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This study aims to examine the effect of human resource management (HRM) in mitigating negative effects of Lean management and Six Sigma (LM&SS) on employee well-being in health care. The authors subdivide well-being into three components: happiness, trust and health.

This is a cross-sectional, multisite survey study in internal service units of hospitals. Data analyzed using multivariate regression come from a sample of 1,886 survey respondents (42 units, N = 218 supervisors, N = 1,668 employees) in eight Dutch academic hospitals that have implemented LM&SS.

The present study findings show no or weak effects of LM&SS on the happiness and health component of employee well-being. In addition, the authors found a significant but weak direct positive effect (ß = 0.07) of the LM&SS bundle on the trusting relationships component of well-being. Therefore, moderating effects of HRM practices on the relationship between LM&SS and employee well-being seem less relevant because an existing relationship between LM&SS and employee well-being is a prerequisite for moderation (Hayes, 2009). There were unexpected side effects. Inspired by research that discusses direct effects of HRM on employee well-being, the authors tested this relationship and found that HRM has a direct positive effect on trust and happiness of employees in health care. For the health component of well-being, the present results show a weak negative effect of HRM.

This study results in a cautiously optimistic view about LM&SS in health care, provided that it is applied in a targeted manner (to improve the performance of their processes) and that HRM is strategically aligned with the goals of LM&SS to improve employees’ happiness and trusting relationships.

Unique features of the study are the focus on the consequences for employees’ well-being related to LM&SS in health care, the role of HRM in regard to this relationship and the participation of all eight Dutch academic hospitals in this research.

Many countries have a renewed focus on health inequalities since COVID-19. In England, integrated care systems (ICSs), formed in 2022 to promote integration, are required to reduce health inequalities. Integration is supported by population health management (PHM) which links data across health and care organisations to inform service delivery. It is not well-understood how PHM can help ICSs reduce health inequalities. This paper describes development of a programme theory to advance this understanding.

This study was conducted as a mixed-methods process evaluation in a local ICS using PHM. The study used Framework to analyse interviews with health and care professionals about a PHM tool, the COVID-19 vaccination uptake Dashboard. Quantitative data on staff Dashboard usage were analysed descriptively. To develop a wider programme theory, local findings were discussed with national PHM stakeholders.

ICS staff used PHM in heterogeneous ways to influence programme delivery and reduce inequalities in vaccine uptake. PHM data was most influential where it highlighted action was needed for “targetable” populations. PHM is more likely to influence decisions on reducing inequalities where data are trusted and valued, data platforms are underpinned by positive inter-organisational relationships and where the health inequality is a shared priority.

The COVID-19 pandemic accelerated a shift toward use of digital health platforms and integrated working across ICSs. This paper used an evaluation of integrated data to reduce inequalities in COVID-19 vaccine delivery to propose a novel programme theory for how integrated data can support ICS staff to tackle health inequalities.

During the 1990s, Italian healthcare organisations (HOs) underwent a process of corporatisation, and the most innovative HOs introduced the balanced scorecard (BSC) to address the need for broader accountability. Currently, there is a limited understanding of the dynamics and outcomes of such a process. Therefore, this study aims to explore whether the BSC is still considered an effective performance management tool and analyse the factors driving and hindering its evolution and endurance in public and non-profit HOs.

We conducted a retrospective longitudinal analysis of two pioneering cases in the adoption of the BSC: one in a public hospital and the other in a non-profit hospital. Data collection relied on accessing institutional documents and reports from the early 2000s to the present, as well as conducting semi-structured interviews with the internal sponsors of the BSC.

We found evidence of three main categories of factors that trigger or hinder the adoption and development of the BSC: (1) the role of the internal sponsor and professionals’ commitment; (2) information technology and the controller’s technological skills; and (3) the relationship between the management and professionalism logics during the implementation process. At the same time, there is no evidence to suggest that specific technical features of the BSC influence its endurance.

The paper contributes to the debate on the key factors for implementing and sustaining multidimensional control systems in professional organisations. It emphasises the importance of knowledge-based assets and distinctive internal capabilities for the success of the business. The implications of the BSC legacy are discussed, along with future developments of multidimensional control tools aimed at supporting strategy execution.

This study aims to explore the management learning during a long-term crisis like a pandemic. The paper addresses both what health-care managers have learnt during the COVID-19 pandemic and how the management learning is characterized.

The paper is based on a qualitative case study carried out during the COVID-19 pandemic at two different public hospitals in Sweden. The study, conducted with semi-structured interviews, applies a combination of within-case analysis and cross-case comparison. The data were analyzed using thematic deductive analysis with the themes, i.e. sensemaking, decision-making and meaning-making.

The COVID-19 pandemic was characterized by uncertainty and a need for continuous learning among the managers at the case hospitals. The learning process that arose was circular in nature, wherein trust played a crucial role in facilitating the flow of information and enabling the managers to get a good sense of the situation. This, in turn, allowed the managers to make decisions meaningful for the organization, which improved the trust for the managers. This circular process was iterated with higher frequency than usual and was a prerequisite for the managers’ learning. The practical implications are that a combined management with hierarchical and distributed management that uses the normal decision routes seems to be the most successful management method in a prolonged crisis as a pandemic.

The gained knowledge can benefit hospital organizations, be used in crisis education and to develop regional contingency plans for pandemics.

This study has explored learning during the COVID-19 pandemic and found a circular process, “the management learning wheel,” which supports management learning in prolonged crises.

Integration, that is, the coordination and alignment of tasks, is widely promoted as a means to improve hospital performance. A previous study examined integration and differentiation, that is, the extent to which tasks are segmented into subsystems, in a hospital's social network. The current study carries this research further, aiming to explain integration and differentiation by studying the rules and coordination mechanisms that agents in a hospital network use.

The current case study deepens the analysis of the social network in a hospital. All planning tasks and tasks for surgery performance were studied, using a naturalistic inquiry approach and a mixed method.

Of the 314 rules found, 85% predominantly exist in people's minds, 31% are in documents and 7% are in the information system. In the early planning stages for a surgery procedure, mutual adjustment based on hospital-wide rules is dominant. Closer to the day of surgery, local rules are used and open loops are closed through mutual adjustment, thus achieving integration. On the day of surgery, there is mainly standardization of work and output, based on hospital-wide rules. The authors propose topics for future research, focusing on increasing the hospital's robustness and stability.

This exploratory case study provides an overview of the rules and coordination mechanisms that are used for organizing hospital-wide logistics for surgery patients. The findings are important for future research on how integration and differentiation are effectively achieved in hospitals.

The purpose of this paper is to empirically explore and conceptualize how healthcare professionals and managers give shape to the increasing call for compassionate care as an alternative for system-based quality management systems. The research demonstrates how quality rebels craft deviant practices of good care and how they account for them.

Ethnographic research was conducted in three Dutch hospitals, studying clinical groups that were identified as deviant: a nursing ward for infectious diseases, a mother–child department and a dialysis department. The research includes over 120 h of observation, 41 semi-structured interviews and 2 focus groups.

The research shows that rebels’ quality practices are an emerging set of collaborative activities to improving healthcare and meeting (individual) patient needs. They conduct “contexting work” to achieve their quality aims by expanding their normative work to outside domains. As rebels deviate from hospital policies, they are sometimes forced to act “under the radar” causing the risk of groupthink and may undermine the aim of public accounting.

The research shows that in order to come to more compassionate forms of care, organizations should allow for more heterogeneity accompanied with ongoing dialogue(s) on what good care yields as this may differ between specific fields or locations.

This is the first study introducing quality rebels as a concept to understanding social deviance in the everyday practices of doing compassionate and good care.

The purpose of this study is to present a quality improvement approach titled “Picture-Understanding-Action” used in Ireland to enhance the role of healthcare boards in the oversight of healthcare quality and its improvement.

The novel and practical “Picture-Understanding-Action” approach was implemented using the Model for Improvement to iteratively introduce changes across three quality improvement projects. This approach outlines the concepts and activities used at each step to support planning and implementation of processes that allow a board to effectively achieve its role in overseeing and improving quality. This approach matured over three quality improvement projects.

The “Picture” included quantitative and qualitative aspects. The quantitative “Picture” consisted of a quality dashboard/profile of board selected outcome indicators representative of the health system using statistical process control (SPC) charts to focus discussion on real signals of change. The qualitative picture was based on the experience of people who use and work in health services which “people-ised” the numbers. Probing this “Picture” with collective grounding, curiosity and expert training/facilitation developed a shared “Understanding”. This led to “Action(s)” from board members to improve the “Picture” and “Understanding” (feedback action), to ask better questions and make better decisions and recommendations to the executive (feed-forward action). The Model for Improvement, Plan-Do-Study-Act cycles and a co-design approach in design and implementation were key to success.

To the authors’ knowledge, this is the first time a board has undertaken a quality improvement (QI) project to enhance its own processes. It addresses a gap in research by outlining actions that boards can take to improve their oversight of quality of care.

The purpose of this paper is to explore the challenges that are experienced by staff responsible for commissioning liaison psychiatry services and to establish if these are shared by other health professionals.

Using a mixed-methods design, the findings from a mental health commissioner workshop (n = 12) were used to construct a survey that was distributed to health care professionals using an opportunistic framework (n = 98).

Four key themes emerged from the workshop, which was tested using the survey. The importance of secure funding; a better understanding of health care systems and pathways; partnership working and co-production and; access to mental health clinical information in general hospitals. There was broad convergence between commissioners, mental health clinicians and managers, except in relation to gathering and sharing of data. This suggests that poor communication between professionals is of concern.

There were a small number of survey respondents (n = 98). The sampling used an opportunistic framework that targeted commissioner and clinician forums. Using an opportunistic framework, the sample may not be representative. Additionally, multiple pairwise comparisons were conducted during the analysis of the survey responses, increasing the risk that significant results were found by chance.

A number of steps were identified that could be applied in practice. These mainly related to the importance of collecting and communicating data and co-production with commissioners in the design, development and monitoring of liaison psychiatry services.

This is the first study that has specifically considered the challenges associated with the commissioning of liaison psychiatry services.

Lean implementations in hospitals tend to be lengthy or lack the desired results. In addressing the question, how can lean be implemented effectively in a hospital-wide setting, this paper aims to examine two opposing approaches.

The authors studied two Dutch university hospitals which engaged in different lean implementation approaches during the same four-year period: top-down vs bottom-up. Inductive qualitative analyses were made of 49 interviews; numerous documents; field notes; 13 frontline meeting observations; and objective hospital performance data. Longitudinally, the authors depict how the sequential events unfolded in both hospitals.

During the six implementation stages, the roles played by top, middle and frontline managers stood out. While the top managers of one hospital initiated the organization-wide implementation and then delegated it to others, the top managers of the other similar hospital merely tolerated the bottom-up lean activities. Eventually, only the hospital with the top-down approach achieved high organization-wide performance gains, but only in its fourth year after the top managers embraced lean in their own daily work practices and had started to co-create lean themselves. Then, the earlier developed lean infrastructure at the middle- and frontline ranks led to the desired hospital-wide lean implementation results.

Change-management insights, including basic tenets of social learning and goal-setting theory, are shown to advance the knowledge of effective lean implementation in hospitals. The authors found lean implementation “best-oiled” through role-modeling by top managers who use a phase-based process and engage in close cross-hierarchical or co-creative collaboration with middle and frontline managerial members.

This article aims to provide the current state of the art of the literature on the contribution of information and communication technologies (ICTs) on the measurement and management of performance in the healthcare sector. In particular, the work aims to identify current and emerging ICTs and how these relate to the performance measurement and management (PMM) cycle of healthcare organizations.

To address the research objective, we adopted a systematic literature review. In particular, we used the preferred reporting items for systematic reviews and meta-analysis (PRISMA) methodology to select articles related to the investigated topic. Based on an initial screening of 560 items retrieved from Scopus and ISI Web of Knowledge, we identified and analyzed 58 articles dealing with ICTs and PMM in the healthcare sector. The last update of the dataset refers to February 2024.

Although we attempted to address a relevant topic for both research and practice, we noticed that a relatively small sample of articles directly addressed it. Through this literature review, in addition to providing descriptive statistics of research on ICTs and PMM in healthcare, we identified six theoretical clusters of scientific streams focusing on the topic and eleven categories of ICTs effectively tackled by the literature. We then provided a holistic framework to link technologies to the different PMM phases and functions.

Nowadays, the availability of ICTs to support healthcare organizations’ processes and services is extensive. In this context, managers at various organizational levels need to understand and evaluate how each ICT can support different activities to benefit most from their adoption. The findings of this study can offer valuable insights to top and line managers of healthcare organizations for planning their investments in both existing and emerging ICTs to support the various stages of development and functions of PMM.

Most of the current literature focusing on ICTs in the healthcare sector refers to the contribution that technology provides to clinical processes and services, devoting limited attention to the impact of ICTs on administrative processes, such as PMM. To the best of the authors’ knowledge, this represents the first literature review on the contribution of ICTs to PMM in the healthcare sector. The review, differently from other research focused on specific ICTs and/or specific PMM functions, provides a holistic perspective to understand how these technologies may support healthcare organizations and systems in measuring and managing their performance.