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Common literature review methods such as systematic review and narrative review are poorly suited to the investigation of complex management phenomena. Systematic reviews are highly driven by protocol and procedure, and are oft-criticized as reductive and poorly equipped to examine the interaction between phenomena and context, nonlinear processes, and empirical outcomes that are less predictable. Narrative reviews, on the other hand, are pluralistic and iterative and thus better suited to descriptions of the complex and unpredictable; however, they tend to lack methodological transparency, trustworthiness, and pragmatism in application. The “realist synthesis” approach to literature review can be seen as the middle-ground between these two common methods, offering both methodological rigor alongside flexibility and nuance. Realist synthesis takes an explanatory frame, with a focus on unearthing the theorized causal mechanisms at play beneath a phenomenon of interest.

The purpose of this paper is to highlight a collaborative effort between academia (University of North Texas, Team Sciences) and practice (Toyota Connected (TC)). This study concentrated on current problems that had been experienced by TC: How to structure and manage multiteam systems (MTSs)?

This research study utilized a realist systematic review to address an existing problem by working collaboratively with TC and academia. This collaboration involved problem identification, the development of research questions and a full systematic review guided by the research questions.

This realist systematic review merged the literature with current practices at TC in an effort to gather evidence to support the best method of structuring and managing MTSs. The findings include a leadership structure that incorporates both shared leadership (bottom-up) and existing hierarchical structures (top-down).

The MTS models presented in this study provide new models for organizations/manufacturers/industries to use as a guide when structuring their MTSs.

This study provides an example of a collaborative research effort between practice and academia using a realist systematic review. The paper also provides some multiteam system models that could be implemented and tested in different organizations. Also, new responsibilities and roles for scrum and MTSs are presented as a new method of achieving Agile.

As the provision of public services in many advanced welfare states has increasingly come to be marked by competition, social enterprises have actively been encouraged by governments to become involved in the delivery of public services. While the evaluation of complex public health interventions has arguably become increasingly more sophisticated, this has not been the case where social enterprise is concerned: evaluation of the actual impacts of social enterprises remains significantly underdeveloped by comparison. This study aims to support the establishment of a robust evidence base for the use of social enterprise as a policy instrument.

This paper assesses the potential of three methodological approaches common in the evaluation of complex public health interventions and applies them to the complex realm of community-led social enterprise.

Only through the involvement of different comparator groups, based on the research questions addressed, would it be possible to disentangle the embedded characteristics of organisations such as social enterprises. Each of the methods adopted in this research is time-consuming and resource-intensive and requires the researcher to possess advanced skills. Public officials should recognise the complexity and resource-intensive nature of such evaluation and resource it accordingly. If the aim of policymakers is to understand the added value of social enterprise organisations, an integrative research approach combining different research methods and design should be implemented to improve generalisability.

This study applies a range of favoured approaches to evaluate “complex” public health interventions include systematic reviews, realist evaluation and quasi-experimental investigation. However, such evaluation approaches have rarely been applied before in the context of social enterprise.

Inter-organisational collaboration (IOC) across healthcare settings has been put forward as a solution to mounting financial and sustainability challenges. Whilst ingredients for successful IOC have been explored, there remains limited understanding of the development of IOCs over time.

The authors systematically reviewed the literature to identify models applied to IOCs in healthcare across databases such as Healthcare Management Information Consortium (HMIC) and MEDLINE, identifying 2,763 titles and abstracts with 26 final papers included. The authors then used a “best fit” framework synthesis methodology to synthesise fourteen models of IOC in healthcare and the wider public sector to formulate an applied composite model describing the process through which collaborations change over time. This synthesis comprised extracting stages and behaviours from included models, selecting an a priori framework upon which to code these stages and behaviours and then re-coding them to construct a new composite model.

Existing models often did not consider that organisations may undergo many IOCs in the organisations' lifetime nor included “contemplation” stages or those analogous to “dissolution”, which might negatively impact papers using such models. The formulated' composite model utilises a life-cycle design comprising five non-linear phases, namely Contemplating, Connecting, Planning, Implementation and Maintenance or Dissolution and incorporates dynamic elements from Complex Adaptive Systems thinking to reflect the dynamic nature of collaborations.

This is the first purpose-built model of the lifecycles of IOCs in healthcare. The model is intended to inform implementers, evaluators and researchers of IOCs alike.

Schools are an important setting for a wide variety of activities to promote health. The purpose of this paper is to map the different types of health promotion programmes and activities in schools, to estimate the amount of published evaluations of health promotion within UK schools, and to identify any provisional “candidate programme theories” to inform a planned theory-driven systematic review.

Review of reviews: in total, 67 published systematic reviews of health promotion in schools were identified, from which a sub-sample of 28 systematic reviews (on 14 health topics) were retrieved for more detailed reading.

Key dimensions of programme design and delivery fell mainly under the following categories: the problem and age-group of children targeted, who delivers the programme and how, and the scale and theoretical underpinning of the programme. Candidate programme theories spanned both effectiveness factors and aspects of programme implementation.

Few detailed “candidate theories” emerged for explaining how and why health promotion can more successfully implemented in different schools.

There are five or more systematic reviews of studies of health promotion programmes in schools which target: smoking prevention; physical activity; sexual health; emotional and behavioural health and well-being; mental health; substance abuse; obesity/overweight. This suggests probable duplication of health problem-specific systematic reviews.

The findings highlight the considerable diversity of health promotion in schools, and specifies key dimensions of this diversity. They underline the need to understand better how, why, and in what circumstances health promotion can be successfully implemented in different schools and education systems.

Given the complex nature of integrated care systems (ICSs), the geographical spread and the large number of organisations involved in partnership delivery, the importance of leadership cannot be overstated. This paper aims to present novel findings from a rapid realist review of ICS leadership in England. The overall review question was: how does leadership in ICSs work, for whom and in what circumstances?

Development of initial programme theories and associated context–mechanism–outcome configurations (CMOCs) were supported by the theory-gleaning activities of a review of ICS strategies and guidance documents, a scoping review of the literature and interviews with key informants. A refined programme theory was then developed by testing these CMOCs against empirical data published in academic literature. Following screening and testing, six CMOCs were extracted from 18 documents. The study design, conduct and reporting were informed by the Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) training materials (Wong et al., 2013).

The review informed four programme theories explaining that leadership in ICSs works when ICS leaders hold themselves and others to account for improving population health, a sense of purpose is fostered through a clear vision, partners across the system are engaged in problem ownership and relationships are built at all levels of the system.

Despite being a rigorous and comprehensive investigation, stakeholder input was limited to one ICS, potentially restricting insights from varied geographical contexts. In addition, the recent establishment of ICSs meant limited literature availability, with few empirical studies conducted. Although this emphasises the importance and originality of the research, this scarcity posed challenges in extracting and applying certain programme theory elements, particularly context.

This review will be of relevance to academics and health-care leaders within ICSs in England, offering critical insights into ICS leadership, integrating diverse evidence to develop new evidence-based recommendations, filling a gap in the current literature and informing leadership practice and health-care systems.

The purpose of this paper is to present a case study describing the progress that is being made in one city in England to increase access to Care Act 2014 assessments and personal budgets among people with experiences of homelessness and multiple exclusion.

A case study employing a “study group” to describe and reflect on local development work.

The authors focus on the “systems change” activity that was undertaken by one voluntary sector partnership project to address issues of referral and access to adult social care. This included the development of a “Multiple Needs Toolkit” designed to support voluntary sector workers to communicate more effectively with adult social care around the application of the new Care Act 2014 eligibility thresholds. The authors discuss the role of “persistent advocacy” in increasing access to assessments and also the limitations of this as regard the potential for poorer joint working.

Throughout, the authors draw on the “ambiguity-conflict” model of policy implementation to assess if the learning from this single case study might be applied elsewhere.

The importance of culture is often emphasized for continuous learning and quality improvement within health care organizations. Limited empirical evidence for cultivating a culture that supports continuous learning and quality improvement in health care settings is currently available.

The purpose of this report is to characterize the evolution of a large division of physical therapists and occupational therapists in a pediatric hospital setting from 2005 to 2018 to identify key facilitators and barriers for cultivating a culture empowered to engage in continuous learning and improvement.

An ethnographic methodology was used including participant observation, document review, and stakeholder interviews to acquire a deep understanding and develop a theoretical model to depict insights gained from the investigation.

A variety of individual, social, and structural enablers and motivators emerged as key influences toward a culture empowered to support continuous learning and improvement. Features of the system that helped create sustainable, positive momentum (e.g., systems thinking, leaders with grit, and mindful design) and factors that hindered momentum (e.g., system uncertainty, staff turnover, slow barrier resolution, and competing priorities) were also identified.

Individual-level, social-level, and structural-level elements all influenced the culture that emerged over a 12-year period. Several cultural catalysts and deterrents emerged as factors that supported and hindered progress and sustainability of the emergent culture.

Cultivating a culture of continuous learning and improvement is possible. Purposeful consideration of the proposed model and identified factors from this report may yield important insights to advance understanding of how to cultivate a culture that facilitates continuous learning and improvement within a health care setting.

The aim of this research is to determine the impact of a learning organisation (LO) on developing quality improvement practices (QIPs) and to propose knowledge-sharing (KS) as a moderator which is anticipated to support the beneficial effect of a LO on QIP. A further objective is to establish whether training provision raises the abilities of healthcare organisations (HCOs) to attain greater standards of QIP via a LO and KS.

A total of 240 responses, obtained from employees working at private HCOs in Jordan, comprised the valid dataset. Structural equation modeling (SEM) was utilised for data analysis. Multigroup analysis (MGA) was performed to compare the impact of workers who had or had not undergone training.

The findings indicated that QIP was significantly enhanced by LO. HCOs with the objective of converting a KS-moderated LO could attain improved QIP standards, but within the surveyed establishments, this effect was only appreciated at modest degrees. By performing MGA, no variations were identified in the impact of workers.

Managers should place more emphasis on training and learning within HCOs. However, respondents did indicate that their establishments had notable degrees of KS, suggesting a potential strength that could be used positively by the managerial hierarchy.

This study encompasses an original contribution to contemporary scholarship in the field of knowledge management and quality through its examination of the moderating effect of KS on LO and QIP.

The purpose of this paper is to examine leadership behaviors associated with lean healthcare (LH) implementation and how they develop throughout the change process.

After a systematic literature review of 107 peer-reviewed articles on lean leaders’ behaviors, the authors undertook a one-year mixed-methods study of 12 leaders within a Brazilian public hospital undergoing LH implementation. Multivariate data analysis techniques were employed.

The literature review showed some convergence between effective lean leader behaviors in both manufacturing and healthcare work settings, implying that lean leaders’ behaviors are generalizable to other contexts than manufacturing. The empirical findings suggest that LH implementation needs leaders to demonstrate a set of task-oriented behaviors, especially if short-term results are mandatory. More mature lean leaders should also continue developing their relations-oriented behaviors.

While the contingency theory assumes that contexts influence (lean) practices adoption, leadership behaviors may not be bound to the work context. The finding resembles the augmentation effect of leadership whereby more mature lean leaders adopt both task- and relations-oriented behaviors.

Longitudinal studies in this field are scarce, regardless of the industrial setting. Many manufacturing and healthcare organizations crave for knowledge about lean leader behaviors throughout the lean implementation journey in order to enhance the effectiveness of their often-struggling lean initiatives. The insights derived from this study could help organizations to adjust their expectations as well as identify behavioral gaps and needs in terms of soft skills development among their leaders.