Search results

Designing and developing safe systems has been a persistent challenge in health care, and in surgical settings in particular. In efforts to promote safety, safety culture, i.e., shared values regarding safety management, is considered a key driver of high-quality, safe healthcare delivery. However, changing organizational culture so that it emphasizes and promotes safety is often an elusive goal. The Safe Surgery Checklist is an innovative tool for improving safety culture and surgical care safety, but evidence about Safe Surgery Checklist effectiveness is mixed. We examined the relationship between changes in management practices and changes in perceived safety culture during implementation of safe surgery checklists. Using a pre-posttest design and survey methods, we evaluated Safe Surgery Checklist implementation in a national sample of 42 general acute care hospitals in a leading hospital network. We measured perceived management practices among managers (n = 99) using the World Management Survey. We measured perceived preoperative safety and safety culture among clinical operating room personnel (N = 2,380 (2016); N = 1,433 (2017)) using the Safe Surgical Practice Survey. We collected data in two consecutive years. Multivariable linear regression analysis demonstrated a significant relationship between changes in management practices and overall safety culture and perceived teamwork following Safe Surgery Checklist implementation.

Purpose – The paper aims at understanding the potential role of management accounting during a public hospital organisational change within a developing country in transition, Egypt. Design/methodology/approach – The paper is based on in‐depth interviews, an analysis of documents, and direct observations. It uses a framework informed by institutional theory together with Giddens' (1990) notion of ‘elements of system contradiction’ to analyse the empirical findings. The paper draws on both DiMaggio and Powell's (1983) notion of coercive, mimic and normative isomorphic mechanisms to link a changing hospital to the changes in the wider social and institutional context wherein public hospitals operate, while exploring the interlinkages between these changes and the hospital's processes of accounting change and institutionalisation (Burns and Scapens, 2000); and Giddens' (1990) notion of ‘elements of system contradiction’ in order to evaluate the role of management accounting. Findings – The paper concludes that both the institutional change and reform around management accounting together with the changes in accounting systems are entrepreneurial processes in order to trigger a public hospital to change. Research limitations/implications – Although the empirical findings suggest resistance to management accounting change within the case study, a full investigation and explanation of such a resistance is an area of future research. Originality/value – In contrast to the technical role of accounting, the paper shows how management accounting is acted upon to disrupt the hospital's micro institutions and routines, challenge physicians' professional and bureaucratic power and therefore engendering the public hospital to change.

Health systems function in an ecosystem that is turbulent and competitive because of demographic, economic, political, technological and lifestyle changes and sociopolitical influences, requiring hospitals to adopt comprehensive business strategies. Failure to do so may result in duplication, waste and deficits. This original article uses the prism of agency theory to examine differences in approach at two levels of hospital management and the consequent problems in the incorporation of necessary changes. Agency theory posits an inherent conflict of interest in organizations, including health organizations: the managers (agents) always aim to maximize their profit or personal interest instead of that of the owner or organization (principal), potentially causing difficulty in managing the organization. The aim is to generate recommendations for policymakers.

The study is based on 30 semi-structured, in-depth interviews with key figures in the health system and on two levels of hospital management: senior managers and heads of selected departments. The analysis used a categorical qualitative methodology.

The main findings are five key themes: views of business behavior, asymmetry of interests, asymmetry of information, transparency and cooperation between various levels of management and ambivalence toward business in hospitals. The two levels of management are clearly divided in terms of interests, information and activity, leading to difficulty in cooperation, efficiency and achievement of organizational goals.

Using agency theory, this study provides a systemic and organizational view of hospitals' management and environmental adaptation. Understanding the processes and increasing cooperation at various managerial levels can help make the system more efficient and ensure its survival in a dynamic market.

Hospitals have adopted new policies, methods and technologies to change their processes, improve services, and support other organizational changes necessary for better performance. The literature regarding the four major areas of strategic leadership, competitive intelligence, management of technology, and specific characteristics of the organization's change process propose their importance in successfully implementing organization innovation. While these factors may indeed be important to enhance hospital performance, the existing literature contains limited empirical evidence supporting their relationship to successfully implementing innovation in hospitals. This study aims to empirically test these relationships proposed in the literature by researchers in separate knowledge areas.

A survey of 223 hospitals has been used to test an integrated model of these relationships. The response rate and the representativeness of the sample in terms of hospital size and geographical location were found satisfactory. The quality assurance/compliance managers for each hospital were the target respondents to questions, which require a corporate perspective while reducing the chance of bias for questions regarding top management leadership abilities.

The results provide clear evidence about the importance of strategic leadership, competitive intelligence, management of technology, and specific characteristics of the hospital's change process to the hospitals success in implementing innovation.

Given the importance of hospitals to change their processes, improve services, and support other organizational changes necessary for better performance, a great benefit is that the main factors for successful innovation have been brought together from scattered literature and tested among hospitals. Further, the items used for measuring the main constructs provide further insights into how hospital administrators should go about developing these areas within their organizations.

This study is a first attempt at empirically testing the importance of strategic leadership, competitive intelligence, management of technology, and specific characteristics of the hospital's change process for the success of innovation efforts.

The purpose of this paper is to give an overview of the use of strategic management accounting (SMA) techniques in hospitals under competitive market environments. The paper analyses the dissemination of SMA techniques in consideration of structural characteristics and perform a cluster analysis in order to investigate performance differences between various groups of hospitals.

The paper collected empirical data in a nationwide survey of German general hospitals. Analyses are based on questionnaires from 116 hospitals.

Results show that strategies are applied and regularly adjusted in most hospitals. However, SMA techniques are not in widespread use. The paper explores performance differences between the clusters comprised. The paper finds evidence that the use of SMA techniques varies among hospitals based on their structural characteristics.

The authors' exploratory analysis suggest that further study exploring both the determinants and effects of the use of SMA techniques in hospitals represents an interesting path for future research. This study is subject to limitations, particularly concerning the limited number of contextual variables and performance measures taken into consideration.

Considering the limited use of SMA techniques, this paper conclude that hospitals should consider the adoption of additional practices. The paper identifies particular potential for development in the areas of risk management and capital budgeting methods.

This study provides the first comprehensive overview of SMA techniques used in hospitals and advances the literature, which primarily includes case study evidence on single SMA techniques or analyses of the impact of strategies and health reforms on “conventional” management accounting practices. This paper, then, constitutes a useful starting point for further research on SMA practices in hospitals.

The hospital sector has expanded in Norway with reforms and a strong demand for better management. The purpose of this paper is to examine: first, how this has affected physicians and nurses in management; second, how management roles in hospitals are changing; and third, how these two professions are tackling their new roles.

The paper presents a review of the secondary literature and a case study undertaken in the spring, 2012.

In Norway, two reforms have been introduced aimed at creating stronger management positions with less professional influence. The leader has full responsibility for a particular unit, which means that the jurisdiction of managers has expanded and that management has become more time consuming. Physicians – traditionally those in charge of hospitals – are facing competition from other professions, especially nursing, which has gained representation in top management positions, particularly at middle management level.

The originality of this paper is the comparison of the evolvement of management among physicians and nurses since the reforms. While the medical profession was critical of management to begin with, i.e. viewing management positions as a trap, it is gradually adapting to the new ideas. Physicians are facing competition from nurses, who readily adjust to the new conditions, and perceive management as a new career track.

This study aims to provide insights into management accounting changes (MACs) and potential roles of big data analytics (BDA) in accelerating the MACs in an Indonesian public hospital as a response towards the adoption of the diagnosis-related groups (DRG)-based payment system.

A mixed-method approach was used to collect and analyse data from a referral public hospital in Indonesia. First, a BDA simulation was carried out to reveal its usefulness in predicting and evaluating patient costs, and finally improving the cost recovery rate (CRR) of each DRG case. This part formulated and tested the mathematical models that predict patient cost, the CRR and determinants (length of stay/LOS, severity/SEV, patient age/AGE and gender/SEX). For this purpose, data of the top ten inpatient cases of 2018 were collected and analysed. Second, semi-structured interviews with senior staff and doctors were carried out to understand cost control strategies implemented in the hospital and the management and doctors’ perceptions regarding the application of tested mathematical models for cost control. Old institutional economics and new institutional sociology were used to gain insight about how and why management accounting practices changed in the hospital.

The findings show that the absence of detailed per-case/patient cost information has not only hindered further evolvement of MACs but also stimulate tensions between managerial and medical worlds in the studied Indonesian public hospital. The simulation of BDA in this study was not only discovering the determinants of case cost recovery but also enabling the prediction of CRR of patients immediately after admission. The application of BDA and casemix accounting in the hospital will potentially become catalysts of discussion and mutual learning between managerial and medical staff in controlling patient costs.

This paper provides a more comprehensive picture of the potential roles of BDA in cost control practices. The study assesses the feasibility of BDA application in the hospital and evaluates the potential roles and acceptance of BDA application by both management and doctors.

This paper aims to fill gaps in one’s knowledge of the impact of organizational change on two outcomes relevant to hospital service quality (performance obstacles and physician job satisfaction) and in one’s knowledge of the role of middle manager change-oriented leadership in relation to the same outcomes. Further, the authors aim to identify how physician participation in decision-making is impacted by organizational change and change-oriented leadership, as well as how it mediates the relationships between these two variables, performance obstacles and job satisfaction.

The study adopted a cross-sectional survey design including data from Norwegian hospital physicians (N = 556). A hypothetical model was developed based on existing theory, confirmatory factor analysis was carried out in order to ensure the validity of measurement concepts, and the structural model was estimated using structural equation modelling.

The organizational changes in question were positively related to performance obstacles both directly and indirectly through participation in decision-making. Organizational change was also negatively related to job satisfaction, both directly and indirectly. Change-oriented leadership was negatively related to performance obstacles, but only indirectly through participation in decision-making, whereas it was positively related to job satisfaction both directly and indirectly.

The authors developed a theoretical model based on existing theory, but to their knowledge no other studies have tested these exact relationships within one model. These findings offer insights relevant to current and ongoing developments in the healthcare field and to the question of how hospitals may deal with continuous changes in ways that could contribute positively towards outcomes relevant to service quality.

Increasing budget constraints, the introduction of new clinical protocols and technologies, and changing community needs and expectations are changing Hong Kong’s health care system. These unprecedented changes are creating powerful and urgent needs for many of Hong Kong’s hospitals to explore alternative approaches to designing and managing their hospital environments. The paper starts by reviewing these changing conditions and then suggests that hospital facilities management professionals must think and act anew. The paper concludes that hospital administrators at the Pamela Youde Nethersole Eastern Hospital in Hong Kong are responding to these corporate challenges by developing a facilities management support response.

Purpose – In the last decades, Italian healthcare organisations have been subject to important normative changes, aimed at increasing their efficiency. As a response, performance measurement and evaluation (PME) systems have been introduced. The present study attempts to examine PME system changes as institutional processes. In studying such processes the healthcare literature acknowledges the presence of two logics: managerial and professional, as peculiar to healthcare settings, whose convergence or divergence can explain the success of any institutional process.

Design/methodology/approach – We adopt Busco et al.'s (2007) framework as an approach for unbundling PME system change into four relevant coordinates, namely: (1) the object (PME system), (2) the subjects (institutional forces), (3) the place and time of change (the managerial and professional logics) and (4) the how and why change happens (change as an institutional process). We conducted a longitudinal case study at a large teaching hospital in Southern Italy, directed to interpret PME system changes during the period from 1998 until 2009.

Findings – Our observation distinguishes episodes of successful institutional processes, where the introduced innovations are transformed into objectivated practices, from episodes of missed institutionalisation, where new procedures were rapidly abandoned.

Research and social implications – This theoretical framework can be useful for interpreting the PME system changes in different institutional contexts.

Originality – The Busco et al.'s framework allows us to understand PME system changes by integrating the perspectives from Neo-Institutional Sociology, representing healthcare organisational responses to external institutional pressures, and Old-Institutional Economics, conceptualising PME system changes as an institutionalisation process.