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While critical approaches have enriched research in proximate fields, their impact has been less marked in studies of healthcare management. In response, the 2016 Organizational Behaviour in Health Care Conference hosted its first-ever session dedicated to the emergent field of critical healthcare management studies (CHMSs). The purpose of this paper is to present five papers selected from that conference.

In this introductory paper, the authors frame the contributions as “green shoots” in a field of CHMS which contains four main furrows of activity: questioning the taken-for-granted; moving beyond instrumentalism; reflexivity and meanings in research; and challenging structures of domination (Kitchener and Thomas, 2016). The authors conclude by presenting an agenda for further cultivating the field of CHMS.

The papers evidence the value of CHMS, and provide insight into the benefits of broadening theoretical and methodological approaches in pursuit of critical insights.

CHMS works to explicate the multiple and competing ideologies and interests inherent in healthcare. As pragmatic imperatives push the provision of health and social care out of the organisational contexts and into private space, there is a particular need to simultaneously understand, and critically interrogate, the implications of new, as well as existing, forms of care.

This paper reviews, frames and details practical next steps in developing CHMS. These include: enhanced engagement with a wider range of actors than is currently the norm in mainstream healthcare management research; a broadening of theoretical and methodological lenses; support for critical approaches among editors and reviewers; and enhanced communication of critical research via its incorporation into education and training programmes.

The paper contributes to an emerging stream of CHMS research, and works to consolidate next steps for the field.

The purpose of this paper is to demonstrate the relevance of psychoanalysis to an emerging sub-field known as “critical healthcare management studies” (CHMS).

Building upon a wave of critical scholarship in the broader field of management, scholars and practitioners of healthcare management have begun to forge a critical scholarly movement of their own. CHMS, short for “critical healthcare management studies,” formally denotes a new subfield of inquiry dedicated to challenging entrenched assumptions, exposing power relations, and cultivating critical praxis, all the while serving as a vital counterpoint to mainstream scholarship. This paper seeks to augment the CHMS movement with psychoanalysis, and particularly the critical vein of organizational psychoanalysis already well-established in critical management studies.

The argument is made that a greater engagement with psychoanalysis offers novel avenues for critical theorizing and practice in healthcare management. Specifically three areas are considered: 1) the exploitative role of guilt in the caring professions, 2) the resurgence of authoritarianism and its implications for unconscious organizational dynamics, and 3) the potential for a psychoanalytically informed critical healthcare praxis.

While there remain wide differences of opinion about the utility of psychoanalysis outside of the clinical arena, this paper reveals just how psychoanalysis can inform today's healthcare organizations, and more broadly the social and political organization of health in society.

The purpose of this paper is to describe a hybrid approach to the research developed during a multi-researcher, ethnographic study of NHS management in the UK.

This methodological paper elaborates a hybrid approach to the sociological analysis – the critical-action theory – and indicates how it can contribute to the critical health management studies.

After exploring the various theoretical, methodological and philosophical options available, the paper discusses the main research issues that influenced the development of this perspective and the process by which the critical-action perspective was applied to the studies of managerial work in four health service sectors – acute hospitals, ambulance services, community services and mental healthcare.

This methodological perspective enabled a critical analysis of health service organisation that considered macro, meso and micro effects, in particular and in this case, how new public management drained power from clinicians through managerialist discourses and practices.

Healthcare organisations are often responding to the decisions that lie outside of their control and may have to enact changes that make little sense locally. In order to make sense of these effects, micro-, meso- and macro-level analyses are necessary.

The critical-action perspective is presented as an adjunct to traditional approaches that have been taken to the study of health service organisation and delivery.

The purpose of this article is to report on case study research conducted in a German hospital and describe the implications that the “Management by walking about” approach had on healthcare employees. “Management by walking about” is widely seen as one of the favoured procedures for increasing employee commitment and shared understanding as well as supporting high trust work relations.

This case study set out to examine the actual labour processes and the concrete experiences of healthcare employees behind the “Management by walking about” approach in a German hospital. This was achieved by means of a six month field study of day‐to‐day life in the hospital's nursing division.

In this case study, the popular initiative of “Management by walking about” was used as a means of managerial control and, as such, the internal promotion of soaring values and path‐finding visions was met with both scepticism and cynicism.

Pre‐commitment and motivation levels were high among healthcare employees, they were passionate about their healthcare work and they actively engaged in open communication and organisational development. But all this had little to do with “Management by walking about”, and its implications raise questions about its influence on high trust work relations more generally.

The paper concludes that a more critical analysis is necessary to challenge the way in which “Management by walking about” is examined by healthcare management academics and practitioners.

Increased attention to improve patient safety in healthcare has challenged healthcare managers to consider innovative approaches to meet this need. Organizational development (OD) programs have been used in both health services and other industries to address organizational training and development requirements, and can provide focused, timely, and effective education and training to a broad spectrum of program participants. In healthcare organizations, OD programs can serve an important institutional function by providing a framework through which patient safety can be emphasized as an organizational priority, and patient safety training can be delivered as part of OD efforts. In addition, organizations committed to creating a patient-focused safety culture can use OD initiatives strategically to support organizational culture change efforts. This chapter describes different approaches to including patient safety in an OD framework, drawing from both management theory and practice. Findings from three extensive qualitative studies of leadership development and corporate universities in healthcare provide specific examples of how healthcare organizations discuss patient safety improvement using this alternative approach. Considering the concepts and findings described in this chapter can help healthcare organizations make strides toward positive changes in organizational culture that will promote patient safety on the organizational agenda.

The aim of this study was to explore the nature of frontline nurses' experiences of living with rapid and continuous organizational change.

A critical hermeneutic approach was utilized. This was a qualitative inquiry theoretically guided by critical management studies.

Participants recognized that many change initiatives reflected an ideological shift in healthcare that supported a culture of service, whilst sacrificing a culture of care. A culture of service prioritized cost-savings and efficiency, which saw nurses lose the time and resources required to provide quality, safe care.

Nurses felt morally responsible to uphold a culture of care, which proved challenging and at times unobtainable. The inability to provide quality, safe care in light of organizational changes resulted in a multitude of negative emotional repercussions, which fostered moral distress.

The findings from this study bring to light ideological tensions that negatively impact nurses. This study supports the conclusion that the planning, implementation and evaluation of organizational change initiatives must reflect a culture of care in order to alleviate the many negative experiences of organizational change noted in this study.

The purpose of this paper is to study critical practices when adopting improvement knowledge as a management innovation in a professional organization.

This paper is based on an action research approach, in which practitioners and researchers are seen as a part of a participative community generating actionable knowledge. Research involved gathering data over a five-year period through more than 250 interviews and 25 focus groups.

This paper identifies five critical practices for adopting a management innovation in a professional context: first, focussing on labeling and theorizing to create an organization’s own vocabulary; second, focussing on the role of internal change agents; third, allowing for an evolutionary adoption process; fourth, building new professional competence through the change agents; and fifth, adopting a research-driven approach to the adoption of a management innovation.

For healthcare practitioners, this paper points to practices to consider when adopting improvement knowledge – for example, identifying the patient as the guiding principle and encouraging involvement and local change initiatives. For practitioners in other professionally driven organizations, this paper identifies critical practices for adopting a management innovation – for example, focussing on theorizing and labeling in order to create an organization’s own vocabulary related to the professional context.

On a generic level, this paper contributes to the understanding of critical aspects when adopting management innovations in a professional organization. In a healthcare context, this paper points to the value of improvement knowledge for improving quality of care. Improvement knowledge is relatively new in healthcare, and this study provides an example of a hospital in which this management innovation helped transform the organization.

This study aims to present Lean Six Sigma (LSS) deployment and sustainment strategies for the healthcare sector from a multi-level perspective. The objective is to present LSS implementation insights to enable policymakers, practitioners and academicians to test and develop an LSS framework for healthcare sectors.

The strategies identified are the result of a multi-method research design involving literature review, action research (AR) and Delphi study. Further, the AR portion of the study involved more than 10 years of projects focused on the deployment of LSS in the healthcare sector.

The strategies include a holistic view from the multi-level perspective, considering the Top Management Level, Middle Management Level and Operational Level. The authors ascertained 27 strategies across the three levels of organizational structure for the effective deployment of LSS. Further, the authors present a customized LSS “pocket guide” from the healthcare perspective for quick reference.

The strategies delineated in this study are based on the Indian healthcare section only; thus, further research in additional geographic contexts is needed. Also, further research is necessary to provide additional empirical validation of the effects of the identified strategies on LSS program outcomes and to verify that the strategies operate at the proposed organizational levels. Future research should also focus on identifying the interrelationships between strategies within and across levels, developing a “road map” for LSS implementation in hospitals and designing the LSS curriculum for medical schools and other medical training programs.

Observations of this study can contribute to developing a holistic framework for successful LSS implementation in the healthcare sector for academicians, practitioners and policymakers. This, in turn, ensures an enhanced value proposition, improved quality of life and reduced healthcare operational costs. Thus, it ensures a win-win situation among all the stakeholders of the healthcare sector.

The strategies put forth will enable the LSS researchers, academicians and, more particularly, practitioners to delve deeper into specific enablers and safeguard the LSS deployment from backlash. The research has two significant benefits. Firstly, it enhances the understanding of LSS from the healthcare perspective. Secondly, it provides direction for future studies with specific components for hospitals’ LSS framework, which can be further tested, refined and improved.

Blockchain technology enhances information management in healthcare supply chains by securing healthcare information and providing medical resource traceability. However, there is no decision framework to support blockchain implementation for managing information, especially in emerging economies’ healthcare supply chains. This paper develops a hierarchical decision model for implementing blockchain technology for information management in emerging economies’ healthcare supply chains.

This study uses 20 health supply chain experts in Ghana to rank 17 decision criteria for implementing blockchain for healthcare information management using the best-worst method (BWM) multi-criteria decision technique.

The results show that “security” and “privacy,” “infrastructural facility” and “presence of training facilities” are the top three critical factors impacting blockchain adoption in the health supply chain for healthcare information management. Other sub-factors are prioritized.

To implement blockchain effectively to enhance information management in the healthcare supply chain, health institutions, blockchain technology providers and state authorities should concentrate on the highly critical factors extracted from the study.

This is the first study that develops a hierarchical decision model for implementing blockchain technology in emerging economies' health supply chains.