across high and low performing mental health providers in the English National Health Service (NHS).
Design/methodology/approach
A multiple case study qualitative design incorporating a full sample of low and high performing mental health providers.
Findings
This study suggests that the organisational approaches used to govern and manage mental health providers are associated with their performance, and the study’s findings give clues as to what areas might need attention. They include, but are not limited to: developing appropriate governance frameworks and organisational cultures, ensuring that staff across the organisation feel “psychologically safe” and able to speak up when they see things that are going wrong; a focus on enhancing quality of services rather than prioritising cost-reduction; investing in new technology and digital applications; and nurturing positive inter-organisational relationships across the local health economy.
Originality/value
Highlights considerable divergence in organisation and management practices that are associated with the performance of mental health trusts in the English NHS
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Éva Tamás, Marie-Louise Södersved Källestedt, Håkan Hult, Liisa Carlzon, Klas Karlgren, Magnus Berndtzon, Magnus Hultin, Italo Masiello and Renée Allvin
Information is scarce on healthcare managers' understanding of simulation educators' impact on clinical work. Therefore, the aim of this study was to explore healthcare managers'…
Abstract
Purpose
Information is scarce on healthcare managers' understanding of simulation educators' impact on clinical work. Therefore, the aim of this study was to explore healthcare managers' perceptions of the significance of clinically active simulation educators for the organisation.
Design/methodology/approach
Healthcare managers were invited to be interviewed in a semi-structured manner. Inductive thematic analysis was used to identify and analyse patterns of notions describing the managers' perceptions of simulation educators' impact as co-workers on their healthcare organisations.
Findings
The identified relevant themes for the healthcare unit were: (1) value for the manager, (2) value for the community and (3) boundaries. Simulation educators were perceived to be valuable gatekeepers of evidence-based knowledge and partners in leadership for educational issues. Their most prominent value for the community was establishing a reflective climate, facilitating open communication and thereby improving the efficacy of teamwork. Local tradition, economy, logistics and staffing of the unit during simulation training were suggested to have possible negative impacts on simulation educators' work.
Practical implications
The findings might have implications for the implementation and support of simulation training programs.
Social implications
Healthcare managers appreciated both the personal value of simulation educators and the effect of their work for their own unit. Local values were prioritised versus global. Simulation training was valued as an educational tool for continual professional development, although during the interviews, the managers did not indicate the importance of employment of pedagogically competent and experienced staff.
Originality/value
The study provided new insights about how simulation educators as team members affect clinical practice.
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Maureen Alice Flynn and Niamh M. Brennan
The paper examines interviewee insights into accountability for clinical governance in high-consequence, life-and-death hospital settings. The analysis draws on the distinction…
Abstract
Purpose
The paper examines interviewee insights into accountability for clinical governance in high-consequence, life-and-death hospital settings. The analysis draws on the distinction between formal “imposed accountability” and front-line “felt accountability”. From these insights, the paper introduces an emergent concept, “grounded accountability”.
Design/methodology/approach
Interviews are conducted with 41 clinicians, managers and governors in two large academic hospitals. The authors ask interviewees to recall a critical clinical incident as a focus for elucidating their experiences of and observation on the practice of accountability.
Findings
Accountability emerges from the front-line, on-the-ground. Together, clinicians, managers and governors co-construct accountability. Less attention is paid to cost, blame, legal processes or personal reputation. Money and other accountability assumptions in business do not always apply in a hospital setting.
Originality/value
The authors propose the concept of co-constructed “grounded accountability” comprising interrelationships between the concept’s three constituent themes of front-line staff’s felt accountability, along with grounded engagement by managers/governors, supported by a culture of openness.
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The purpose of this paper is to review the current literature and summarises the benefits and limitations of having doctors in health management roles in today’s complex health…
Abstract
Purpose
The purpose of this paper is to review the current literature and summarises the benefits and limitations of having doctors in health management roles in today’s complex health environment.
Design/methodology/approach
This paper reviews the current literature on this topic.
Findings
Hospitals have evolved from being professional bureaucracies to being managed professional business with clinical directorates in place that are medically led.
Research limitations/implications
Limitations include the difficulty doctors have balancing clinical duties and management, restricted profession-specific view and the lack of management competencies and/or training.
Practical implications
The benefits of having doctors in health management include bottom-up leadership, specialised knowledge of the profession, expert knowledge of clinical care, greater political influence, effective change champions to have on-side, frontline leadership and management, improved communication between doctors and senior management, advocacy for patient safety and quality, greater credibility with public and peers and the perception that doctors have more power and influence compared to other health professionals can be leveraged.
Originality/value
Overall, there are more benefits than there are limitations to having doctors in health management but there is a need for more management training for doctors.
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