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The Institute for Healthcare Improvement (IHI) has broadened their campaign focus to include protecting hospital patients from five million incidents of medical harm through 2008. A critical component of this campaign is the engagement of governance in the process, noting evidence of better patient outcomes for hospitals with governing boards that spend at least 25% of their time on quality and safety. St. Francis Medical Center (SFMC), a 384-bed hospital in Southeast Los Angeles serving a high number of uninsured and underinsured patients and a population characterized by significant poverty, has initiated through a top-down approach, an aggressive plan to improve the care at its facilities through a call to action by its board of directors. In this article innovative methods are shared, tools are provided, and the initial positive results achieved are reported which show how a cultural change is occurring regarding quality and patient safety (QPS) at this hospital's organizational and delivery system level.

Persistent change has placed considerable pressure on organizations to keep up or fade into obscurity. Firms that remain viable, or even thrive, are staffed with decision-makers who capably steer organizations toward opportunities and away from threats. Accordingly, leadership development has never been more critical. In this chapter, the authors propose that leader development is an inherently dyadic process initiated to communicate formal and informal expectations. The authors focus on the informal component, in the form of organizational politics, as an element of leadership that is critical to employee and company success. The authors advocate that superiors represent the most salient information source for leader development, especially as it relates to political dynamics embedded in work systems. The authors discuss research associated with our conceptualization of dyadic political leader development (DPLD). Specifically, the authors develop DPLD by exploring its conceptual underpinnings as they relate to sensemaking, identity, and social learning theories. Once established, the authors provide a refined discussion of the construct, illustrating its scholarly mechanisms that better explain leader development processes and outcomes. The authors then expand research in the areas of political skill, political will, political knowledge, and political phronesis by embedding our conceptualization of DPLD into a political leadership model. The authors conclude by discussing methodological issues and avenues of future research stemming from the development of DPLD.

We study the decision-making process behind business model change, focusing specifically on the tactics managers employ to gain support for such changes. We first argue for the prominent role of middle management in business model change, and second, we revisit the literature on issue selling and championing as they may apply to business model change decision-making. We subsequently analyze the case of a business model change initiative in the Dutch water authority sector, revealing two specific tactics that middle management employed to obtain top management’s agreement to business model change: leveraging external agreements and continuously informing top management. We discuss how these findings extend and in some ways suggest a rethink of the literature on organizational change. Finally, we describe the specificities of business model change that distinguish it from other types of change. In sum, this paper demonstrates the interest of research at the nexus of business models and organizational change.

At the beginning of the 20th century, three intertwined ambitions drove federal legislation over wildlife and biodiversity: establishment of multiple-use federal lands, the economic development of natural resources, and the maintenance of option values. We examine this federal intervention in natural resource use by analyzing roll call votes over the past century with a Random Utility Model (Manski, 1977) and conclude that economics mattered. So did ideology, but not uniformly. After World War II, the pro-environment vote which had been conservative shifted to being liberal. All these votes involved decisions regarding public land that reallocated the returns to users by changing the asset’s physical character or its usage rights. We suggest that long-term consequences affecting current resource allocations arose from disparities between broadly dispersed benefits and locally concentrated socioeconomic and geophysical (spatial) costs. We show that a primary intent of public land management has become to preserve multiple-use option values and identify important factors in computing those option values. We do this by demonstrating how the willingness to forego current benefits for future ones depends on the community’s resource endowments. These endowments are defined not only in terms of users’ current wealth accumulation but also from their expected ability to extract utility from natural resources over time.

The last decade has seen a significant increase in self-initiated expatriation research across various cohorts; however, limited research exists on the self-initiated expatriation of medical doctors despite their high mobility rates. The purpose of this paper is to investigate the determinants of cross-cultural adjustment among self-initiated medical doctors working and living in a host culture.

A questionnaire was distributed to self-initiated expatriate (SIE) doctors working in Irish hospitals. In total, 193 valid responses were collected. Three linear regression analyses were conducted to explore factors influencing cross-cultural adjustment among SIE medical doctors, along with qualitative insight into their adjustment to working and living in Ireland.

This study found that age, marital status, cultural novelty, previous international work experience, length of time working in the host culture did not influence the cross-cultural adjustment of SIE doctors. However, gender, language ability and perceived fair treatment were found to influence their cross-cultural adjustment in the study. Specifically, female SIE doctors reported higher levels of general adjustment to that of SIE male doctors. SIE doctors' language ability was found to influence their work adjustment, and those who perceived unfair treatment in the host culture reported lower levels of general adjustment.

This paper contributes to the limited knowledge and understanding surrounding the self-initiated expatriation of medical doctors and their cross-cultural adjustment to the host hospital and host culture.

The paper argues that the diatextual analysis could be considered a psycho-cultural path of critical discourse analysis because it stresses the role of hermeneutical procedures in catching the inter-subjective nature of meanings. The purpose of this paper is to discuss these theoretical speculations in light with some empirical evidences coming from a discursive study exploring the construction of organizational identity through socialization practices.

Two focus group discussions were conducted, respectively, with retired workers and young workers employed in the same working organization to investigate how workers discursively shape their sense of belonging to the organization. Narratives of past and present membership were analyzed adopting the diatextual perspective, which was precious in tracking down the discursive traces of subjectivity, modality and argumentation emerging from their discourses.

Diatextual analysis was a precious tool to explore organizational identity through the different rhetoric that older and young workers used to make sense of it: “enchantment” vs “disenchantment.”

The study was a case study. It involved few people and results cannot be generalized, but the main aim of the paper was to support qualitative methodology.

The implication of the study are precious to design formal socialization and human resource management practices better attuned with the need of workers.

The social implications are connected with a wider revision of the organizational policies in terms of HRM.

The value of this paper is the discursive diatextual approach in organizational research.

The critical input of middle managers as they make sense of the organisation's plans is paramount during the process of strategic change. Through the lens of middle manager sensemaking literature, this explorative research identifies key organisational practices that underpin sensemaking. An understanding of these practices will allow organisations better develop and support them, thereby enabling middle managers' contribution to strategic change.

This study employed an innovative diary methodology. 42 middle managers, across three organisations, completed a weekly, online diary for 12 weeks. A qualitative analysis of the final 355 diaries isolated and explained the sensemaking practices in which middle managers engaged as they sought to achieve the shared understanding required to progress strategic change.

This study identifies the key practice underpinning middle manager sensemaking as formal and frequent discourse opportunities between leaders and middle managers. Through leader participation beyond the initiation stages of strategic change, and the organisation's positive positioning of time and metrics, these discourse opportunities enable a form of sensemaking associated with a number of positive organisational outcomes. These include middle manager sensegiving across the organisation, the successful enactment of strategic change, positive perceptions of change outcomes and organisational climate among middle managers and middle manager well-being.

This study advances our theoretical understanding of the practice of sensemaking in organisations through the isolation and identification of its key practices. However, given the difficulty in obtaining access for such a lengthy and intrusive methodology, the study is confined to three organisations. Additionally, the focus on the practice of sensemaking did not fully explore any contextual factors within these organisations. Also, middle manager perceptions of successful organisational outcomes are not very reliable performance indicators. While the self-reporting of perceptions is a worthwhile means of gathering data, a measure and comparison of actual business performance indicators would significantly strengthen the findings.

From a practitioner perspective, this study not only underlines the importance for organisations of developing critical sensemaking practices for middle managers but also provides a clear pathway to achieving this. In approaching the intangible process of sensemaking from a practice perspective, it provides key stakeholders such as leaders, change agents and the HR department with a guide as to the types and forms of discourse practices which can be enabled. Maybe more importantly, it also highlights the practices which disable middle manager sensemaking. The study also provides organisations with insights into the positive outcomes stemming from middle manager sensemaking that should strengthen their case towards the development of sensemaking practices.

This paper responds to the call for new approaches to the study of sensemaking as an ongoing practice within organisations. The qualitative diary analysis provides rich insights into the specific organisational practices that can enable middle manager sensemaking, while also highlighting those practices that can disable their role during strategic change. These findings provide organisations with clear approaches for developing sensemaking as a practice, thereby engaging and supporting the multiple actors and levels required to deliver successful strategic change.