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Article
Publication date: 1 February 1997

Martin Kitchener and Richard Whipp

Examines the process of change in hospitals that has emerged following the introduction of the health quasi‐market in 1991. Blends empirical evidence with Greenwood and…

Abstract

Examines the process of change in hospitals that has emerged following the introduction of the health quasi‐market in 1991. Blends empirical evidence with Greenwood and Hinings’ archetype and tracks of change concepts to analyse the process which is labelled quasi‐market transformation (QMT). Argues that, before 1991, hospitals tended to operate within structures and systems underpinned by an interpretive scheme. Represents these similarities of configuration as the directly‐managed (DM) hospital archetype. When change initiatives challenged this configuration, the outcomes were negotiated and resulted in “adjustmental” change. In contrast, shows the introduction of the quasi‐market to have involved the first transformation of the DM archetype’s interpretive scheme, systems and structures. Analyses four years of transition to reveal that QMT has been interpreted differently within hospitals. However, presents data to suggest that many hospitals now display significant similarities in terms of configuration. Represents these similarities within the emerging Trust hospital archetype.

Details

International Journal of Public Sector Management, vol. 10 no. 1/2
Type: Research Article
ISSN: 0951-3558

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Article
Publication date: 7 October 2014

Danielle A. Tucker, Jane Hendy and James Barlow

As management innovations become more complex, infrastructure needs to change in order to accommodate new work practices. Different challenges are associated with work…

Abstract

Purpose

As management innovations become more complex, infrastructure needs to change in order to accommodate new work practices. Different challenges are associated with work practice redesign and infrastructure change however; combining these presents a dual challenge and additional challenges associated with this interaction. The purpose of this paper is to ask: what are the challenges which arise from work practice redesign, infrastructure change and simultaneously attempting both in a single transformation?

Design/methodology/approach

The authors present a longitudinal study of three hospitals in three different countries (UK, USA and Canada) transforming both their infrastructure and work practices. Data consists of 155 ethnographic interviews complemented by 205 documents and 36 hours of observations collected over two phases for each case study.

Findings

This paper identifies that work practice redesign challenges the cognitive load of organizational members whilst infrastructure change challenges the project management and structure of the organization. Simultaneous transformation represents a disconnect between the two aspects of change resulting in a failure to understand the relationship between work and design.

Practical implications

These challenges suggest that organizations need to make a distinction between the two aspects of transformation and understand the unique tensions of simultaneously tackling these dual challenges. They must ensure that they have adequate skills and resources with which to build this distinction into their change planning.

Originality/value

This paper unpacks two different aspects of complex change and considers the neglected challenges associated with modern change management objectives.

Details

Journal of Organizational Change Management, vol. 27 no. 6
Type: Research Article
ISSN: 0953-4814

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Article
Publication date: 6 June 2016

Heru Fahlevi

This paper aims to understand why an expected enhanced role of accounting in Indonesian public hospitals has not occurred, although serial organizational changes and…

Abstract

Purpose

This paper aims to understand why an expected enhanced role of accounting in Indonesian public hospitals has not occurred, although serial organizational changes and reform of hospital payment systems have taken place.

Design/methodology/approach

This study adopts a multiple case study research approach. It was carried out in two Indonesian public hospitals. Interviews were the main tool used for collecting data. The primary interviewees were the top managers, accountants and senior physicians in the hospitals surveyed.

Findings

Insights from the interviews revealed that the owners’ traditional role of funding deficits plus the conventional mindsets of managements and physicians who are only interested in health outcomes have hindered the infiltration of economic and accounting logic into the management of these two public hospitals. Consequently, the expected accounting innovations, i.e. an enhanced role of accounting in the hospitals’ daily activities did not emerge.

Research limitations/implications

This case study is not a longitudinal study and the interviewees, particularly senior physicians, were selected based on their availability and willingness to participate in the interviews. Thus, the findings should be treated with caution.

Practical implications

An enhanced role of accounting and other accounting innovations would indicate that the hospitals are responding as expected to the institutional and financial reforms.

Originality/value

Contingency theory and institutional theory have been used together in this study which aims to not only discuss the reasons for accounting changes occurring or not occurring, but also to understand the motivations behind the accounting changes or lack of change. Thus, a more comprehensive understanding of accounting innovations is expected.

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Article
Publication date: 1 April 2004

Ronald J. Burke

This study examined employee reactions to a process reengineering initiative in a large financial services organization. Data were obtained from 2,514 employees, using…

Abstract

This study examined employee reactions to a process reengineering initiative in a large financial services organization. Data were obtained from 2,514 employees, using questionnaires completed anonymously. Employees having longer company tenure, those at higher levels, and men held more favorable attitudes toward the reengineering initiative. Employees indicating greater understanding of the reengineering effort had more favorable attitudes toward it. Employees holding more favorable attitudes toward the process reengineering initiative also reported more positive work experiences and outcomes and described the organization in more favorable ways. Implications for managing large‐scale change efforts are proposed.

Details

The TQM Magazine, vol. 16 no. 2
Type: Research Article
ISSN: 0954-478X

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Article
Publication date: 30 September 2013

Mariado Carmo Caccia-Bava, Valerie C.K. Guimaraes and Tor Guimaraes

Business process reengineering (BPR) is touted in the literature as the dramatic improvements necessary for competitiveness, but in practice there are many unsuccessful…

Abstract

Purpose

Business process reengineering (BPR) is touted in the literature as the dramatic improvements necessary for competitiveness, but in practice there are many unsuccessful cases. A more systematic and rigorous factor-assessment deemed important to each BPR phase and overall project success is needed. This paper aims to assess the extent to which proposed success factors in a hospital contribute to each BPR phase's success.

Design/methodology/approach

Based on the relevant literature, desirable results from each project phase were defined. Overall project success was defined as the benefits hospital managers derive from BPR according to manager opinions. A total of 192 hospital administrators shared their last BPR experience, where changes were operational for at least one year.

Findings

Recommendations are made for hospital managers to focus attention and resources on factors important to BPR success. Hospital managers are not emphasizing the most important activities and tasks recommended in the BPR literature, such as changes to customer/market related business processes, every business activity's value-added element and applying the right innovative technology. Based on the whole findings, top managers should not engage BPR before ensuring that important success factors are present.

Originality/value

While many researchers identified and/or tested factors important to BPR success, this is the first study to explore BPR success factors' importance to each project phase, from inception to overall project success assessment phase.

Details

International Journal of Health Care Quality Assurance, vol. 26 no. 8
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 1 December 2005

Maria do Carmo Caccia‐Bava, Valerie C.K. Guimaraes and Tor Guimaraes

Business process reengineering has been touted in the literature as a dramatic improvement necessary for organization competitiveness, but in practice there are many…

Abstract

Purpose

Business process reengineering has been touted in the literature as a dramatic improvement necessary for organization competitiveness, but in practice there are many unsuccessful cases. Thus, there is need for a more systematic and rigorous assessment of the factors deemed important to project success. The main objective of this study is to examine this issue.

Design/methodology/approach

For this research, success has been defined as the benefits the hospital has derived from the BPR project, according to top managers' opinions. A sample of 192 hospital administrators shared their organizations' experience with their last BPR project implementation, where the changes have been operational for at least one year.

Findings

Based on the results, recommendations are made for hospital managers to focus attention and resources on factors important to BPR project success. In general, hospitals are not emphasizing some of the most important activities and tasks recommended in the BPR literature, such as changes to customer/market‐related business processes, the value‐added element of every business activity, and applying the right innovative technology.

Originality/value

Based on the findings as a whole, it behoves top managers not to engage in BPR before ensuring the presence of the success factors found to be important.

Details

International Journal of Health Care Quality Assurance, vol. 18 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 1 April 1996

Stuart D. Francis and Patrick G. Alley

Describes a business process re‐engineering project in the department of surgery of a publicly‐funded hospital in Auckland, New Zealand. Through the creation of an…

Abstract

Describes a business process re‐engineering project in the department of surgery of a publicly‐funded hospital in Auckland, New Zealand. Through the creation of an internal marketing approach, by splitting the health system into purchaser and provider elements, the need to refocus on service provision became very apparent. Patient focus review teams were put together to analyse internal processes. Discusses in detail the outcomes of the review, highlighting the need for further changes and setting the direction for a re‐engineering programme.

Details

Business Process Re-engineering & Management Journal, vol. 2 no. 1
Type: Research Article
ISSN: 1355-2503

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Article
Publication date: 3 September 2018

Luca Gastaldi, Francesco Paolo Appio, Mariano Corso and Andrea Pistorio

The purpose of this paper is to understand how digital technologies can help healthcare organisations and improve the exploration-exploitation paradox over time. The…

Abstract

Purpose

The purpose of this paper is to understand how digital technologies can help healthcare organisations and improve the exploration-exploitation paradox over time. The authors explore inputs, processes and outcomes of implementing digital transformation programs and advance four testable propositions.

Design/methodology/approach

The authors conducted multiple case studies with embedded units of analysis: digital transformation processes; hospitals; and regional healthcare systems. Primary sources come from 107 semi-structured interviews with key informants within 14 Italian hospitals between 2009 through 2011.

Findings

Three complementary paths emerge as fundamental to balance exploratory and exploitatory efforts in healthcare: assets digitalisation within hospitals; digitally based process integration; and disruptive decision-making through analytics. Intra- and inter-path characteristics are discussed to show how digital transformation can both move hospital within the exploration-exploitation space.

Research limitations/implications

By its very nature, this study is exploratory. Notwithstanding the number of cases and interviews, its generalisability is limited.

Practical implications

Digital transformation programs are fundamental to resolve the tensions raised by the exploration-exploitation paradox. Their implementation leads to better performance (cost reductions, quality improvements). A framework is provided for practitioners to make better decisions.

Originality/value

This study sheds new light on how digital technologies are actually adopted and adapted in healthcare contexts. It does it by entailing a longitudinal perspective.

Details

Business Process Management Journal, vol. 24 no. 5
Type: Research Article
ISSN: 1463-7154

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Article
Publication date: 1 December 1999

William Ho

Kwong Wah Hospital was founded by the charity organization, Tung Wah Group of Hospitals, some 88 years ago, with management transfer to the Hong Kong Hospital Authority in…

Abstract

Kwong Wah Hospital was founded by the charity organization, Tung Wah Group of Hospitals, some 88 years ago, with management transfer to the Hong Kong Hospital Authority in 1991. Capitalizing both from the traditional caring culture of its founder, as well as opportunities in the new management environment, the hospital has scored remarkable successes in service quality, community partnership, organizational effectiveness, and staff development. Underpinning these transformations were structure, process, people, and culture strategies. The learning imperative is heavily mandated for the success of each of these strands of development. Indeed, the embodiment of a learning organization culture provides the impetus in sustaining the change momentum, towards achieving the vision of becoming a “most preferred hospital” in Hong Kong.

Details

Managing Service Quality: An International Journal, vol. 9 no. 6
Type: Research Article
ISSN: 0960-4529

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Article
Publication date: 19 June 2009

Gregory Gourdin and Rita Schepers

This paper aims to attempt to explore current transformations in hospital governance by tracing the evolution of medical autonomy in the Belgian hospital sector in the…

Abstract

Purpose

This paper aims to attempt to explore current transformations in hospital governance by tracing the evolution of medical autonomy in the Belgian hospital sector in the second half of the twentieth century.

Design/methodology/approach

Using published secondary sources and archive data the paper developed a historical approach to the relationship between profession and organisation, asking qualitative questions of the characteristics of professional power and knowledge.

Findings

Since World War II, two important evolutions have occurred: first, the hospital evolved into an organisational entity that is described as a “professional bureaucracy”; second, at the sectoral level the hospital adopted a position that is characterised as a “divisional structure”. Both evolutions are linked by the processes of rationalisation and bureaucratisation. The findings do not support the thesis of an overall loss of autonomy but bring into focus the transformation of medical autonomy. New forms of professional power and knowledge are emerging with the processing (bureaucracy) and pre‐processing (rationalisation) of information on medical work as key elements.

Originality/value

The paper explores the evolution of the medical profession's autonomy in the second half of the twentieth century. It highlights reflexivity in the changing relationship between professions and organisations and how physicians are becoming “managers of expertise” who are important for both the hospital organisation and the state.

Details

Journal of Health Organization and Management, vol. 23 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

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