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The purpose of this paper is to consider organisational climate as the vehicle to get an understanding, map and enhance the appropriate organisational culture for good clinical governance (CG). Based on this assertion, the purpose of this research is fourfold: to investigate CG attributes embedded in Greek hospitals' climate; to test the validity and reliability of the Clinical Governance Climate Questionnaire (CGCQ) and highlight the dimensions of CG climate in the Greek context; to illuminate the “red flag” aspects of hospital's climate and areas shaping the perceptions of the quality of the provided services; and to explore the influence of hospital's legal status on CG climate and service quality.

Empirical research using the CGCQ was conducted in three Greek NHS hospitals. A total of 214 usable questionnaires completed by the hospitals' personnel were gathered.

The validity and reliability tests proved that the study's five‐dimension structure of CGCQ is capable of conceptualising the basic elements of CG climate in the Greek context. Hospital's climate was found to be not supportive to successful CG implementation, and areas that demand attention were illuminated. Hospital's legal status seems to mediate CG climate and service quality.

CGCQ proved to be a useful tool for managers and policymakers to trace “problematic” areas of hospital's climate and develop strategies for successful CG initiatives.

The paper contributes to the field of health care management, since it demonstrates that CG climate can be used as a “gauge” of the prevailing CG culture. CGCQ is revealed as a valid, reliable and flexible tool.

The purpose of this paper is to investigate the cases of Bangladeshi, Filipina, Nigerian, Palestinian and Pakistani migrant workers and how the frame of their work and employment in precarious, low-status/low-wage jobs affects their perceptions and practices regarding health and access to healthcare services.

Using qualitative research methodology, the analysis via in-depth interviews focuses on male Bangladeshi, Nigerian, Pakistani and Palestinian unskilled manual and textile laborers as well as street vendors, and female Filipina live-in domestic workers.

Migrants are entrapped in a context of isolative and exploitative working conditions, i.e., in unskilled labor, textile work, street-vending, personal services, care and domestic work, which lead them to adopt a self-perception in which healthcare and social protection are not a priority.

Throughout the paper it has become clear that these precarious low-status/low-wage jobs have an important underside effect on migrants’ lives, intensifying labor and health instability and exposing migrants to employment-generating activities that do not guarantee health safety. In Greek society, the impact of migration on public health is characterized by many as a “time bomb ready to explode,” especially in urban centers. Meanwhile, the economy and particularly the informal sector of the labor market is benefiting from migrant workers. More research is needed as this mode of exploitative labor and precarious employment needs to be adequately addressed to mitigate barriers in the access of labor and healthcare rights.

Via its contribution to the sociology of migration with particular emphasis on labor healthcare, the paper provides evidence that due to their concentration in precarious, low-status/low-wage jobs migrant workers have very limited access to healthcare services. The removal of inequalities and discrimination against migrant workers in accessing healthcare services and medical care is a challenge for South European Union countries and particularly for Greece. However, in spite of this, there is no uniform policy in the management of migrants with respect to their access to health services. The paper will aid debates between policy makers and academics working on migration and inequalities due to the division of labor and health disparities, will contribute to the understanding of the perils attached to precarious, low-status/low-wage jobs and in addressing health inequalities effectively.

Greek society is in a transition period, because it has become host to nearly a million immigrants in less than a decade. The increasing inflow and settlement of migrants and refugees with diverse socio‐economic and socio‐cultural backgrounds have led to a growing need for services that will meet the needs of migrant populations. The country has to adapt to the demands of a multi‐cultural society, and at this stage the health sector ‐ and more specifically health practitioners ‐ appear to lack awareness of the complex needs of these populations, particularly the cultural diversity among migrant women and the crucial role of health staff in promoting integration of these social groups. This paper will discuss the challenges faced by health care providers in Greece and a pilot intervention in Greek hospitals to address cultural diversity for women.

This study investigates the occupational stress amongst 355 male and female Greek junior hospital doctors (JHDs) working in the Greater Athens area. The initial phase of the research involved in‐depth interviews with a random stratified sample of sixty JHDs, both male and female, in a variety of specialties of junior hospital staff. An extended version of the occupational stress indicator (OSI) questionnaire was developed, incorporating additional items based on the results of the qualitative part of the study, and on previous research findings in the same area. The sample consisted of 193 males and 162 females JHDs, who completed the OSI. Analyses of the data demonstrated that, overall, JHDs presented significantly higher levels of sources of pressure than the normative population and other comparative occupational samples. As regards the various sub‐group comparisons, bivariate analyses revealed that there were significant differences between male and female JHDs in certain aspects of pressure (“career and achievement” and “home/work interface”). Multivariate analyses revealed that predictors of physical and mental ill health and job dissatisfaction were type A behaviour and “demands of the profession” respectively. The research implications of the findings are discussed.

This paper aims at understanding how clinical guidelines' use in the labour process relates to clinical autonomy, that is, the self-control medical professionals exercise over medical practice.

Drawing on a qualitative case study research strategy, this paper explores how medical professionals use clinical guidelines in the labour process in one public general hospital of the Greek National Health System. Supplemented by an extensive study of documents, semi-structured interviews were conducted with 33 doctors of several specialties.

The analysis shows (1) how clinical autonomy, as a self-control structure, mediates the use of clinical guidelines as a knowledge tool in the labour process, and (2) how employing clinical guidelines as a means towards coordinating medical work, but also towards regulating and standardising medical practice, is exercising pressure on the individualistic character of clinical autonomy.

Advancing the analytic value of workplace control structures, this paper contributes novel theoretical understanding of emerging tendencies characterising medical work organisation and clinical autonomy, and explains how medical professionals' non-adherence to clinical practice guidelines (CPGs) relates to CPGs' role as a resource to medical practice. Finally, this research proposes a more critical approach to health policy towards addressing the challenges associated with centrally introducing clinical guidelines in healthcare organisations.

The purpose of this paper is to elicit Greek doctors' and nurses' views about adverse event reporting.

This is an exploratory study using an adverse events questionnaire administered to 209 doctors and 214 nurses in 14 major Athens universities and tertiary hospitals.

The paper finds that Greek doctors and nurses prefer a strictly confidential or conditionally confidential reporting scheme. Most doctors favoured disclosing department identity, while a nursing majority argued that it should remain unknown. When asked about the person's professional affiliation that, under a confidential scheme, receives reports and gives feedback, most doctors and nurses preferred the receiver to belong to their profession. Most medical personnel preferred the mandatory model or the discretionary model with a set of guidelines exemplifying adverse event types, while a nurse majority preferred the discretionary with a set of guidelines exemplifying adverse events.

It is necessary to establish a strictly confidential, non‐punitive reporting scheme that supports learning and knowledge and one that is separate from any disciplinary scheme.

The study indicates that culture, legal and patient complaint systems do not affect healthcare professional notions with respect to reporting adverse events.

It is widely accepted that the use of information and communication technology (ICT) in the healthcare sector offers great potential for improving the quality of services provided, the efficiency and effectiveness of personnel, and also reducing organizational expenses. This paper seeks to examine various hospital information system (HIS) evaluation methods.

In this paper a comprehensive search of the literature concerning the evaluation of complex health information systems is conducted and used to generate a synthesis of the literature around evaluation efforts in this field. Three approaches for evaluating hospital information systems are presented – user satisfaction, usage, and economic evaluation.

The main results are that during the past decade, computers and information systems, as well as their resultant products, have pervaded hospitals worldwide. Unfortunately, methodologies to measure the various impacts of these systems have not evolved at the same pace. To summarize, measurement of users' satisfaction with information systems may be the most effective evaluation method in comparison with the rest of the methods presented.

The methodologies, taxonomies and concepts presented in this paper could benefit researchers and practitioners in the evaluation of HISs.

This review points out the need for more thorough evaluations of HISs that look at a wide range of factors that can affect the relative success or failure of these systems.

The purpose of this paper is to investigate service-oriented architecture organizational studies (SOA OS) in healthcare through a rigorous literature review, development and testing in an eGovernment health-care setting. The application of SOA paradigm to integrate information systems has been pursued mainly by private organizations. However, SOA starts to appear in the public agenda and specifically in health-care reengineering, as well. Recently, government strategies for eHealth have been slowly incorporating the SOA paradigm to integrate isolated systems, provide cost-effective solutions and expand the capabilities of their health-care information system. Yet, literature indicates that eHealth government strategies, including SOA, require the support of SOA OS to be successfully implemented.

To investigate the less acknowledged phenomena like SOA OS in healthcare, the authors incorporate an interpretive, qualitative case study approach to conduct this research. This method will assist in examining the phenomenon in its natural setting, examine the in-depth complexities and health-care processes and provide rich qualitative data during interviews and observations.

The authors critically review the literature and synthesize a SOA OS with specific attributes, sub-elements, guidelines and healthcare-specific parameters. This conceptual structure was tested in the practical arena leading to an evaluated SOA OS blueprint.

As the outcome of the research was based on a single case, the paper concludes that the SOA OS in health-care research needs to broaden its perspective with more empirical data.

This research revealed empirical insights that can help practitioners and researchers focus their attention to the significant role that the SOA OS plays during SOA implementations.

This paper focuses on critical success factors related to SOA implementations in health-care organizations and can be considered as novel as it identifies and structures a SOA OS element that can be part of a SOA governance approach in the area of healthcare.

The purpose of this paper is to explore the reasons why Greek doctors are reluctant to report adverse events.

The paper is an exploratory study using the adverse events questionnaire, administered to 209 doctors in 14 major Athens hospitals, comprising university as well as tertiary.

The questionnaire showed a high degree of internal consistency (Cronbach's alpha 0.84), which revealed a four‐factor solution, explaining 67.4 per cent of the variance. Three dominant reasons for not reporting, with which almost or more than 50 per cent of doctors strongly or slightly agreed, were identified as no tradition for bringing up adverse events and a belief that bringing up adverse events will not lead to any improvement and workload.

Factors that dissuade doctors from bringing up adverse events may be projected not only by cultural aspects such as professional, national and organisational cultures but also by healthcare structural issues such as safety systems, rules and procedures, and relevant acts and regulations. The study has several noteworthy limitations. First, doctors' response was poor, which might conceal sample bias problems. Second, the present study identified four factors but the fourth factor was not well defined.

The study provides an understanding why physicians fail to report adverse events so that systems can be introduced and cultures developed, which make this easier.

Aims at providing a classification of the ERP integration concept in a healthcare organization and at presenting a real world example of process integration using SAP R/3.

Research is based on a case study involving in‐depth semi‐structured interviews with key stakeholders and action research conducted in the hospital during the ERP implementation period.

Findings suggest that an apparently simple software implementation of an ordering process can have a considerable impact on stakeholders in a complex environment operating ERP software. Organizational change issues, implementation and integration issues of SAP R/3 with other non‐SAP systems and SCM considerations are discussed.

Analyzes enterprise integration concept specifically in a healthcare environment and describes a real world process integration solution (missing from the literature) achieved by using SAP R/3 software.