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Healthcare organisations are often described as less innovative than other organisations, since organisational culture works against innovations. In this paper, the authors ask whether it has to be that way or whether is possible to nurture an innovative culture in a healthcare organisation. The aim of this paper is to describe and analyse nurturing an innovative culture within a healthcare organisation and how culture can support innovations in such a healthcare organisation.

Based on a qualitative case study of a healthcare unit that changed, within a few years, from having no innovations to repeatedly generating innovations, the authors describe important aspects of how innovative culture can be nurtured in healthcare. Data were analysed using inductive and deductive analysis steps.

The study shows that it is possible to nurture an innovative culture in a healthcare organisation. Relationships and competences beyond healthcare, empowering structures and signalling the importance of innovation work with resources all proved to be important. All are aspects that a manager can influence. In this case, the manager's role in nurturing innovative culture was very important.

This study highlights that an innovative culture can be nurtured in healthcare organisations and that managers can play a key role in such a process.

The paper describes and analyses an innovative culture in a healthcare unit and identifies important conditions and strategies for nurturing innovative culture in healthcare organisations.

The purpose of this paper is to highlight the prominent cognitive biases that influence Lean practices in organisations that have a multi-cultural work environment which will aid the organisational managers and academics in enhancing the understanding of the human thought process and mitigate them suitably.

A multiple case study was conducted in organisations that were previously committed to Lean practices and had a multi-cultural work environment. This research was conducted on five companies based on 99 in-depth semi-structured interviews and seven process observations that sought to establish the system-wide cognitive biases present in a multi-cultural Lean environment.

The novel findings indicate that nine new biases influence Lean implementation and practices in a multi-cultural environment. This study also found strong connectivity between Lean practices and 45 previously identified biases that could affect positively or negatively the lean methodologies and their implementation. Biases were resilient enough that their influence on Lean in multi-cultural workplaces, even with transient populations, did not demonstrate cultural differentiation.

Like any qualitative research, constructivism and narrative analyses are subjected to understanding based on knowledge gained on the subject, and data may have been interpreted differently. Constructivist co-recreation of process scenarios based result limitations is therefore acknowledged. The interactive participation in exploring the knowledge sought after and interaction that could have a probable influence on the participant need to be acknowledged. However, the research design, multiple methods of data collection, generalisation based on data collection and analysis methods limit the effects of these and findings are reliable to a greater extent.

The results can provide an enhanced understanding of biases and insights into a new managerial approach to take remedial steps on biases’ influence on Lean practices that can result in improved productivity and well-being from a business process perspective. Understanding and mitigating the prominent biases can aid Lean manufacturing processes and support decision makers and line managers in improving lean methodologies’ effectiveness and productivity. The biases can be negated and used to implement decisions with ease. The influence of biases and the model could be used as a basis to counter implementation barriers.

To the best of the authors’ knowledge, this is the first study that connects the cognitive perspectives of Lean business processes in a multi-cultural environment to identify the cognitive biases that influence Lean practices in organisations that were previously committed to Lean practices. The novel findings indicate that nine new biases and 45 previously identified biases influence Lean implementation and practices in a multi-cultural environment. The second novelty of this study shows the connection between cognitive biases, Lean implementation and practices in multi-cultural business processes.

People with intellectual disability die prematurely and from avoidable causes. Innovative solutions and proactive strategies have been limited in addressing this disparity. This paper aims to detail the process of developing a risk stratification tool to identify those individuals who are higher risk of premature mortality.

This study used population health management principles to conceptualise a risk stratification tool for avoidable deaths in people with intellectual disability. A review of the literature examined the existing evidence of causes of death in people with intellectual disability. A qualitative methodology using focused groups of specialist clinicians was used to understand the factors that contributed towards avoidable deaths in people with intellectual disability. Delphi groups were used for consensus on the variables for inclusion in the risk stratification tool (Decision Support Tool for Physical Health).

A pilot of the Decision Support Tool for Physical Health within specialist intellectual disability service demonstrated effective utility and acceptability in clinical practice. The tool has also demonstrated good face and construct validity. A further study is currently being completed to examine concurrent and predictive validity of the tool.

To the best of the authors’ knowledge, this is the only study that has used a systematic approach to designing a risk stratification tool for identifying premature mortality in people with intellectual disability. The Decision Support Tool for Physical Health in clinical practice aims to guide clinical responses and prioritise those identified as at higher risk of avoidable deaths.