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1 – 10 of over 1000
Open Access
Article
Publication date: 5 March 2024

Thanduxolo Elford Fana and Jane Goudge

In this paper, the authors examine the strategies used to reduce labour costs in three public hospitals in South Africa, which were effective and why. In the democratic era, after…

Abstract

Purpose

In this paper, the authors examine the strategies used to reduce labour costs in three public hospitals in South Africa, which were effective and why. In the democratic era, after the revelations of large-scale corruption, the authors ask whether their case studies provide lessons for how public service institutions might re-make themselves, under circumstances of austerity.

Design/methodology/approach

A comparative qualitative case study approach, collecting data using a combination of interviews with managers, focus group discussions and interviews with shop stewards and staff was used.

Findings

Management in two hospitals relied on their financial power, divisions between unions and employees' loyalty. They lacked the insight to manage different actors, and their efforts to outsource services and draw on the Extended Public Works Program failed. They failed to support staff when working beyond their scope of practice, reducing employees' willingness to take on extra responsibilities. In the remaining hospital, while previous management had been removed due to protests by the unions, the new CEO provided stability and union–management relations were collaborative. Her legitimate power enabled unions and management to agree on appropriate cost cutting strategies.

Originality/value

Finding an appropriate balance between the new reality of reduced financial resources and the needs of staff and patients, requires competent unions and management, transparency and trust to develop legitimate power; managing in an authoritarian manner, without legitimate power, reduces organisational capacity. Ensuring a fair and orderly process to replace ineffective management is key, while South Africa grows cohorts of competent managers and builds managerial experience.

Details

Journal of Health Organization and Management, vol. 38 no. 9
Type: Research Article
ISSN: 1477-7266

Keywords

Open Access
Article
Publication date: 15 November 2022

Antoinette Pavithra, Russell Mannion, Neroli Sunderland and Johanna Westbrook

The study aimed to understand the significance of how employee personhood and the act of speaking up is shaped by factors such as employees' professional status, length of…

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Abstract

Purpose

The study aimed to understand the significance of how employee personhood and the act of speaking up is shaped by factors such as employees' professional status, length of employment within their hospital sites, age, gender and their ongoing exposure to unprofessional behaviours.

Design/methodology/approach

Responses to a survey by 4,851 staff across seven sites within a hospital network in Australia were analysed to interrogate whether speaking up by hospital employees is influenced by employees' symbolic capital and situated subjecthood (SS). The authors utilised a Bourdieusian lens to interrogate the relationship between the symbolic capital afforded to employees as a function of their professional, personal and psycho-social resources and their self-reported capacity to speak up.

Findings

The findings indicate that employee speaking up behaviours appear to be influenced profoundly by whether they feel empowered or disempowered by ongoing and pre-existing personal and interpersonal factors such as their functional roles, work-based peer and supervisory support and ongoing exposure to discriminatory behaviours.

Originality/value

The findings from this interdisciplinary study provide empirical insights around why culture change interventions within healthcare organisations may be successful in certain contexts for certain staff groups and fail within others.

Details

Journal of Health Organization and Management, vol. 36 no. 9
Type: Research Article
ISSN: 1477-7266

Keywords

Open Access
Article
Publication date: 31 August 2022

Helge Schnack, Sarah Anna Katharina Uthoff and Lena Ansmann

Like other European countries, Germany is facing regional physician shortages, which have several consequences on patient care. This study analyzes how hospitals perceive…

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Abstract

Purpose

Like other European countries, Germany is facing regional physician shortages, which have several consequences on patient care. This study analyzes how hospitals perceive physician shortages and which strategies they adopt to address them. As a theoretical framework, the resource dependency theory is chosen.

Design/methodology/approach

The authors conducted 20 semi-structured expert interviews with human resource officers, human resource directors, and executive directors from hospitals in the northwest of Germany. Hospitals of different ownership types, of varying sizes and from rural and urban locations were included in the sample. The interviews were analyzed by using qualitative content analysis.

Findings

The interviewees reported that human resource departments in hospitals expand their recruiting activities and no longer rely on one single recruiting instrument. In addition, they try to adapt their retaining measures to physicians' needs and offer a broad range of employment benefits (e.g. childcare) to increase attractiveness. The study also reveals that interviewees from small and rural hospitals report more difficulties with attracting new staff and therefore focus on recruiting physicians from abroad.

Practical implications

Since the staffing situation in German hospitals will not change in the short term, the study provides suggestions for hospital managers and health policy decision-makers in dealing with physician shortages.

Originality/value

This study uses the resource dependency theory to explain hospitals' strategies for dealing with healthcare staff shortages for the first time.

Details

Journal of Health Organization and Management, vol. 36 no. 9
Type: Research Article
ISSN: 1477-7266

Keywords

Open Access
Article
Publication date: 12 August 2019

Naif Alzahrani, Russell Jones, Amir Rizwan and Mohamed E. Abdel-Latif

The purpose of this paper is to perform and report a systematic review of published research on patient safety attitudes of health staff employed in hospital emergency departments…

2976

Abstract

Purpose

The purpose of this paper is to perform and report a systematic review of published research on patient safety attitudes of health staff employed in hospital emergency departments (EDs).

Design/methodology/approach

An electronic search was conducted of PsychINFO, ProQuest, MEDLINE, EMBASE, PubMed and CINAHL databases. The review included all studies that focussed on the safety attitudes of professional hospital staff employed in EDs.

Findings

Overall, the review revealed that the safety attitudes of ED health staff are generally low, especially on teamwork and management support and among nurses when compared to doctors. Conversely, two intervention studies showed the effectiveness of team building interventions on improving the safety attitudes of health staff employed in EDs.

Research limitations/implications

Six studies met the inclusion criteria, however, most of the studies demonstrated low to moderate methodological quality.

Originality/value

Teamwork, communication and management support are central to positive safety attitudes. Teamwork training can improve safety attitudes. Given that EDs are the “front-line” of hospital care and patients within EDs are especially vulnerable to medical errors, future research should focus on the safety attitudes of medical staff employed in EDs and its relationship to medical errors.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 7
Type: Research Article
ISSN: 0952-6862

Keywords

Open Access
Article
Publication date: 27 December 2021

Geraldine Robbins, Breda Sweeney and Miguel Vega

This study examines how an externally imposed management control system (MCS) – hospital accreditation – influences the salience of organisational tensions and consequently…

2143

Abstract

Purpose

This study examines how an externally imposed management control system (MCS) – hospital accreditation – influences the salience of organisational tensions and consequently attitudes of management towards the system.

Design/methodology/approach

Data are collected using a case study of a large public hospital in Spain. In-depth interviews were conducted with 27 senior and middle managers across different functions. Relying on the organisational dualities classification in the literature, tensions are unpacked and analysed.

Findings

Evidence is presented of how hospital accreditation increases the salience of organisational tensions arising from exposition of the organisational dualities of learning, performing, organising and belonging. Salient tensions were evident in the ambivalent attitudes of management towards the hospital accreditation system.

Practical implications

The role of mandatory external control systems in exposing ambivalence and tensions will be of interest to organisational managers.

Originality/value

The study extends the management control literature by identifying an active role for an external MCS (accreditation) in increasing the salience of organisational tensions and triggering ambivalence. Contrary to the prior literature, the embedding of both poles of an organisational duality into the MCS is not a necessary precondition for increased tension salience. The range of attitudes towards MCSs beyond those specified in the previous literature (positive/negative/neutral) is extended to include ambivalence.

Details

Accounting, Auditing & Accountability Journal, vol. 35 no. 9
Type: Research Article
ISSN: 0951-3574

Keywords

Open Access
Article
Publication date: 29 June 2018

Jonathan Erskine, Michele Castelli, David Hunter and Amritpal Hungin

The purpose of this paper is to determine whether some aspects of the distinctive Mayo Clinic care model could be translated into English National Health Service (NHS) hospital

2551

Abstract

Purpose

The purpose of this paper is to determine whether some aspects of the distinctive Mayo Clinic care model could be translated into English National Health Service (NHS) hospital settings, to overcome the fragmented and episodic nature of non-emergency patient care.

Design/methodology/approach

The authors used a rapid review to assess the literature on integrated clinical care in hospital settings and critical analysis of links between Mayo Clinic’s care model and the organisation’s performance and associated patient outcomes.

Findings

The literature directly concerned with Mayo Clinic’s distinctive ethos and approach to patient care is limited in scope and largely confined to “grey” sources or to authors and institutions with links to Mayo Clinic. The authors found only two peer-reviewed articles which offer critical analysis of the contribution of the Mayo model to the performance of the organisation.

Research limitations/implications

Mayo Clinic is not the only organisation to practice integrated, in-hospital clinical care; however, it is widely regarded as an exemplar.

Practical implications

There are barriers to implementing a Mayo-style model in English NHS hospitals, but they are not insurmountable and could lead to much better coordination of care for some patients.

Social implications

The study shows that there is an appetite among NHS patients and staff for better coordinated, multi-specialty care within NHS hospitals.

Originality/value

In the English NHS integrated care generally aims to improve coordination between primary, community and secondary care, but problems remain of fragmented care for non-emergency hospital patients. Use of a Mayo-type care model, within hospital settings, could offer significant benefits to this patient group, particularly for multi-morbid patients.

Details

Journal of Health Organization and Management, vol. 32 no. 4
Type: Research Article
ISSN: 1477-7266

Keywords

Open Access
Article
Publication date: 5 October 2023

Maria Vincenza Ciasullo, Alexander Douglas, Emilia Romeo and Nicola Capolupo

Lean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are…

1997

Abstract

Purpose

Lean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are not generalizable, and their effective implementation relies on contextual variables. The purpose of this study is to explore the readiness of Italian hospitals for Lean Six Sigma and Quality Performance Improvement (LSS&QPI), with a focus on gender differences.

Design/methodology/approach

A survey comprising 441 healthcare professionals from public and private hospitals was conducted. Multivariate analysis of variance was used to determine the mean scores on the LSS&QPI dimensions based on hospital type, gender and their interaction.

Findings

The results showed that public healthcare professional are more aware of quality performance improvement initiatives than private healthcare professionals. Moreover, gender differences emerged according to the type of hospital, with higher awareness for men than women in public hospitals, whereas for private hospitals the opposite was true.

Research limitations/implications

This study contributes to the Lean Six Sigma literature by focusing on the holistic assessment of LSS&QPI implementation.

Practical implications

This study informs healthcare managers about the revolution within healthcare organisations, especially public ones. Healthcare managers should spend time understanding Lean Six Sigma as a strategic orientation to promote the “lean hospital”, improving processes and fostering patient-centredness.

Originality/value

This is a preliminary study focussing on analysing inter-relationship between perceived importance of soft readiness factors such as gender dynamics as a missing jigsaw in the current literature. In addition, the research advances a holistic assessment of LSS&QPI, which sets it apart from the studies on single initiatives that have been documented to date.

Details

International Journal of Quality & Reliability Management, vol. 41 no. 3
Type: Research Article
ISSN: 0265-671X

Keywords

Open Access
Article
Publication date: 7 August 2020

Elizabeth Mansfield, Jane Sandercock, Penny Dowedoff, Sara Martel, Michelle Marcinow, Richard Shulman, Sheryl Parks, Mary-Lynn Peters, Judith Versloot, Jason Kerr and Ian Zenlea

In Canada, integrated care pilot projects are often implemented as a local reform strategy to improve the quality of patient care and system efficiencies. In the qualitative study…

2093

Abstract

Purpose

In Canada, integrated care pilot projects are often implemented as a local reform strategy to improve the quality of patient care and system efficiencies. In the qualitative study reported here, the authors explored the experiences of healthcare professionals when first implementing integrated care pilot projects, bringing together physical and mental health services, in a community hospital setting.

Design/methodology/approach

Engaging a qualitative descriptive study design, semi-structured interviews were conducted with 24 healthcare professionals who discussed their experiences with implementing three integrated care pilot projects one year following project launch. The thematic analysis captured early implementation issues and was informed by an institutional logics framework.

Findings

Three themes highlight disruptions to established logics reported by healthcare professionals during the early implementation phase: (1) integrated care practices increased workload and impacted clinical workflows; (2) integrating mental and physical health services altered patient and healthcare provider relationships; and (3) the introduction of integrated care practices disrupted healthcare team relations.

Originality/value

Study findings highlight the importance of considering existing logics in healthcare settings when planning integrated care initiatives. While integrated care pilot projects can contribute to organizational, team and individual practice changes, the priorities of healthcare stakeholders, relational work required and limited project resources can create significant implementation barriers.

Details

Journal of Integrated Care, vol. 29 no. 2
Type: Research Article
ISSN: 1476-9018

Keywords

Open Access
Article
Publication date: 22 February 2011

Zaid Ahmad Wani, Arshad Hussain, Abdul Wahid Khan, M Maqbool Dar, AkashYousf Khan, Yasir H. Rather and Sheikh Shoib

Suicide and attempted suicide is an important health issue and the number of people who die of suicide exceeds that of conflicts. Kashmir has been suffering from a low intensity…

Abstract

Suicide and attempted suicide is an important health issue and the number of people who die of suicide exceeds that of conflicts. Kashmir has been suffering from a low intensity war since last 20 years in which thousands have been killed or injured. There has been phenomenal increase in cases of psychological disorders along with suicide and and suicide attempters. Suicide in a conflict zone is viewed with indifference due to focus on the physical part of trauma. Difficulties faced by the suicidal patient and his attendants are seldom highlighted. 1408 patients who reported to emergency room for suicide attempt from 2000 to 2008 were taken for the study. All the patients underwent the hospital protocol for poisoning management. Patients were subjected to detailed psychiatric evaluation and questions were specifically asked about the difficulties encountered during management. Most of the cases were females with 92.11% belonging to the Muslim religion. 76.20% cases were from a rural background. 32.5% had been referred because of the lack of specific antidotes. Forty-three percent required arrangement of transportation by their own family members. Fifty-seven percent had been stopped for security checks along the way. Seventy-three percent felt that the attitude of the staff hostile. Twenty-three percent of patients had to share a bed. Almost all patients were questioned by security agencies within the hospital. More than 68% patient reported hostility amongst their neighbors. Suicidal poisoning is a significant health problem in Kashmir and management of these cases is fraught with difficulties across the spectrum of health care. Educating the doctors at primary care about first aid, improvement in community services followed by long term resolution of the conflict would go some way in alleviating the difficulties faced by a suicidal patient and his family in a conflict zone.

Details

Mental Illness, vol. 3 no. 1
Type: Research Article
ISSN: 2036-7465

Keywords

Open Access
Article
Publication date: 19 November 2021

Lakshya Arora and Feroz Ikbal

Mumbai needs to be transformed into a world-class city as stated in the 2005–2025 development plan of Municipal Corporation. For this initiative, hospital management information…

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Abstract

Purpose

Mumbai needs to be transformed into a world-class city as stated in the 2005–2025 development plan of Municipal Corporation. For this initiative, hospital management information system (HMIS) has to be implemented across 400+ health facilities in the city.

Design/methodology/approach

A case study methodology was adopted to study HMIS implementation. Wave 1 of Phase 1 implementation of HMIS is carried out as a pilot project at Film City’s Hospital, Mumbai, which “go-live” on 21st June 2018. The work for hardware and software implementation was awarded to HardSystems and Solutions Limited and SoftSolutions India Private Limited, respectively, through e-tender.

Findings

Provision of inadequate quantity of hardware, slowness of network or system, non-satisfactory training after observation confirmation and sign-off process, lack of data entry operators, mismatch in numbering systems in blood bank and many other challenges concerned with the specific departments had become a major impediment in the efforts to maximize number of patients registered into HMIS.

Practical implications

Even after providing many clinical and managerial benefits, being the first cloud-based centrally located HMIS in any of the hospitals in the city, it imposes a major challenge for the management in terms of resistance of employees toward technology and need for the adoption of theoretical models for implementing change for the overall organizational development.

Originality/value

To the best of the authors’ knowledge, no other teaching case study is conducted to study the HMIS implementation in large-scale public health-care services. This is a dummy case study for teaching exercises. The identity of the stakeholders, organizations and events has been masked to maintain confidentiality.

Details

Vilakshan - XIMB Journal of Management, vol. 20 no. 1
Type: Research Article
ISSN: 0973-1954

Keywords

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