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Book part
Publication date: 25 July 2008

Michal Tamuz, Cynthia K. Russell and Eric J. Thomas

Hospital nurse managers are in the middle. Their supervisors expect that they will monitor and discipline nurses who commit errors, while also asking them to create a…

Abstract

Hospital nurse managers are in the middle. Their supervisors expect that they will monitor and discipline nurses who commit errors, while also asking them to create a culture that fosters reporting of errors. Their staff nurses expect the managers to support them after errors occur. Drawing on interviews with 20 nurse managers from three tertiary care hospitals, the study identifies key exemplars that illustrate how managers monitor nursing errors. The exemplars examine how nurse managers: (1) sent mixed messages to staff nurses about incident reporting, (2) kept two sets of books for recording errors, and (3) developed routines for classifying potentially harmful errors into non-reportable categories. These exemplars highlight two tensions: the application of bureaucratic rule-based standards to professional tasks, and maintaining accountability for errors while also learning from them. We discuss how these fundamental tensions influence organizational learning and suggest theoretical and practical research questions and a conceptual framework.

Details

Patient Safety and Health Care Management
Type: Book
ISBN: 978-1-84663-955-5

Article
Publication date: 1 February 2006

Rosalía Cascón‐Pereira, Mireia Valverde and Gerard Ryan

Few definitions in the HRM literature have reached as much consensus as the term “devolution”. However, devolution is a phenomenon that has been defined from the…

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Abstract

Purpose

Few definitions in the HRM literature have reached as much consensus as the term “devolution”. However, devolution is a phenomenon that has been defined from the perspective of HRM specialists, with little or no contribution from middle managers. This paper seeks to explore what is behind the commonly shared definition of devolution, by examining not only the actual tasks that are being devolved, but also by trying to establish different degrees of devolution according to a number of dimensions.

Design/methodology/approach

An approach that facilitated the exploration of the extent of devolution and impact on middle managers' perceptions was required. A qualitative approach was adopted. Specifically, a case study of a hospital in Spain was undertaken. The research methods included in‐depth interviews, participant observation and internal documentation.

Findings

The findings emphasize the importance of reflecting on the reality and the rhetoric of devolution. The results indicate that it is worthwhile to break down the concept of devolution into dimensions (tasks and responsibilities, decision‐making power, financial power and expertise power) and to specify what dimensions are devolved.

Practical implications

There is a clear difference between the rhetoric of devolution and what actually happens in practice. In order to distinguish between those organisations that go beyond the rhetoric of devolution, it is important to differentiate between the devolution of tasks and the devolution of decision‐making power and autonomy in order to undertake these tasks. This differentiation facilitates the identification of those companies which display superficial levels of devolution and take steps to advance the process.

Originality/value

This paper questions the traditional definition of devolution. It proposes a new definition of devolution based on the identification of various dimensions and incorporates the perspectives of all the actors involved in the process.

Details

Journal of European Industrial Training, vol. 30 no. 2
Type: Research Article
ISSN: 0309-0590

Keywords

Open Access
Article
Publication date: 29 July 2021

John C.A.M. van Beers, Desirée H. van Dun and Celeste P.M. Wilderom

Lean implementations in hospitals tend to be lengthy or lack the desired results. In addressing the question, how can lean be implemented effectively in a hospital-wide…

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Abstract

Purpose

Lean implementations in hospitals tend to be lengthy or lack the desired results. In addressing the question, how can lean be implemented effectively in a hospital-wide setting, this paper aims to examine two opposing approaches.

Design/methodology/approach

The authors studied two Dutch university hospitals which engaged in different lean implementation approaches during the same four-year period: top-down vs bottom-up. Inductive qualitative analyses were made of 49 interviews; numerous documents; field notes; 13 frontline meeting observations; and objective hospital performance data. Longitudinally, the authors depict how the sequential events unfolded in both hospitals.

Findings

During the six implementation stages, the roles played by top, middle and frontline managers stood out. While the top managers of one hospital initiated the organization-wide implementation and then delegated it to others, the top managers of the other similar hospital merely tolerated the bottom-up lean activities. Eventually, only the hospital with the top-down approach achieved high organization-wide performance gains, but only in its fourth year after the top managers embraced lean in their own daily work practices and had started to co-create lean themselves. Then, the earlier developed lean infrastructure at the middle- and frontline ranks led to the desired hospital-wide lean implementation results.

Originality/value

Change-management insights, including basic tenets of social learning and goal-setting theory, are shown to advance the knowledge of effective lean implementation in hospitals. The authors found lean implementation “best-oiled” through role-modeling by top managers who use a phase-based process and engage in close cross-hierarchical or co-creative collaboration with middle and frontline managerial members.

Details

International Journal of Lean Six Sigma, vol. 13 no. 1
Type: Research Article
ISSN: 2040-4166

Keywords

Article
Publication date: 20 July 2012

Bodil Ekholm

The purpose of this project was to study how middle managers look on and shape their work and leadership with regard to the demands and expectations that exist from…

965

Abstract

Purpose

The purpose of this project was to study how middle managers look on and shape their work and leadership with regard to the demands and expectations that exist from different participants within the home help service operation. The participants are politicians, officials at central level, nursing staff, persons receiving care and their relatives.

Design/methodology/approach

The participants are eight managers in eight different home‐help service units. The units are spread out in four districts with high socioeconomic status and four districts with low. Four managers are at public units and four are at units with private executor. The majority of the managers had worked as leaders between three and eight years. The study is based on individual interviews and observations of the managers and of staff meetings. The data were subjected to content analysis. Two main categories and five subcategories were generated.

Findings

There were large similarities in how the managers perceived the demands and expectations, but there were differences when it came to how they handled them. Three of the managers experienced that they could handle the demands and expectations through organizing and structuring the operation and prioritizing the assignments, while five of the managers experienced difficulties to handle them and they conveyed that they suffered from stress. The managers who could handle the demands combine a professional and an organizational perspective in their leadership.

Originality/value

The knowledge from the study may be of great value in recruiting new managers in elderly care but also in creating programs of competence development for managers.

Details

Leadership in Health Services, vol. 25 no. 3
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 7 July 2014

Laila Nordstrand Berg and Haldor Byrkjeflot

The hospital sector has expanded in Norway with reforms and a strong demand for better management. The purpose of this paper is to examine: first, how this has affected…

1058

Abstract

Purpose

The hospital sector has expanded in Norway with reforms and a strong demand for better management. The purpose of this paper is to examine: first, how this has affected physicians and nurses in management; second, how management roles in hospitals are changing; and third, how these two professions are tackling their new roles.

Design/methodology/approach

The paper presents a review of the secondary literature and a case study undertaken in the spring, 2012.

Findings

In Norway, two reforms have been introduced aimed at creating stronger management positions with less professional influence. The leader has full responsibility for a particular unit, which means that the jurisdiction of managers has expanded and that management has become more time consuming. Physicians – traditionally those in charge of hospitals – are facing competition from other professions, especially nursing, which has gained representation in top management positions, particularly at middle management level.

Originality/value

The originality of this paper is the comparison of the evolvement of management among physicians and nurses since the reforms. While the medical profession was critical of management to begin with, i.e. viewing management positions as a trap, it is gradually adapting to the new ideas. Physicians are facing competition from nurses, who readily adjust to the new conditions, and perceive management as a new career track.

Details

International Journal of Public Sector Management, vol. 27 no. 5
Type: Research Article
ISSN: 0951-3558

Keywords

Article
Publication date: 12 October 2017

Pieterbas Lalleman, Joanne Bouma, Gerhard Smid, Jananee Rasiah and Marieke Schuurmans

The purpose of this study was to explore the experiences and impact of peer-to-peer shadowing as a technique to develop nurse middle managers’ clinical leadership practices.

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Abstract

Purpose

The purpose of this study was to explore the experiences and impact of peer-to-peer shadowing as a technique to develop nurse middle managers’ clinical leadership practices.

Design/methodology/approach

A qualitative descriptive study was conducted to gain insight into the experiences of nurse middle managers using semi-structured interviews. Data were analysed into codes using constant comparison and similar codes were grouped under sub-themes and then into four broader themes.

Findings

Peer-to-peer shadowing facilitates collective reflection-in-action and enhances an “investigate stance” while acting. Nurse middle managers begin to curb the caring disposition that unreflectively urges them to act, to answer the call for help in the here and now, focus on ad hoc “doings”, and make quick judgements. Seeing a shadowee act produces, via a process of social comparison, a behavioural repertoire of postponing reactions and refraining from judging. Balancing the act of stepping in and doing something or just observing as well as giving or withholding feedback are important practices that are difficult to develop.

Originality/value

Peer-to-peer shadowing facilitates curbing the caring disposition, which is essential for clinical leadership development through unlocking a behavioural repertoire that is not easy to reveal because it is, unreflectively, closely knit to the professional background of the nurse managers. Unlike most leadership development programmes, that are quite introspective and detached from context, peer-to-peer shadowing does have the potential to promote collective learning while acting, which is an important process.

Details

Leadership in Health Services, vol. 30 no. 4
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 3 January 2022

Yennuten Paarima, Atswei Adzo Kwashie, James Avoka Asamani and Adelaide Maria Ansah Ofei

This paper aims to examine the leadership competencies of first-line nurse managers (FLNMs) at the unit level in the eastern region of Ghana.

Abstract

Purpose

This paper aims to examine the leadership competencies of first-line nurse managers (FLNMs) at the unit level in the eastern region of Ghana.

Design/methodology/approach

The paper is a quantitative cross-section design.

Findings

Nurse managers exhibited a moderate level of knowledge and ability to apply leadership competencies. Gender, rank, qualification, professional experience, management experience and management training jointly predicted the leadership competencies of FLNMs [(R2 = 0.158, p = 0.016]. However, only management training was a significant predictor in the model.

Practical implications

Inappropriate leadership competencies have severe consequences for patients and staff outcomes. This situation necessitates a call for a well-structured program for the appointment of FLNMs based on competencies.

Originality/value

This study is the first in Ghana which we are aware of that examined the leadership competencies at the unit level that identifies predictors of leadership competencies.

Details

Leadership in Health Services, vol. 35 no. 3
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 1 December 2005

Laura Purcell and Brigid Milner

The purpose of this paper is to investigate the dramatic reforms in the health service in recent years.

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Abstract

Purpose

The purpose of this paper is to investigate the dramatic reforms in the health service in recent years.

Design/methodology/approach

Examines management development in health care, and explores the experiences of clinical nurse managers.

Findings

Duplication of agencies and multiplication of roles have led to tensions in terms of both the management and organisation of the health service and pressures to accommodate local and national agendas have proved difficult and, as such, a complex, bureaucratic organisation is seen to be the resultant outcome.

Originality/value

This paper fulfils the need of exploring the experiences of clinical nurse managers in the NHS.

Details

Journal of European Industrial Training, vol. 29 no. 9
Type: Research Article
ISSN: 0309-0590

Keywords

Article
Publication date: 25 September 2020

Raffaella Gualandi, Cristina Masella, Daniela Viglione and Daniela Tartaglini

This study aims to describe and understand the contributions of frontline, middle and top management healthcare professionals in detecting areas of potential improvement…

Abstract

Purpose

This study aims to describe and understand the contributions of frontline, middle and top management healthcare professionals in detecting areas of potential improvement in hospital patient flow and proposing solutions.

Design/methodology/approach

This is a qualitative interview study. Semistructured interviews were conducted with 22 professionals in the orthopedic department of a 250-bed academic teaching hospital. Data were analyzed through a thematic framework analytical approach by using an a priori framework. The Consolidated Criteria for Reporting Qualitative (COREQ) checklist for qualitative studies was followed.

Findings

When dealing with a hospital-wide process, the involvement of all professionals, including nonhealth professionals, can reveal priority areas for improvement and for services integration. The improvements identified by the professionals largely focus on covering major gaps detected in the technical and administrative quality.

Research limitations/implications

This study focused on the professional viewpoint and the connections between services and further studies should explore the role of patient involvement. The study design could limit the generalizability of findings.

Practical implications

Improving high-quality, efficient hospital patient flow cannot be accomplished without learning the perspective of the healthcare professionals on the process of service delivery.

Originality/value

Few qualitative studies explore professionals' perspectives on patient needs in hospital flow management. This study provides insights into what produces value for the patient within a complex process by analyzing the contribution of professionals from their particular role in the organization.

Details

Journal of Health Organization and Management, vol. 34 no. 8
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 16 November 2015

Elisa Giulia Liberati, Mara Gorli and Giuseppe Scaratti

The purpose of this paper is to understand how the introduction of a patient-centered model (PCM) in Italian hospitals affects the pre-existent configuration of clinical…

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Abstract

Purpose

The purpose of this paper is to understand how the introduction of a patient-centered model (PCM) in Italian hospitals affects the pre-existent configuration of clinical work and interacts with established intra/inter-professional relationships.

Design/methodology/approach

Qualitative multi-phase study based on three main sources: health policy analysis, an exploratory interview study with senior managers of eight Italian hospitals implementing the PCM, and an in-depth case study that involved managerial and clinical staff of one Italian hospital implementing the PCM.

Findings

The introduction of the PCM challenges clinical work and professional relationships, but such challenges are interpreted differently by the organisational actors involved, thus giving rise to two different “narratives of change”. The “political narrative” (the views conveyed by formal policies and senior managers) focuses on the power shifts and conflict between nurses and doctors, while the “workplace narrative” (the experiences of frontline clinicians) emphasises the problems linked to the disruption of previous discipline-based inter-professional groups.

Practical implications

Medical disciplines, rather than professional groupings, are the main source of identification of doctors and nurses, and represent a crucial aspect of clinicians’ professional identity. Although the need for collaboration among medical disciplines is acknowledged, creating multi-disciplinary groups in practice requires the sustaining of new aggregators and binding forces.

Originality/value

This study suggests further acknowledgment of the inherent complexity of the political and workplace narratives of change rather than interpreting them as the signal of irreconcilable perspectives between managers and clinicians. By addressing the specific issues regarding which the political and workplace narratives clash, relationship of trust may be developed through which problems can be identified, mutually acknowledged, articulated, and solved.

Details

Journal of Health Organization and Management, vol. 29 no. 7
Type: Research Article
ISSN: 1477-7266

Keywords

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