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Open Access
Article
Publication date: 19 June 2017

Joy Furnival, Kieran Walshe and Ruth Boaden

Healthcare regulation is one means to address quality challenges in healthcare systems and is carried out using compliance, deterrence and/or improvement approaches. The four…

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Abstract

Purpose

Healthcare regulation is one means to address quality challenges in healthcare systems and is carried out using compliance, deterrence and/or improvement approaches. The four countries of the UK provide an opportunity to explore and compare different regulatory architecture and models. The purpose of this paper is to understand emerging regulatory models and associated tensions.

Design/methodology/approach

This paper uses qualitative methods to compare the regulatory architecture and models. Data were collected from documents, including board papers, inspection guidelines and from 48 interviewees representing a cross-section of roles from six organisational regulatory agencies. The data were analysed thematically using an a priori coding framework developed from the literature.

Findings

The findings show that regulatory agencies in the four countries of the UK have different approaches and methods of delivering their missions. This study finds that new hybrid regulatory models are developing which use improvement support interventions in parallel with deterrence and compliance approaches. The analysis highlights that effective regulatory oversight of quality is contingent on the ability of regulatory agencies to balance their requirements to assure and improve care. Nevertheless, they face common tensions in sustaining the balance in their requirements connected to their roles, relationships and resources.

Originality/value

The paper shows through its comparison of UK regulatory agencies that the development and implementation of hybrid models is complex. The paper contributes to research by identifying three tensions related to hybrid regulatory models; roles, resources and relationships which need to be managed to sustain hybrid regulatory models.

Details

Journal of Health Organization and Management, vol. 31 no. 4
Type: Research Article
ISSN: 1477-7266

Keywords

Open Access
Article
Publication date: 12 November 2019

Joy Furnival, Ruth Boaden and Kieran Walshe

Organisations within healthcare increasingly operate in rapidly changing environments and present wide variation in performance. It can be argued that this variation is influenced…

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Abstract

Purpose

Organisations within healthcare increasingly operate in rapidly changing environments and present wide variation in performance. It can be argued that this variation is influenced by the capability of an organisation to improve: its improvement capability. However, there is little theoretical research on improvement capability. The purpose of this paper is to set out the current diverse body of research on improvement capability and develop a theoretically informed conceptual framework.

Design/methodology/approach

This paper conceptualises improvement capability as a dynamic capability. This suggests that improvement capability is comprised of organisational routines that are bundled together, and adapt and react to organisational circumstances. Existing research conceptualises these bundles as three elements (microfoundations): sensing, seizing and reconfiguring. This conceptualisation is used to explore how improvement capability can be understood, by inductively categorising eight dimensions of improvement capability to develop a theoretically informed conceptual framework.

Findings

This paper shows that the three microfoundations which make up a dynamic capability are present in the identified improvement capability dimensions. This theoretically based conceptual framework provides a rich explanation of how improvement capability can be configured.

Originality/value

Identifying the component parts of improvement capability helps to explain why some organisations are less successful in improvement than others. This theoretically informed framework can support managers and policy makers to identify improvement capability dimensions in need of development. Further empirical research, particularly in non-market settings, such as publicly funded healthcare is required to enhance understanding of improvement capability and its configuration.

Details

Journal of Health Organization and Management, vol. 33 no. 7/8
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 13 February 2017

Lisa Rogan and Ruth Boaden

Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely…

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Abstract

Purpose

Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care.

Design/methodology/approach

Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management.

Findings

There are various elements of the principal-agent framework that can be applied in primary care. Goal alignment is relevant, but can only be achieved through clear, strategic direction and consistent interpretation of objectives at all levels. There is confusion between performance measurement and performance management and a tendency to focus on things that are easy to measure whilst omitting aspects of care that are more difficult to capture. Appropriate use of incentives, good communication, clinical engagement, ownership and trust affect the degree to which information asymmetry is overcome and goal alignment achieved. Achieving the right balance between accountability and clinical autonomy is important to ensure governance and financial balance without stifling innovation.

Originality/value

The principal-agent theoretical framework can be used to attain a better understanding of performance management in primary care; although it is likely that only partial goal alignment will be achieved, dependent on the extent and level of alignment of a range of factors.

Details

International Journal of Health Care Quality Assurance, vol. 30 no. 1
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 1 January 1999

Barrie Dale, Ruth Boaden, R McQuater, Mick Marchington, Martin Spring, Adrian Wilkinson and Mark Wilcox

Over the past decade, the establishment and growth of quality awards has stimulated organizational self‐assessment using the award models. Four new methods developed from…

Abstract

Over the past decade, the establishment and growth of quality awards has stimulated organizational self‐assessment using the award models. Four new methods developed from fieldwork in the UK can be used not only to support the gathering of data required by the models, but also in stand‐alone mode to assist managers to identify and recognize the symptoms, root causes and issues that are adversely affecting their improvement process in the areas of sustainability, tools and techniques, human resources and product design and development.

Details

Measuring Business Excellence, vol. 3 no. 1
Type: Research Article
ISSN: 1368-3047

Article
Publication date: 1 April 1997

Ethne Swartz and Ruth Boaden

Describes the combination of research methods used to investigate the process of Information Management (IM) in small firms. IM was defined as encompassing all management issues…

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Abstract

Describes the combination of research methods used to investigate the process of Information Management (IM) in small firms. IM was defined as encompassing all management issues related to Information Systems (IS) and involving processes relating to planning, organization, control and technology.A large body of literature details the issues associated with IM in large organizations, assisting the understanding of the processes involved in this organizational context. This is not the case for small firms. Due to the different situational context of small firms, it is essential that the issues associated with IM be made explicit. Argues that a “between‐methods” triangulated approach is most suitable for researching IM in small firms, enabling cross‐validation of data yielded by different methods. The research approach was inductive, making use of a combination of quantitative and qualitative methods. A mailed questionnaire study was conducted to identify macro level phenomena which were investigated at a later stage by developing case studies of four companies which had participated in the questionnaire study. This second phase of the research provided rich data on phenomena which occur at the micro level. The use of multi‐site studies overcame the problems associated with the specificity of single case studies. The findings of the two research strategies were reconciled using Grounded Theory; conclusions were drawn and models generated for use by other researchers.

Details

International Journal of Entrepreneurial Behavior & Research, vol. 3 no. 1
Type: Research Article
ISSN: 1355-2554

Keywords

Article
Publication date: 1 May 1986

R.J. Boaden and B.G. Dale

The development of a method of planning for computer‐integrated manufacture (CIM) used within Eaton Corporation (Truck Components Europe) which produces complex engineering…

Abstract

The development of a method of planning for computer‐integrated manufacture (CIM) used within Eaton Corporation (Truck Components Europe) which produces complex engineering products is described. The method relies heavily on a model of CIM as the basis for planning. Different types of models (the wheel model, linked models and linked and defined models) are described with their usefulness in CIM planning outlined. The development of a CIM model is beneficial for planning and the process of the model's evolution can greatly increase CIM understanding. CIM models help to focus on functions and business objectives rather than being constrained by departmental boundaries, bringing a new dimension to strategic planning.

Details

International Journal of Operations & Production Management, vol. 6 no. 5
Type: Research Article
ISSN: 0144-3577

Keywords

Article
Publication date: 14 June 2013

Paula Hyde, Paul Sparrow, Ruth Boaden and Claire Harris

The purpose of this paper is to examine National Health Service (NHS) employee perspectives of how high performance human resource (HR) practices contribute to their performance.

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Abstract

Purpose

The purpose of this paper is to examine National Health Service (NHS) employee perspectives of how high performance human resource (HR) practices contribute to their performance.

Design/methodology/approach

The paper draws on an extensive qualitative study of the NHS. A novel two‐part method was used; the first part used focus group data from managers to identify high‐performance HR practices specific to the NHS. Employees then conducted a card‐sort exercise where they were asked how or whether the practices related to each other and how each practice affected their work.

Findings

In total, 11 high performance HR practices relevant to the NHS were identified. Also identified were four reactions to a range of HR practices, which the authors developed into a typology according to anticipated beneficiaries (personal gain, organisation gain, both gain and no‐one gains). Employees were able to form their own patterns (mental models) of performance contribution for a range of HR practices (60 interviewees produced 91 groupings). These groupings indicated three bundles particular to the NHS (professional development, employee contribution and NHS deal).

Practical implications

These mental models indicate employee perceptions about how health services are organised and delivered in the NHS and illustrate the extant mental models of health care workers. As health services are rearranged and financial pressures begin to bite, these mental models will affect employee reactions to changes both positively and negatively.

Originality/value

The novel method allows for identification of mental models that explain how NHS workers understand service delivery. It also delineates the complex and varied relationships between HR practices and individual performance.

Details

Journal of Health Organization and Management, vol. 27 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 1 August 1999

Ruth Boaden, Nathan Proudlove and Melanie Wilson

This paper analyses the role of bed managers and the processes involved in admission, stay, transfer and discharge of patients in the hospital setting. The paper seeks to begin a…

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Abstract

This paper analyses the role of bed managers and the processes involved in admission, stay, transfer and discharge of patients in the hospital setting. The paper seeks to begin a discussion of the difficulties entailed in the allocation of beds within the context of confined resources. This is achieved by: a review of the somewhat sparse literature on bed management and associated issues; the development of frameworks of analysis with regard to what bed managers do and the information used to support the bed management function; and an explication of results from fieldwork. This is followed by a discussion of the scope of responsibility and career role of the bed manager as well as the potential and problems of bed data. Contacts with others investigating this field and other trusts indicate that the situation in Greater Manchester may be typical of most areas.

Details

Journal of Management in Medicine, vol. 13 no. 4
Type: Research Article
ISSN: 0268-9235

Keywords

Article
Publication date: 1 January 2006

Ruth J. Boaden

This paper seeks to examine the impact of a leadership development programme provided for, and funded by, the NHS.

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Abstract

Purpose

This paper seeks to examine the impact of a leadership development programme provided for, and funded by, the NHS.

Design/methodology/approach

It analyses the context, process of delivery and outcomes of the programme in the light of relevant leadership research. The programme itself is described after some consideration of the literature. Although the programme was originally commissioned by the NHS Leadership Centre for Human Resource (HR) professionals from the NHS, it is now offered to any aspiring or newly‐appointed director, and aims (amongst other things) to enable NHS staff to manage people more effectively within the context of change.

Findings

The paper concludes that the programme has, to date, been successful in impacting on personal and organisational contribution, as far as individual participants, commissioners and providers are concerned, and as far as can be measured within current understanding.

Originality/value

The programme fits well with the most recent typologies of leadership development.

Details

Leadership & Organization Development Journal, vol. 27 no. 1
Type: Research Article
ISSN: 0143-7739

Keywords

Article
Publication date: 1 January 1993

B.G. Dale and R.J. Boaden

Following research on the subject of TQM, the authors decided that what was lacking was a framework for the introduction and development of the process for continuous quality…

Abstract

Following research on the subject of TQM, the authors decided that what was lacking was a framework for the introduction and development of the process for continuous quality improvement.

Details

The TQM Magazine, vol. 5 no. 1
Type: Research Article
ISSN: 0954-478X

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