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Artificial intelligence (AI) raises many expectations regarding its ability to profoundly transform health care delivery. There is an abundant literature on the technical performance of AI applications in many clinical fields (e.g. radiology, ophthalmology). This article aims to bring forward the importance of studying organizational readiness to integrate AI into health care delivery.

The reflection is based on our experience in digital health technologies, diffusion of innovations and healthcare organizations and systems. It provides insights into why and how organizational readiness should be carefully considered.

As an important step to ensure successful integration of AI and avoid unnecessary investments and costly failures, better consideration should be given to: (1) Needs and added-value assessment; (2) Workplace readiness: stakeholder acceptance and engagement; (3) Technology-organization alignment assessment and (4) Business plan: financing and investments. In summary, decision-makers and technology promoters should better address the complexity of AI and understand the systemic challenges raised by its implementation in healthcare organizations and systems.

Few studies have focused on the organizational issues raised by the integration of AI into clinical routine. The current context is marked by a perplexing gap between the willingness of decision-makers and technology promoters to capitalize on AI applications to improve health care delivery and the reality on the ground, where it is difficult to initiate the changes needed to realize their full benefits while avoiding their negative impacts.

The purpose of this paper is to articulate cutting-edge conceptions of the relationship between local processes in the here-and-now, and the broader influences on those processes, that are both organic and overtly designed, and to discern the implications of this relationship for future research, policy and practice.

A focused and structured approach was taken to give effect to this purpose by reviewing the chosen articles in this collection, which from the 2018 Organizational Behavior in Health Care conference papers.

Research in coordination within and across health care boundaries increasingly recognizes: the multilevel influences on human action and interaction in health care delivery; the challenge of balancing individual or local agency with overt interventions; the everchanging the local circumstances of healthcare delivery; and the need to foster reflexivity, that is, self-improvement capacity, in healthcare organizations.

Interventions to improve care coordination must be grounded in the reality of changing local circumstances and incentives for action from the broader environment.

This paper articulates the implied tension in health care delivery between individual and local agency, and imposed structures that may contradict, but are at the same time necessary, to foster such agency.

This paper aims to produce a framework for climate-smart agriculture (CSA) in the Yangambi landscape, Democratic Republic of the Congo (DRC). This would enable the authors to identify agricultural practices, assess vulnerability to climate change, identify options for improving agricultural systems from a climate change mitigation and adaptation perspective and finally provide climate-smart agricultural options.

The study used household survey methods of data collection. The data were collected using a structured questionnaire survey by interviewing 250 farm households, subdivided using three axes of the Yangambi landscape. Fisher’s exact test was used to determine relationships between two or more variables.

Results of the survey revealed that the vast majority (98%) of respondents perceived changes in temperature, rainfall and weather patterns. Reduction of crop yields and the emergence of new weed species and new crop pests are the main impacts on agricultural activities. Although 87.6% of respondents have no means of adaptation and resilience, some of them use crops rotation, fallow practice, fertilizers and bio-pesticides. A framework for CSA is proposed for the Yangambi landscape.

Policies and strategies to promote CSA in the study area should take into account local farmers' perceptions of climate change and consider first the adequacy of CSA practices for the specific conditions of the target area before its promotion. This study is thus useful for many REDD+ initiatives that are currently being promoted in DRC and particularly in the Tshopo Province.

This study is one of the first studies to focus on CSA in the Yangambi landscape, DRC. It assists the use of agriculture as a response to reducing deforestation while at the same time lowering agriculture’s carbon footprint and promoting a resilient and more productive farming system.

Despite growing attention to physician engagement there is a lack of literature to guide the development of physician-led interventions. A scoping review was conducted to describe physician-led strategies that have been implemented to promote increased physician engagement in acute care settings. Strategies are viewed through the theoretical lens of institutional work to advance the understanding about how the theory can be applied. The paper aims to discuss this issue.

Searches were conducted in English-language publications (2012–2017). Of 35 retained articles, 15 were from the gray literature; and 20 were peer reviewed. The review was guided by Arskey and O’Malley’s (2005) five-stage process.

Five themes reflecting different foci of physician-led activity were examined from the perspective of institutional work: systematically analyze context using participatory methods; work collaboratively toward locally defined, shared targets and build in processes to monitor progress; expand physicians’ role and capacity to include leadership toward shared organizational goals; promote appropriate rewards and incentives for work that builds engagement; and invest in opportunities for formal and informal communication and interaction.

Physicians considering action to increase their engagement in system improvement may benefit from analysis of local opportunities and barriers in selecting context-relevant activities that will motivate participation and build engagement through a balance of institutional work.

The paper considers the potential for physicians to initiate and support activity that will increase their engagement. It provides pragmatic strategies for designing intervention and research using the theoretical lens of institutional work.

The purpose of this paper is to explore the appropriation of control rooms based on value-based integrated performance management tools implemented in all publicly funded health organizations in Quebec (Canada) as a form of legitimate sociomaterial work.

Multi-site organizational ethnographic case studies in two Integrated health and social services centers, with narrative process analysis of triangulated qualitative data collected through non-participant observation (163 h), individual semi-structured interviews (N = 34), and document review (N = 143).

Three types of legitimate sociomaterial work are accomplished when actors appropriate control rooms: 1) reformulating performance management work; 2) disrupting accountability work and; 3) effecting value-based integrated performance management. Each actor (tools, institutions and people) follows recurrent institutional work-paths: tools consistently engage in disruptive work; institutions consistently engage in maintaining work, and people consistently engage in creation work. The study reveals the potential of performance management tools as “effective integrators” of the technological, managerial, policy and delivery levels of data-driven health system performance and improvement.

This paper draws on theoretically informed empirical insights to develop actionable knowledge around how to better design, implement and adapt tool-driven health system change: 1) Packaging the three agents of data-driven system change in health care: tools, institutions, people; 2) Redefining the search for performance in health care in the context of value creation, and; 3) Strengthening clinical and managerial relevance in health performance management practice.

The authors aim to stimulate new and original scholarship around the under-theorized concept of sociomaterial work, challenging theoretical, ontological and practical conceptions of work in healthcare organizations and beyond.

Health systems are periodically confronted by crises – think of Severe Acute Respiratory Syndrome, H1N1, and Ebola – during which they are called upon to manage exceptional situations without interrupting essential services to the population. The ability to accomplish this dual mandate is at the heart of resilience strategies, which in healthcare systems involve developing surge capacity to manage a sudden influx of patients. The paper aims to discuss these issues.

This paper relates insights from resilience research to the four “S” of surge capacity (staff, stuff, structures and systems) and proposes a framework based on complexity theory to better understand and assess resilience factors that enable the development of surge capacity in complex health systems.

Detailed and dynamic complexities manifest in different challenges during a crisis. Resilience factors are classified according to these types of complexity and along their temporal dimensions: proactive factors that improve preparedness to confront both usual and exceptional requirements, and passive factors that enable response to unexpected demands as they arise during a crisis. The framework is completed by further categorizing resilience factors according to their stabilizing or destabilizing impact, drawing on feedback processes described in complexity theory. Favorable order resilience factors create consistency and act as stabilizing forces in systems, while favorable disorder factors such as diversity and complementarity act as destabilizing forces.

The framework suggests a balanced and innovative process to integrate these factors in a pragmatic approach built around the fours “S” of surge capacity to increase health system resilience.

The purpose of this paper is to describe experimental and numerical investigations focussed on the shock wave modification induced by a dc glow discharge. The model is a flat plate in a rarefied Mach 2 air flow, equipped with a plasma actuator composed of two electrodes. The natural flow without actuation exhibits a shock wave with a hyperbolic shape. When the discharge is on, the shock wave shape remains hyperbolic but the shock wave is pushed forward, leading to an increase in the shock wave angle. In order to discriminate thermal effects from purely plasma ones, the plasma actuator is then replaced by an heating element.

The experimental study is carried out with the super/hypersonic wind tunnel MARHy located at the ICARE Laboratory in Orléans. The experimental configuration with the heating element is simulated with a code using the 2D full compressible Navier-Stokes equations adapted for the rarefied conditions.

For heating element temperatures equal to the flat plate wall surface ones with the discharge on, experimental and numerical investigations showed that the shock wave angle was lower with the heating element, only 50 percent of the values got with the plasma actuator, meaning that purely plasma effects must also be considered to fully explain the flow modifications observed. The results obtained with the numerical simulations are then used to calculate the aerodynamic forces, i.e. the drag and the lift. These numerical results are then extrapolated to the plasma actuator case and it was found that the drag coefficient rises up to 13 percent when the plasma actuator is used, compared to only 5 percent with the heating element.

This paper matters in the topic of atmospheric entries where flow control, heat management and aerodynamic forces are of huge importance.

This study aims to identify opportunities and constraints of community forestry in the context of forest decentralization in Cameroon and what can be capitalized on for sound REDD+ design and implementation.

A qualitative approach to data collection was used through content analysis of 1994 forestry law, reports and publications related to decentralized forest management, community forestry and REDD+ in Cameroon. Principles that govern community forest and REDD+ were highlighted and opportunities and constraints of community forestry for REDD+ projects were discussed.

Community forestry was developed principally to protect forests in order to support the subsistence and income-generating extractive activities of forest-dependent communities. Community forestry governance arrangements were not designed with the objective of achieving verifiable emissions reductions or carbon stock values. Hence, existing community forestry institutions may not address all the specific demands of REDD+ programs. However, existing community institutions and practices can be strengthened or modified to align better with climate change mitigation goals and to achieve REDD+ objectives in community forestry sites. On the other hand, REDD+ was developed principally to mitigate climate change by reducing emissions from deforestation and forest degradation principally within developing countries where the livelihoods of forest-dependent people are a central component of all forest management policies. However, despite fundamental differences between community forestry and REDD+, there is substantial synergy between their objectives, and the dual forest conservation and livelihood development focus of both programs means that policies that strengthen and support existing community forestry institutions and sites will advance REDD+ objectives. As such, REDD+ will likely to be more successful if it builds on lessons learned from community forestry.

This paper demonstrates how REDD+ is more likely to succeed if it builds on the lessons learned from community forestry over the past 20-plus years in Cameroon. It also discusses how REDD+ can benefit from community forestry and how some of the many challenges related to community forestry can be directly addressed by the REDD+ mechanism. Further, this paper also argues how the congruence between community forestry and REDD+ can effectively facilitate the direct use of community forestry as a tool to achieve REDD+ goals.

The purpose of this paper of inter-professional networks is to analyze the evolution of relationships between professional groups enacting new forms of collaboration to address clinical imperatives.

This paper uses a case study based on semi-structured interviews with physicians and nurses, document analysis and informal discussions.

This study documents how two inter-professional networks were developed through professional agency. The findings show that the means by which networks are developed influence the form of collaboration therein. One of the networks developed from day-to-day, immediately relevant, exchange, for patient care. The other one developed from more formal and infrequent research and training exchanges that were seen as less decisive in facilitating patient care. The latter resulted in a loosely knit network based on a small number of ad hoc referrals while the other resulted in a tightly knit network based on frequent referrals and advice seeking.

Developing inter-professional networks likely require a sustained phase of interpersonal contacts characterized by persuasion, knowledge sharing, skill demonstration and trust building from less powerful professional groups to obtain buy-in from more powerful professional groups. The nature of the collaboration in any resulting network depends largely on the nature of these initial contacts.

The literature on inter-professional healthcare networks focusses on mandated networks such as NHS managed care networks. There is a lack of research on inter-professional networks that emerged from the bottom up at the initiative of healthcare professionals in response to clinical imperatives. This study looks at some forms of collaboration that these “grass-root” initiatives engender and how they are consolidated.