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The purpose of this paper is to discuss the construction of the theoretic model of systematic knowledge creation in the healthcare process according to professionals' collaboration using clinical‐pathways.

Healthcare is a knowledge‐intensive service conducted by professionals. A clinical‐pathway is an effective tool in the knowledge management aspect of this service. The theoretic model of the medical knowledge management which used the clinical‐pathway from case studies in two hospitals is constructed.

The theoretical model shows the interaction between explicit knowledge and tacit knowledge in the healthcare process using clinical‐pathways. This theoretical model is a knowledge creation model which creates new knowledge continuously. Therefore, the clinical‐pathways are suggested as an effective tool for knowledge management in healthcare.

Promotion of knowledge communication between healthcare professionals by clinical‐pathways activities is important for excellent healthcare management.

This paper will be valuable for sustained improvement of healthcare quality by knowledge management with clinical‐pathways. In this paper, the detailed theoretic model which explains medical knowledge management with clinical‐pathways has been constructed.

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.

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 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.

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.

This study investigates the perceptions of intellectual capital (IC) among senior managers at Italian local healthcare units (LHUs) and the interrelations among IC components. It also provides a comprehensive definition of IC in the healthcare context and managerial guidance on improving IC to enhance LHU performance.

A survey was carried out to investigate perceptions among LHU senior management and identify characteristics of each primary IC component. The pilot study's results were examined using principal component analysis.

The findings illustrate senior management's perceptions of IC in LHUs and the extent to which management identifies and manages IC. A comprehensive definition of IC components in the healthcare sector is derived from these findings.

The research provides a better understanding of IC in the healthcare context and facilitates further research into how IC may be incorporated in quotidian organizational procedures. Results suggest that LHU managers should invest in increasing trust and respect and engage employees in organizational processes to provide recognition for the active role they play. Ongoing management of the three primary IC components is shown to have clear advantages, particularly on their connectivity.

The paper contributes to an increasingly important strand of theoretical research – IC in the healthcare context – and also adds new knowledge on the practical applications of IC in LHUs.

This paper aims to investigate the consequences of the coercive regulations for performance measurement and comparability that strengthened regional health authority’s control over organizations’ activities on management accountants’ relationship with clinician managers, who are the recipients of accounting information for decisional processes in health-care organizations. To achieve this aim, the research focuses on management accountants’ perception of their role and whether they perceive role conflict and role ambiguity.

A case study was undertaken in a public university hospital in the Emilia-Romagna region, Italy; 9 management accountants and 11 clinician managers were interviewed and secondary data analyzed.

Management accountants show low capabilities to support clinician managers’ decisional processes. Following the enactment of regulations, management accountants perform their role with a primary focus on functional responsibility. The focus on the provision of information to address regulations influenced management accountants’ capability to act as business partners in the organization. Because of the conflicting information needs from regulations and clinician managers, management accountants experience role conflict and ambiguity.

The paper has implications for policymakers, underlining the consequences of strict regulations on management accountants’ role. It also emphasizes the importance of revising accounting techniques to satisfy both regional requirements and clinician managers’ needs for decision-making.

The article contributes to knowledge related to the role of management accountants in health care. It explores, in particular, the consequences of coercive regulations in health-care organizations, adding knowledge to a field that remains quite unexplored.

The purpose of this paper is to assess perceptions of organizational readiness to integrate clinic-based community health workers (cCHWs) between traditional CHWs and potential cCHW employers and their staff in order to inform training and implementation models.

A cross-sectional mixed-methods approach evaluated readiness to change perceptions of traditional CHWs and potential employers and their staff. Quantitative methods included a printed survey for CHWs and online surveys in Qualtrics for employers/staff. Data were analyzed using SPSS software. Qualitative data were collected via focus groups and key informant interviews. Data were analyzed with NVIVO 11 Plus software.

CHWs and employers and staff were statistically different in their perceptions on appropriateness, management support and change efficacy (p<0.0001, 0.0134 and 0.0020, respectively). Yet, their differences lay within the general range of agreement for cCHW integration (4=somewhat agree to 6=strongly agree). Three themes emerged from the interviews which provided greater insight into their differences and commonalities: perspectives on patient-centered care, organizational systems and scope of practice, and training, experiences and expectations.

Community health workers serve to fill the gaps in the social and health care systems. They are an innovation as an emerging workforce in health care settings. Health care organizations need to learn how to integrate paraprofessionals such as cCHWs. Understanding readiness to adopt the integration of cCHWs into clinical settings will help prepare systems through trainings and adapting organizational processes that help build capacity for successful and sustainable integration.

One of the latest trends within public administration and healthcare organizations (HCOs) is process orientation, often in the shape of Lean management. The purpose of this study is to expand our understanding of process orientation of HCOs and the more specific aim is to investigate what measures are taken to re-frame the HCOs to include the process dimension.

This empirical study is based on 67 interviews and 20 meeting observations.

The main observation in this study is that introducing process-oriented management solutions is about disconnecting and cutting-off existing links. The authors see how attempts are made to cut-off links to the logic of functional specialization, the autonomy of the professional worker, equal treatment of patients and other objectives.

This study adds to and expands previous studies that have problematized the use of Lean-inspired ways of organizing in the public sector.

Measuring attitudes of healthcare providers and managers toward change in health care organizations (HCOs) has been of widespread interest. The purpose of this paper is to evaluate the psychometric characteristics and usability of an abbreviated German version of the Change Attitude Scale.

The Change Attitude Scale was used in a survey of healthcare providers and managers in German hospitals after the implementation of a breast cancer center concept. Reliability analysis, confirmatory factor analysis, structural equation modeling and bivariate analysis were conducted.

Data from 191 key persons in 82 hospitals were analyzed. The item-scale structure produced an acceptable model fit. Convergent validity was shown by significant correlations with measures of individuals’ general opinions of the breast center concept. A non-significant correlation with a scale measuring the hospital’s hierarchical structure of leadership verified discriminant validity. The interaction of key persons’ change attitude and hospitals’ change performance through change culture as a mediator supported the predictive validity.

The study found general support for the validity and usability of a short version of the German Change Attitude Scale.

Since attitudes toward change influence successful implementation, the survey may be used to tailor the design of implementation programs and to create a sustainable culture of high readiness for change.

This is the first study finding that a short instrument can be used to measure attitudes toward change among healthcare providers and managers in HCOs.