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In this chapter, we identify three distinct transformational performance improvement (TPI) approaches commonly used to redesign work processes in health care organizations. We describe the unique components or tools that each approach uses to improve the delivery of health services. We also summarize what is empirically known about the effectiveness of each TPI approach according to systematic reviews and recent studies published in the peer-reviewed literature. Based on examination of this research, we discuss what knowledge is still needed to strengthen the evidence for whole system transformation. This involves the use of conceptual frameworks to assess and guide implementation efforts, and facilitators and barriers to change as revealed in a recent evaluation of one major initiative, the Lean Enterprise Transformation (LET) at the Veterans Health Administration. The analysis suggests ways in which TPI facilitators can be developed and barriers reduced to improve the effectiveness and sustainability of quality initiatives. Finally, we discuss appropriate study designs to evaluate TPI interventions that may strengthen the evidence for their effectiveness in real world practice settings.

In contrast to the largely functionalist and apolitical literature which dominates organisational scholarship on exploitation and exploration after March, this paper seeks to complement this view of exploitation and exploration with a Marxist reading which is unwittingly implied by these terms. More specifically, we combine neo-Marxist and paleo-Marxist arguments to more fully understand the conflictual relations that underpin exploitation and exploration in the management of firms. This enables us to address both the objective and subjective dimensions of exploitation and exploration which firms and workers are involved in through the contemporary capitalist labour process. We illustrate this by drawing on a case study of a large Swedish manufacturing firm which sought to improve lean production by systematically helping employees to explore their own lifestyles and possibilities for a healthier and happier life.

Originally developed by the Japanese firm Toyota in the 1950s, the core innovation of lean production is to reorient all organizational activity around continuous improvement and the elimination of waste. We use the case of lean production in two healthcare organizations to explore the process of translating management models into new environments (Czarniawska & Sevón, 1996; Mohr, 1998). We draw on insights from organizational sociology and social movement theory to understand the strategies of actors as they attempt to overcome opposition to model transfer (Battilana, Leca, & Boxenbaum, 2009; Friedland & Alford, 1991; Snow, Rochford, Worden, & Benford, 1986). We examine two attempts to export lean production to healthcare organizations: Riverside Hospital, a research and teaching institution, and Lakeview Associations, a managed health provider. We use these cases to illustrate two ways that management models can get lost in the process of institutional translation: model attenuation, and model decoupling.

Clinical front-line staff are best positioned within the organizations to identify patient safety problems and craft solutions. However, in traditional models, safety committees are led by senior executives who are not clinically responsible for patients. This top-down approach can result in missed opportunities to address patient-centered challenges and better manage the health of the defined populations served by these organizations.

To foster teamwork, enhance empowerment, and improve the patient care environment, Operations Councils led by trained front-line staff were deployed in 15 clinical areas at the Ohio State University Wexner Medical Center (OSUWMC) as a performance improvement tool.

Standardized training of Council facilitators was designed and implemented to guide the performance improvement process. Balanced scorecards were developed in each Council based on the risks and concerns of that particular clinical area. After initial implementation of the Operations Councils, patient safety events declined and team engagement improved by over 34% across the medical center; the highest changes were seen in areas where Operations Councils had been deployed. Additionally, outcome metrics including area-specific and system-wide mortality and readmissions improved after implementation.

We suggest that this type of approach may be an appropriate strategy to consider in other health care organizations as such institutions are challenged to better manage the health of their defined patient populations.

Nowadays, organizations have to resist the rising competition more effectively than their competitors and take a step closer to excellence in offering the product to customer demands. To do this, organizations need agile leaders in order to implement agility principles and practices. Especially in the health sector, health managers must be agile because of the specific characteristics of health services. From this view, this chapter aims to develop a theoretical agile leadership model in healthcare organizations. First, the authors define agile leadership and its sub-dimensions based on previous literature. Then, the antecedents and outcomes of agile leadership have been analyzed. “Drivers of agile leadership,” “organizational factors affecting agile leadership” and “individual factors affecting agile leadership” are identified as the antecedents of agile leadership. “Organizational outcomes” and “individual outcomes” are determined as the outcomes of agile leadership in the health sector.

This study examines challenges to the retrospective financial evaluation of continuous improvement (CI) activities. Through a review of the literature and active engagement with CI implementations, we identify several issues that may lead to divergence between operational and financial assessments. Out of this conflict emerges a set of concepts that we find important − the delineation of soft versus hard capacity benefits, the distinction between capacity used and capacity paid for, and the data gaps that relate to these benefits – and recognize operational improvement and financial improvement as distinct, yet interrelated, theoretical constructs. This study helps explain a series of persistent gaps in the management accounting literature: Conflict between operations and accounting managers, the divergent perspectives of Johnson and Kaplan after their publication of Relevance Lost (Johnson & Kaplan, 1987), and the need for both operational control (including detailed capacity control) and accounting control in CI firms. Instead of one control system being at odds with the other, or co-existing despite each other, each of these systems support a different component of the financial improvement process. Operational control systems in CI firms emphasize non-financial information and social and behavioral controls that empower decision-making by employees, while accounting control systems seek to motivate and translate operational gains into financial gains. Soft and hard benefits linked to capacity play an integral role in understanding the difference in focus of each control system, while data limitations help to explain why these systems remain loosely coupled in practice (or absent, as seems to be the case with detailed Capacity Management Systems).

The hospital–physician relationship (HPR) has been the focus of many scholars given the potential impact of this relationship on hospitals’ ability to achieve socially and organizationally desirable health care outcomes. Hospitals are dominated by professionals and share many commonalities with professional service firms (PSFs). In this chapter, we explore an alternative HPR based on the governance models prevalent in PSFs.

We summarize the issues presented by current HPRs and discuss the governance models dominant in PSFs.

We identify the non-equity partnership model as a governance archetype for hospitals; this model accounts for both the professional dominance in health care decisions and the increasing demand for higher accountability and efficiency.

There should be careful consideration of existing regulations such as the Stark law and the antikickback statue before the proposed governance model and the compensation structure for physician partners is adopted.

While our governance archetype is based on a review of the literature on HPRs and PSFs, further research is needed to test our model.

Given the dominance of not-for-profit (NFP) ownership in the hospital industry, we believe the non-equity partnership model can help align physician incentives with those of the hospital, and strengthen HPRs to meet the demands of the changing health care environment.

This is the first chapter to explore an alternative hospital–physician integration strategy by examining the governance models in PSFs, which similar to hospitals have a high reliance on a predominantly professional staff.

This chapter provides an introduction to the volume and reviews some issues related to access, quality and satisfaction with care as three critical concepts in health services and health care delivery. In addition to this review of some of the material on access, quality and satisfaction with care, this chapter also serves as an introduction to the volume. As such, the chapter explains the organization of the volume and briefly comments on each of the chapters included in the volume.