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Article
Publication date: 24 February 2020

V. Vaishnavi and M. Suresh

This paper aims to identify, analyze and categorize the major readiness factors for implementing Lean Six Sigma (LSS) in health-care organizations using total interpretive…

Abstract

Purpose

This paper aims to identify, analyze and categorize the major readiness factors for implementing Lean Six Sigma (LSS) in health-care organizations using total interpretive structural modelling technique. The readiness factors are identified would help the managers to recognize the areas that lack and provide importance to the successful implementation of LSS in those areas. The paper further intends to understand the hierarchical interrelationships among the readiness factors identified using dependence and driving power.

Design/methodology/approach

In total, 16 readiness factors are identified from the literature review and expert opinions are collected from hospitals. The scheduled interview is conducted based on a questionnaire survey in hospitals in the Indian context to identify the relevance of the relations among the readiness factors. The expert opinions are used in the initial reachability matrix and interpretative interaction matrix. Matrix impact cross multiplication applied to classification (MICMAC) analysis uses dependence and driving power to understand the hierarchical relationship among the readiness factors identified.

Findings

The result indicates that customer-oriented and goal management cultures are the key readiness factors for LSS. The execution technique and training are given according to the current demand of customers and goal change of organization. The manager needs to concentrate more on readiness factors to formulate the execution process of LSS for continuous improvement of the health-care organization. The readiness level helps the manager to identify the target area for LSS execution.

Research limitations/implications

This research focuses mainly on readiness factors for the implementation of LSS in the health-care industry.

Practical implications

This study would be useful for researchers and practitioners to understand the readiness factors before starting the implementation process of LSS.

Originality/value

Many research studies are being done on the success and failure rate of implementation of factors. The present study identifies the readiness factors related to LSS, especially for the health-care industry.

Details

International Journal of Lean Six Sigma, vol. 11 no. 4
Type: Research Article
ISSN: 2040-4166

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Article
Publication date: 30 October 2009

Louise Kippist and Anneke Fitzgerald

This article aims to examine tensions between hybrid clinician managers' professional values and health care organisations' management objectives.

Abstract

Purpose

This article aims to examine tensions between hybrid clinician managers' professional values and health care organisations' management objectives.

Design/methodology/approach

Data are from interviews conducted with, and observation of, 14 managerial participants in a Cancer Therapy Unit set in a large teaching hospital in New South Wales, Australia, who participated in a Clinical Leadership Development Program.

Findings

The data indicate that there are tensions experienced by members of the health care organisation when a hybrid clinician manager appears to abandon the managerial role for the clinical role. The data also indicate that when a hybrid clinician manager takes on a managerial role other members of the health care organisation are required concomitantly to increase their clinical roles.

Research limitations/implications

Although the research was represented by a small sample and was limited to one department of a health care organisation, it is possible that other members of health care organisations experience similar situations when they work with hybrid clinician managers. Other research supports the findings. Also, this paper reports on data that emerged from a research project that was evaluating a Clinical Leadership Development Program. The research was not specifically focused on organisational professional conflict in health care organisations.

Practical implications

This paper shows that the role of the hybrid clinician manager may not bring with it the organisational effectiveness that the role was perceived to have. Hybrid clinician managers abandoning their managerial role for their clinical role may mean that some managerial work is not done. Increasing the workload of other clinical members of the health care organisation may not be optimal for the health care organisation.

Originality/value

Organisational professional conflict, as a result of hybridity and divergent managerial and clinical objectives, can cause conflict which affects other organisational members and this conflict may have implications for the efficiency of the health care organisation. The extension or duality of organisational professional conflict that causes interpersonal or group conflict in other members of the organisation, to the authors' knowledge, has not yet been researched.

Details

Journal of Health Organization and Management, vol. 23 no. 6
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 21 June 2011

Sandra G. Leggat, Timothy Bartram and Pauline Stanton

Studies of high‐performing organisations have consistently reported a positive relationship between high performance work systems (HPWS) and performance outcomes. Although…

Abstract

Purpose

Studies of high‐performing organisations have consistently reported a positive relationship between high performance work systems (HPWS) and performance outcomes. Although many of these studies have been conducted in manufacturing, similar findings of a positive correlation between aspects of HPWS and improved care delivery and patient outcomes have been reported in international health care studies. The purpose of this paper is to bring together the results from a series of studies conducted within Australian health care organisations. First, the authors seek to demonstrate the link found between high performance work systems and organisational performance, including the perceived quality of patient care. Second, the paper aims to show that the hospitals studied do not have the necessary aspects of HPWS in place and that there has been little consideration of HPWS in health system reform.

Design/methodology/approach

The paper draws on a series of correlation studies using survey data from hospitals in Australia, supplemented by qualitative data collection and analysis. To demonstrate the link between HPWS and perceived quality of care delivery the authors conducted regression analysis with tests of mediation and moderation to analyse survey responses of 201 nurses in a large regional Australian health service and explored HRM and HPWS in detail in three case study organisations. To achieve the second aim, the authors surveyed human resource and other senior managers in all Victorian health sector organisations and reviewed policy documents related to health system reform planned for Australia.

Findings

The findings suggest that there is a relationship between HPWS and the perceived quality of care that is mediated by human resource management (HRM) outcomes, such as psychological empowerment. It is also found that health care organisations in Australia generally do not have the necessary aspects of HPWS in place, creating a policy and practice gap. Although the chief executive officers of health service organisations reported high levels of strategic HRM, the human resource and other managers reported a distinct lack of HPWS from their perspectives. The authors discuss why health care organisations may have difficulty in achieving HPWS.

Originality/value

Leaders in health care organisations should focus on ensuring human resource management systems, structures and processes that support HPWS. Policy makers need to consider HPWS as a necessary component of health system reform. There is a strong need to reorient organisational human resource management policies and procedures in public health care organisations towards high performing work systems.

Details

Journal of Health Organization and Management, vol. 25 no. 3
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 March 2009

Barbara Ann Allen, Elizabeth Wade and Helen Dickinson

Current English health policy is focused on strengthening the ‘demand-side’ of the health care system. Recent reforms are designed to significantly enhance the capability…

Abstract

Current English health policy is focused on strengthening the ‘demand-side’ of the health care system. Recent reforms are designed to significantly enhance the capability and status of the organisations responsible for commissioning health care services and, in so doing, to address some of the perceived problems of a historically provider/supplierled health system. In this context, commissioning organisations are being encouraged to draw on concepts and processes derived from commercial procurement and supply chain management (SCM) as they develop their expertise. While the application of such principles in the health sector is not new, existing work in the UK has not often considered the role of health care purchasers in the management of health service supply-chains. This paper describes the status of commissioning in the NHS, briefly reviews the procurement and SCM literature and begins to explore the links between them. It lays the foundations for further work which will test the extent to which lessons can be extracted in principle from the procurement literature and applied in practice by health care commissioners.

Details

Journal of Public Procurement, vol. 9 no. 1
Type: Research Article
ISSN: 1535-0118

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Article
Publication date: 23 May 2008

Sadhvi Dar

The aim of the paper is to connect the field of health management to other related academic discourses (critical management studies and critical development studies) that…

Abstract

Purpose

The aim of the paper is to connect the field of health management to other related academic discourses (critical management studies and critical development studies) that can contribute to a more interdisciplinary approach to understanding health organizations and management.

Design/methodology/approach

The paper's design is theoretical critique that blends post‐structural, critical management and critical development approaches into a focused discussion of modernity and its relevance to contemporary health management issues.

Findings

Modernity proliferates through a variety of rhetorical tropes that go unnoticed or remain invisible. Through a brief analysis of historical definitions of management and development, the findings suggest that health management could also be critiqued as a cultural and social construction, enriching anthropological studies as well as informing practical critiques of health projects in the development sector.

Research limitations/implications

The conceptualisation of healthmanagement as a cultural construct of modernity opens up the prospect for some rich empirical studies into what management practices support the scientific‐rational claims on which it rests.

Practical implications

The critique informs a re‐appraisal of health management practices that are often taken for granted and ritualistic parts of organizational life. Such a re‐evaluation could lead to the implementation of more nuanced and appropriate health practices.

Originality/value

Connecting management and development discourses in this way has not been done before and its relevance to health management remains under‐researched. This paper highlights the way these discourses can enrich the study of health organizations and create a truly interdisciplinary understanding of health.

Details

Journal of Health Organization and Management, vol. 22 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 9 February 2021

Marta Marsilio and Martina Pisarra

The aims of the implementation of lean management in health care are to improve quality of care, to eliminate waste and to increase efficiency. The purpose of this study…

Abstract

Purpose

The aims of the implementation of lean management in health care are to improve quality of care, to eliminate waste and to increase efficiency. The purpose of this study is to contribute to the advancement of knowledge by investigating which main socio-technical factors are considered to be effective for the implementation and management of lean initiatives.

Design/methodology/approach

A systematic review of literature reviews on lean management in health care was conducted. The components of the socio-technical system are identified by moving from the socio-technical drivers that support organization-wide quality improvement practices and the lean implementation process in health care. The impacts of lean management are classified using the internal processes, patient, learning and financial dimensions.

Findings

The 28 reviews retrieved confirm the current and increasing interest in lean management. While more than 60% of them call for a system-wide approach, system-wide implementations have rarely been observed, and, instead, adoption in isolated units or departments, or the use of single techniques and tools, prevails. The most commonly investigated socio-technical components are organizational structure, techniques and tools and organizational culture and strategic management. Significant impacts are reported for all the four dimensions. Nonetheless, the review reveals that there is still a lack of evidence on the sustainability of lean results and a need for a standardized impact measurement system.

Originality/value

This work stands out as the first review of reviews of how the socio-technical components of the lean management approach obtain positive impacts within the patient, internal processes, learning and financial dimensions.

Details

Journal of Health Organization and Management, vol. 35 no. 4
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 3 August 2012

Harri Laihonen

This paper aims to hypothesize that modern health systems are transforming towards what has been called a health ecosystem in complexity‐based health care literature. It…

Abstract

Purpose

This paper aims to hypothesize that modern health systems are transforming towards what has been called a health ecosystem in complexity‐based health care literature. It has been argued that complexity arises from the interconnectedness, which in this paper is equated with knowledge flows between actors. The paper seeks to discuss the possible implications of a health ecosystem approach to health system management.

Design/methodology/approach

The paper is conceptual in nature but the transition towards a health ecosystem is illustrated with an example of a regional health care system in Finland. The case description and related analysis presented are based on qualitative data gathered by interviewing leading office‐holders, by process modeling and by observing management group meetings.

Findings

Conceptually, a health ecosystem seems to have potential for the system‐level analysis of the health care system. The discussion concludes that management of knowledge flows should be a strategic management function for individual health organizations as well as for the wider health system.

Research limitations/implications

This study focuses on a Finnish health care system. The operations and structures of health care services and systems vary in different areas and countries.

Practical implications

The practical illustration of the health ecosystem provides a reminder that health care systems are dynamic and largely based on interaction between different actors. The approach provides new strategic insights for the development of health care systems by concentrating on interrelationships and knowledge flows.

Originality/value

The literature has suggested that the ecosystem metaphor offers useful insights for the development of health care systems. Nevertheless, this approach has not been thoroughly studied so far. This paper makes a contribution by presenting a practical illustration of the framework and in light of this discusses the possible implications for health care management.

Details

Journal of Health Organization and Management, vol. 26 no. 4
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 March 2016

Daniel M. Walker, Timothy R. Huerta and Mark L. Diana

Policy makers and practitioners argue that electronic exchange of clinical data across the healthcare system is a key component of improving health service delivery in the…

Abstract

Policy makers and practitioners argue that electronic exchange of clinical data across the healthcare system is a key component of improving health service delivery in the United States. Provider administrators, however, question the strategic value of participation in health information exchanges (HIEs) and remain reluctant to participate. Existing research fails to adequately illuminate the potential value derived from HIEs by participating organizations. This paper addresses this gap by developing a conceptual model informed by the complementary theoretical perspectives of the relational view and systems theory to specify both a provider organizationʼs internal conditions and the HIE structure necessary for both financial accrual and quality improvement. This two-sided model can assist policymakers as they attempt to encourage HIE development, as well as provider and HIE leadership that seek to benefit from HIEs. The propositions developed from this model can also help guide researchers as they evaluate the impact of HIEs.

Details

International Journal of Organization Theory & Behavior, vol. 19 no. 2
Type: Research Article
ISSN: 1093-4537

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Article
Publication date: 6 June 2017

Pernille Eskerod, Just Bendix Justesen and Gisela Sjøgaard

Project success requires effective and efficient cooperation between the project organization and the permanent organization in which the project takes place. The purpose…

Abstract

Purpose

Project success requires effective and efficient cooperation between the project organization and the permanent organization in which the project takes place. The purpose of this paper is to discuss potentials and pitfalls from enriching project organizations by appointing peers as formal change agents.

Design/methodology/approach

The paper is based on a literature review and a multiple-case study in which six organizations participated in an action-oriented research project. The aim for the organizations was to obtain a better health status among the employees by accomplishing an internal change project that enhanced physical activity at the workplace and in leisure time. Change agents in the form of peer health ambassadors were selected by middle management and hereafter trained by the project representatives.

Findings

The findings suggest that the selection of change agents and middle and top management support are major determinants of success within change projects. To select change agents that the employees respect and can identify with, combined with top management prioritization, is important in order for the project organization to benefit from the additional role.

Practical implications

Selecting the “wrong” change agents can jeopardize a change project, even when the project is supported by top management and the target group members at the starting point are highly motivated to change.

Originality/value

The research contributes to the understanding of project organizing by building theory on how formal peer change agents can enhance project success in change projects.

Details

International Journal of Managing Projects in Business, vol. 10 no. 3
Type: Research Article
ISSN: 1753-8378

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Article
Publication date: 20 March 2009

Kari Nyland, Inger Johanne Pettersen and Katarina Östergren

The purpose of this paper is to discuss the dilemma that exists between the aims of public sector reforms and the ways organisations adjust to the management control reforms.

Abstract

Purpose

The purpose of this paper is to discuss the dilemma that exists between the aims of public sector reforms and the ways organisations adjust to the management control reforms.

Design/methodology/approach

To study the research purpose, empirical data were collected from Norwegian Regional Hospital Enterprises. The aim was to describe how these institutions have chosen to implement formal and informal mechanisms of control for coordination and management of hospitals.

Findings

The results indicated a comprehensive map of the different formal and informal adjustments to radical institutional reform changes. The reform strategies were met with a mixture of intended adjustments, partly realised ambitions and ignorance in the organisations, and the change towards accrual accounting system was found to have reversed effects compared with the original ambitions.

Research limitations/implications

This study was based on a small sample of organisations and interviews. The dimensions were somewhat crude, and the findings can be generalised reliably only to the population studied here. More research is needed for further explorations of these findings. The study reveals as similar with prior macro level institutional research a complex view on the implications of government initiatives as only one of many potentially powerful actors in such regulatory processes.

Practical implications

This work adds to leaders' understanding of how intended governmental strategies follow diverse paths of implementation.

Originality/value

These results provide useful support of prior findings as to the deeper understanding of why organisations that are exposed to the same reform initiatives, turn out to behave differently.

Details

Journal of Accounting & Organizational Change, vol. 5 no. 1
Type: Research Article
ISSN: 1832-5912

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