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Article
Publication date: 29 April 2021

Mikael Ohrling, Sara Tolf, Karin Solberg-Carlsson and Mats Brommels

Decentralisation in health care has been proposed as a way to make services more responsive to local needs and by that improve patient care. This study analyses how the…

Abstract

Purpose

Decentralisation in health care has been proposed as a way to make services more responsive to local needs and by that improve patient care. This study analyses how the senior management team conceptualised and implemented a decentralised management model within a large public health care delivery organisation.

Design/methodology/approach

Data from in-depth interviews with a senior management team were used in a directed content analysis. Underlying assumptions and activities in the decentralisation process are presented in the logic model and scrutinised in an a priori logic analysis using relevant scientific literature.

Findings

The study found support in the scientific literature for the underlying assumptions that increased responsibility will empower managers as clinical directors know their local prerequisites best and are able to adapt to patient needs. Top management should function like an air traffic control tower, trust and loyalty improve managerial capacity, increased managerial skills release creativity and engagement and a system perspective will support collaboration and learning.

Originality/value

To the authors’ knowledge this is the first a priori logic analysis of a decentralised management model in a healthcare delivery organisation in primary and community care. It shows that the activities consist with underlying assumptions, supported by evidence, and timely planned give managers decision space and ability to use their delegated authority, not disregarding accountability and fostering necessary organisational and individual capacities to avoid suboptimisation.

Details

Journal of Health Organization and Management, vol. 35 no. 5
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 1 February 1991

M. Brommels

The broad perspective and synthetic approach of technologyassessment raises the question whether the technology assessment modelcan be utilised for practical decision…

Abstract

The broad perspective and synthetic approach of technology assessment raises the question whether the technology assessment model can be utilised for practical decision support. The idea is tested in the environment of local care decision making. Technology assessment‐like management instruments for assisting goal formulation, enhancement of organisational efficiency and quality assurance are presented.

Details

Journal of Management in Medicine, vol. 5 no. 2
Type: Research Article
ISSN: 0268-9235

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Article
Publication date: 17 July 2009

Fauziah Rabbani, S.M. Wasim Jafri, Farhat Abbas, Firdous Jahan, Nadir Ali Syed, Gregory Pappas, Syed Iqbal Azam, Mats Brommels and Göran Tomson

Organizational culture is a determinant for quality improvement. This paper aims to assess organizational culture in a hospital setting, understand its relationship with…

Abstract

Purpose

Organizational culture is a determinant for quality improvement. This paper aims to assess organizational culture in a hospital setting, understand its relationship with perceptions about quality of care and identify areas for improvement.

Design/methodology/approach

The paper is based on a cross‐sectional survey in a large clinical department that used two validated questionnaires. The first contained 20 items addressing perceptions of cultural typology (64 respondents). The second one assessed staff views on quality improvement implementation (48 faculty) in three domains: leadership, information and analysis and human resource utilization (employee satisfaction).

Findings

All four cultural types received scoring, from a mean of 17.5 (group), 13.7 (developmental), 31.2 (rational) to 37.2 (hierarchical). The latter was the dominant cultural type. Group (participatory) and developmental (open) culture types had significant positive correlation with optimistic perceptions about leadership (r=0.48 and 0.55 respectively, p<0.00). Hierarchical (bureaucratic) culture was significantly negatively correlated with domains; leadership (r=−0.61, p<0.00), information and analysis (−0.50, p<0.00) and employee satisfaction (r=−0.55, p<0.00). Responses reveal a need for leadership to better utilize suggestions for improving quality of care, strengthening the process of information analysis and encouraging reward and recognition for employees.

Research limitations/implications

It is likely that, by adopting a participatory and open culture, staff views about organizational leadership will improve and employee satisfaction will be enhanced. This finding has implications for quality care implementation in other hospital settings.

Originality/value

The paper bridges an important gap in the literature by addressing the relationship between culture and quality care perceptions in a Pakistani hospital. As such a new and informative perspective is added.

Details

International Journal of Health Care Quality Assurance, vol. 22 no. 5
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 23 March 2010

Johan Thor, Bo Herrlin, Karin Wittlöv, John Øvretveit and Mats Brommels

The purpose of this paper is to examine the outcomes and evolution over a five‐year period of a Swedish university hospital quality improvement program in light of…

Abstract

Purpose

The purpose of this paper is to examine the outcomes and evolution over a five‐year period of a Swedish university hospital quality improvement program in light of enduring uncertainty regarding the effectiveness of such programs in healthcare and how best to evaluate it.

Design/methodology/approach

The paper takes the form of a case study, using data collected as part of the program, including quality indicators from clinical improvement projects and participants' program evaluations.

Findings

Overall, 58 percent of the program's projects (39/67) demonstrated success. A greater proportion of projects led by female doctors demonstrated success (91 percent, n=11) than projects led by male doctors (51 percent, n=55). Facilitators at the hospital continuously adapted the improvement methods to the local context. A lack of dedicated time for improvement efforts was the participants' biggest difficulty. The dominant benefits included an increased ability to see the “bigger picture” and the improvements achieved for patients and employees.

Research limitations/implications

Quality measurement, which is important for conducting and evaluating improvement efforts, was weak with limited reliability. Nevertheless, the present study adds evidence about the effectiveness of healthcare improvement programs. Gender differences in improvement team leadership merit further study. Improvement program evaluation should assess the extent to which improvement methods are locally adapted and applied.

Originality/value

This case study reports the outcomes of all improvement projects undertaken in one healthcare organization over a five‐year period and provides in‐depth insight into an improvement program's changeable nature.

Details

International Journal of Health Care Quality Assurance, vol. 23 no. 3
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 2 May 2017

Kwabena G. Boakye, Charles Blankson, Victor R. Prybutok and Hong Qin

The purpose of this paper is to propose and test a healthcare framework of service quality, perceived value, and satisfaction in Ghana. More specifically, this study…

Abstract

Purpose

The purpose of this paper is to propose and test a healthcare framework of service quality, perceived value, and satisfaction in Ghana. More specifically, this study investigates the role and effect of service quality on patient satisfaction and perceived value in Ghana’s healthcare delivery.

Design/methodology/approach

Data were gathered through surveys administered to 113 healthcare patients in Ghana. partial least square-structural equation modeling analysis was used to empirically test the research model.

Findings

Results show healthcare quality significantly influences satisfaction and perceived value of healthcare delivery. Additionally, perceived value’s impact on satisfaction and behavioral intention shows that increasing perceived benefits while reducing perceived costs leads to repeat behavior and paves the way for retention strategy for healthcare management.

Research limitations/implications

This study yields a series of limitations in its results and conclusions. These limitations and future research are discussed in Section 7 of the study.

Originality/value

This study contributes to the literature by examining the effects of healthcare service quality on patient satisfaction and perceived value, determining the effect of healthcare service quality on patients’ behavioral intention, and testing the proposed framework in Ghana, a fast growing and economically liberalized emerging country in Sub-Saharan Africa.

Details

International Journal of Quality & Reliability Management, vol. 34 no. 5
Type: Research Article
ISSN: 0265-671X

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Book part
Publication date: 19 September 2014

Paulina Junni and Riikka Mirja Sarala

In this chapter, we examine the role of M&A (mergers and acquisitions) leadership by conducting a review of recent empirical studies on M&A leadership. Our aim is to…

Abstract

In this chapter, we examine the role of M&A (mergers and acquisitions) leadership by conducting a review of recent empirical studies on M&A leadership. Our aim is to provide an overview of the current state of knowledge concerning M&A leadership. More specifically, we examine how M&A leadership has been studied (i.e., study methods, data sources), where M&A leadership has been studied (i.e., geographic distribution, industries, level of analysis), which leadership M&A outcomes and M&A leadership perspectives have been examined, and finally, how M&A leadership influences post-M&A outcomes. This allows us to identify main areas of interest and provide suggestions for further research.

Details

Advances in Mergers and Acquisitions
Type: Book
ISBN: 978-1-78350-970-6

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Article
Publication date: 20 March 2017

John Ovretveit, Albert Wu, Richard Street, Harold Thimbleby, Friederike Thilo and Annegret Hannawa

The purpose of this paper is to explore a non-technical overview for leaders and researchers about how to use a communications perspective to better assess, design and use…

Abstract

Purpose

The purpose of this paper is to explore a non-technical overview for leaders and researchers about how to use a communications perspective to better assess, design and use digital health technologies (DHTs) to improve healthcare performance and to encourage more research into implementation and use of these technologies.

Design/methodology/approach

Narrative overview, showing through examples the issues and benefits of introducing DHTs for healthcare performance and the insights that communications science brings to their design and use.

Findings

Communications research has revealed the many ways in which people communicate in non-verbal ways, and how this can be lost or degraded in digitally mediated forms. These losses are often not recognized, can increase risks to patients and reduce staff satisfaction. Yet digital technologies also contribute to improving healthcare performance and staff morale if skillfully designed and implemented.

Research limitations/implications

Researchers are provided with an introduction to the limitations of the research and to how communications science can contribute to a multidisciplinary research approach to evaluating and assisting the implementation of these technologies to improve healthcare performance.

Practical implications

Using this overview, managers are more able to ask questions about how the new DHTs will affect healthcare and take a stronger role in implementing these technologies to improve performance.

Originality/value

New insights into the use and understanding of DHTs from applying the new multidiscipline of communications science. A situated communications perspective helps to assess how a new technology can complement rather than degrade professional relationships and how safer implementation and use of these technologies can be devised.

Details

Journal of Health Organization and Management, vol. 31 no. 1
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 9 March 2010

Kelly Rouse Riesenmy

The purpose of this paper is to explore physician sensemaking and readiness to implement electronic medical records (EMR) as a first step to finding strategies that…

Abstract

Purpose

The purpose of this paper is to explore physician sensemaking and readiness to implement electronic medical records (EMR) as a first step to finding strategies that enhance EMR adoption behaviors.

Design/methodology/approach

The case study approach provides a detailed analysis of individuals within an organizational unit. Using a theoretical lens of sensemaking and readiness for change gives a framework for triangulated inquiry.

Findings

Findings reveal that physicians' key sensemaking factors are alignment, expectations, symbols (i.e. voice activation technology), outside influences, emotional arousal, trust, faith, forced implementation, controlled influence, and clarification of identity. These factors collectively describe how physician derive meaning through innovation.

Research limitations/implications

The findings elucidate physicians as autonomous learners utilizing innovative thought processes to prepare for EMR implementation. Physicians used innovation in EMR implementation as a method of controlled influence to clarify their identity as efficient, competent professionals who demand performance excellence.

Practical implications

These findings have implications for EMR implementation strategies and future research in innovation and EMR adoption behaviors.

Originality/value

This study provides needed information about how physicians grasp EMR technology in the practice of medicine and how it impacts their readiness to use EMR. Much is known about the barriers, difficulties, and benefits of EMR, but little is know about how physicians construct meaning from the use of this new technology.

Details

The Learning Organization, vol. 17 no. 2
Type: Research Article
ISSN: 0969-6474

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Article
Publication date: 3 August 2012

Soki Choi, Ingalill Holmberg, Jan Löwstedt and Mats Brommels

This paper seeks to explore critical factors that may obstruct or advance integration efforts initiated by the clinical management following a hospital merger. The aim is…

Abstract

Purpose

This paper seeks to explore critical factors that may obstruct or advance integration efforts initiated by the clinical management following a hospital merger. The aim is to increase the understanding of why clinical integration succeeds or fails.

Design/methodology/approach

The authors compare two cases of clinical integration efforts following the Karolinska University Hospital merger in Sweden. Each case represents two merged clinical departments of the same specialty from each hospital site. In total, 53 interviews were conducted with individuals representing various staff categories and documents were collected to check data consistency.

Findings

The study identifies three critical factors that seem to be instrumental for the process and outcome of integration efforts and these are clinical management's interpretation of the mandate; design of the management constellation; and approach to integration. Obstructive factors are: a sole focus on the formal assignment from the top; individual leadership; and the use of a classic, planned, top‐down management approach. Supportive factors are: paying attention to multiple stakeholders; shared leadership; and the use of an emergent, bottom‐up management approach within planned boundaries. These findings are basically consistent with the literature's prescriptions for managing professional organisations.

Practical implications

Managers need to understand that public healthcare organisations are based on competing institutional logics that need to be handled in a balanced way if clinical integration is to be achieved – especially the tension between managerialism and professionalism.

Originality/value

By focusing on the merger consequences for clinical units, this paper addresses an important gap in the healthcare merger literature.

Details

Journal of Health Organization and Management, vol. 26 no. 4
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 13 May 2014

Pamela Mazzocato, Johan Thor, Ulrika Bäckman, Mats Brommels, Jan Carlsson, Fredrik Jonsson, Magnus Hagmar and Carl Savage

The purpose of this paper is to explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in…

Abstract

Purpose

The purpose of this paper is to explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in hospital process performance data.

Design/methodology/approach

A multiple case study based on a realistic evaluation approach to identify mechanisms for how lean impacts process performance and services’ capability to learn and continually improve. Four years of process performance data were collected from seven emergency services at a Swedish University Hospital: ear, nose and throat (ENT) (two), pediatrics (two), gynecology, internal medicine, and surgery. Performance patterns were linked with qualitative data collected through realist interviews.

Findings

The complexity of the care process influenced how improvement in access to care was achieved. For less complex care processes (ENT and gynecology), large and sustained improvement was mainly the result of a better match between capacity and demand. For medicine, surgery, and pediatrics, which exhibit greater care process complexity, sustainable, or continual improvement were constrained because the changes implemented were insufficient in addressing the higher degree of complexity.

Originality/value

The variation in process performance and sustainability of results indicate that lean efforts should be carefully adapted to the complexity of the care process and to the educational commitment of healthcare organizations. Ultimately, the ability to adapt lean to a particular context of application depends on the development of routines that effectively support learning from daily practices.

Details

Journal of Health Organization and Management, vol. 28 no. 2
Type: Research Article
ISSN: 1477-7266

Keywords

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