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We discuss the impact of complexity science on the design and management of health care organizations over the past decade. We provide an overview of complexity science issues and their impact on thinking about health care systems, particularly with the rising importance of information systems. We also present a complexity science perspective on current issues in today’s health care organizations and suggest ways that this perspective might help in approaching these issues.

We review selected research, focusing on work in which we participated, to identify specific examples of applications of complexity science. We then take a look at information systems in health care organizations from a complexity viewpoint.

Complexity science is a fundamentally different way of understanding nature and has influenced the thinking of scholars and practitioners as they have attempted to understand health care organizations. Many scholars study health care organizations as complex adaptive systems and through this perspective develop new management strategies. Most important, perhaps, is the understanding that attention to relationships and interdependencies is critical for developing effective management strategies.

Increased understanding of complexity science can enhance the ability of researchers and practitioners to develop new ways of understanding and improving health care organizations.

This analysis opens new vistas for scholars and practitioners attempting to understand health care organizations as complex adaptive systems. The analysis holds value for those already familiar with this approach as well as those who may not be as familiar.

Hospitals, physician groups, and other healthcare organizations (HCOs) are joining together in a multitude of new ways in ever increasing numbers. This process or strategy is often called “integrating” and results in some form of integrated delivery system (IDS) or accountable health plan (AHP) if an insurance function is part of the system. Recent literature suggests that many HCOs are not meeting their integration objectives, with resulting financial and structural difficulties. One of the major causes is the failure to follow a developed plan for integration planning and implementation. Organizations in other industries often rely on written guides to help them efficiently accomplish complex projects. HCOs that use a guide such as the one suggested here should improve the chances of a successful and financially viable integration.

The relentless onslaught of computers and communications technologies has recently descended on the healthcare industry. Fortunately, however, the utilization of technologies in healthcare delivery and administration could not be timelier because of the need to control escalating health costs. While the proliferation of information and communication technologies in healthcare, referred to as health management information systems (HMIS), is certainly long overdue in healthcare organizations (HCOs), it is important to recognize and be prepared for the vulnerabilities of these technologies to natural, technological, and man‐made disasters. This paper describes how HCOs have justifiably become dependent on HMIS and how these organizations may proactively plan for disasters which can impact on HMIS. A phased approach, referred to as the disaster recovery and business continuity (DRBC) planning model, is presented in the paper as an approach to develop and implement business continuity plans in HCOs.

The aim of this paper is to investigate the role that halal certification organisations (HCOs) play in the UK in assuring quality in halal cosmetics.

The study evaluates whether halal certification assures the quality of halal cosmetic products. This research evaluated the quality assurance systems of major UK HCOs, using a hypothetical product as a test vehicle. The investigation considered whether these organisations differ in their definition of “halal” and “halal cosmetics” and also considered how effectively their certification signals quality assurance.

The study indicated that there is a failure to adopt holistic halal terminology which implies that within the UK halal cosmetics industry, manufacturers may not be working within agreed standards for halal product integrity.

This study focussed on UK certification for halal cosmetics by three HCOs and disregarded other forms of halal businesses. The literature review is based solely on literature available in the English language. The study lacks generalisability, as only one hypothetical product was tested; therefore, it was not possible to reach an understanding of all the costs involved in UK HCO certification.

This study undertook a comprehensive literature review on halal certification to produce a comparison of halal sanctioning laws, certification processes and the level of supply chain verification by UK HCOs.

This study adds value to the knowledge on UK halal certification.

Given that staff‐management relationships are a core concern for communication management, upward feedback is emerging as a key theme in the literature. It is, however, most often associated with upward appraisal. This study looks at upward feedback in a more general sense, and in particular at whether such feedback is critical or positive in its response to senior management decisions. One hundred and forty‐six staff within a health care organisation (HCO) were surveyed, using a depth communication audit instrument. Fifteen staff were also interviewed in detail, and six focus groups each composed of six people were also convened. The results indicated that informal upward feedback was mostly absent; that where it occurred the feedback was inaccurately positive; that senior managers were unaware of such distortions and unwilling to contemplate the possibility that they did indeed exist; that they had an exaggerated impression of how much upward feedback they received; and that they discouraged the transmission of critical feedback. The implications for the practice of communication management, the development of upward influence within organisations and general theoretical reasons for distortions in feedback processes are considered.

The purpose of this paper is to develop a framework for the application of evidence-based management to chronic disease healthcare.

Chronic healthcare is specially characterized by recursive patient-physician interactions in which evidence-based medicine (EBM) is applied. However, implementing evidence-based solutions to improve healthcare quality requires managers to effect changes in many different areas: organizational structure, procedures, technology and in physician/provider behaviors. To complicate matters further, they must achieve these changes using the tools of resource allocation or incentives. The literature contains many systematic reviews evaluating the question of physician and patient behavior under various types and structures of incentives. Similarly, systematic reviews have also been done regarding specific changes to the healthcare process and their effectiveness in improving patient outcomes. Yet, these reviews uniformly lament a lack of appropriate data from well-organized studies on the question of “Why?” solutions may work in one instance while not in another. The authors present a new theoretical framework that aids in answering this question.

This paper presents a new theoretical framework (Influence Model of Chronic Healthcare) that identifies: the critical areas in which managers can effect changes that improve patient outcomes; the influence these areas can have on each other, as well as on patient and physician behavior; and the mechanisms by which these influences are exerted. For each, the authors draw upon, and present the evidence in the literature. Ultimately, the authors recognize that this is a complex question that has not yet been fully researched. The contribution of this model is twofold: first, the authors hope to focus future research efforts, and second, provide a useful heuristic to managers who must make decisions with only the lesser-quality evidence the literature contains today.

This model can be used by managers as a heuristic either ex ante or ex post to determine the effectiveness of their decisions and strategies in improving healthcare quality. In addition, it can be used to analyze why actions or decisions taken achieved a given outcome, and how best to proceed to effect further improvements on patient outcomes. Last, the model serves to focus attention on specific questions for further research.

The purpose of this paper is to discuss the value of post‐modern psychosocial approaches to studying knowledge and practice construction in health care organizations and settings (HCO&S) and the increasing ability of qualitative research to furnish a deeper, more ecological, and more usable understanding of the social construction of health knowledge and practices.

The argument proposed in the paper is based on a critical literature review conducted on the Psychinfo, Scopus, PubMed and Web of Science databases.

Recent years have seen cultural changes in the values and goals of healthcare interventions that are deeply reconfiguring HCO&S. These changes are reframing HCO&S action and are highlighting the importance of understanding and managing not only the “expert context” but also the “lay contexts” of healthcare interventions. In an attempt to deal with these emergent changes (and challenges), HCO&S are taking advantage of new insights matured in the post‐modern turn of organizational analysis. In this frame, qualitative research proves suitable for connecting HCO&S needs and priorities with the new post‐modern paradigm of knowledge‐ and practice‐sharing in organizations.

The paper demonstrates the value of qualitative research in the analysis of HCO&S and casts light on the new research trends and new technical‐methodological options arising in this field.

The primary objective of this article is to explore what senior managers think they should be doing to improve communication in their organization, what they actually do in communication terms, and the high work load which senior managers undertake.

This understanding is advanced by using the results of a communication audit which was conducted in a major European health‐care organization (HCO) undergoing significant internal re‐organization. A communication audit can be defined as: “a comprehensive and thorough study of communication philosophy, concepts, structure, flow and practice within an organisation”. It assists managers by “providing an objective picture of what is happening compared with what senior executives think (or have been told) is happening”.

First, senior managers who over‐work are even less likely to have the time for reflection, followed by behaviour change. Second, the absence of adequate upward communication may blind managers to the full nature of their problems, which in turn guides the search for solutions.

Clearly there is a need to examine other types of organizations to establish the universality of the communication issues and problems that were found in a large HCO in Europe, using both quantitative and qualitative methodologies.

The data suggest that attempting to cover up communication weaknesses by managers working even longer hours only has the effect of further disempowering people, and so accentuating rather than alleviating the underlying difficulty.

The article has value to fellow academics and managers in practice and contributes to the debate on upward communication and the workload of managers.

Health systems are changing at variable rates. Periods of significant change can create new challenges or amplify existing barriers to accreditation program credibility and reliability. The purpose of this paper is to examine, during the transition to a new Australian accreditation scheme and standards, challenges to health service accreditation survey reliability, the salience of the issues and strategies to manage threats to survey reliability.

Across 2013-2014, a two-phase, multi-method study was conducted, involving five research activities (two questionnaire surveys and three group discussions). This paper reports data from the transcribed group discussions involving 100 participants, which was subject to content and thematic analysis. Participants were accreditation survey coordinators employed by the Australian Council on Healthcare Standards.

Six significant issues influencing survey reliability were reported: accreditation program governance and philosophy; accrediting agency management of the accreditation process, including the program’s framework; survey coordinators; survey team dynamics; individual surveyors; and healthcare organizations’ approach to accreditation. A change in governance arrangements promoted reliability with an independent authority and a new set of standards, endorsed by Federal and State governments. However, potential reliability threats were introduced by having multiple accrediting agencies approved to survey against the new national standards. Challenges that existed prior to the reformed system remain.

Capturing lessons and challenges from healthcare reforms is necessary if improvements are to be realized. The study provides practical and theoretical strategies to promote reliability in accreditation programs.

This paper examines how informal knowledge transfer processes unfold during the repatriation of Malaysian executives. The goal is to develop a repatriate knowledge transfer process model, explaining the informal process through which repatriates make decisions about and transfer newly acquired knowledge.

Given the unexplored nature of the informal knowledge transfer process the study investigates, this research adopts an exploratory qualitative research approach using interview data from 10 Malaysian corporate executives over a period of 14 months, covering prerepatriation and postrepatriation stages.

The findings indicate that from the repatriates' perspectives, the process flows during repatriates' knowledge transfer depend on the ability and motivation of repatriates, as well as their opportunity to communicate the newly acquired knowledge to their home country organization. We likewise learned that the repatriates' ability to overcome repatriate adjustment and knowledge transfer challenges is crucial in order for them to proactively initiate informal knowledge transfer.

This research is significant as it will assist current and future expatriates to plan and prepare for repatriation and eventual knowledge transfer. The findings will also be useful to organizations that employ repatriates in preparing action plans for repatriation rather than solely focusing on expatriation.

Research and practice formally argue that expatriates are expected to transfer knowledge from the home country organization to the host country organization. While on assignment, expatriates become exposed to various types of new knowledge during the assignment, setting them up to disseminate this newly acquired knowledge to their home country organization upon repatriation – however, knowledge transfer upon repatriation is largely informal. This paper examines how this informal knowledge transfer process unfolds in the repatriation context over a period of 14 months by qualitatively tracing the experiences of 10 Malaysian corporate executives.