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Unlocking and transferring skills and capabilities in individuals to the teams they work within, and across, is the key to positive organisational development and improved patient care. Using the “deep smarts” model, the purpose of this paper is to examine these issues.

The “deep smarts” model is described, reviewed and proposed as a way of transferring knowledge and capabilities within healthcare organisations.

Effective healthcare delivery is achieved through, and continues to require, integrative care involving numerous, dispersed service providers. In the space of overlapping organisational boundaries, there is a need for “deep smarts” people who act as “boundary spanners”. These are critical integrative, networking roles employing clinical, organisational and people skills across multiple settings.

Studies evaluating the barriers and enablers to the application of the deep smarts model and 13 knowledge development strategies proposed are required. Such future research will empirically and contemporary ground our understanding of organisational development in modern complex healthcare settings.

An organisation with “deep smarts” people – in managerial, auxiliary and clinical positions – has a greater capacity for integration and achieving improved patient-centred care.

In total, 13 developmental strategies, to transfer individual capabilities into organisational capability, are proposed. These strategies are applicable to different contexts and challenges faced by individuals and teams in complex healthcare organisations.

Palliative care is a complex environment in which teams of health care professionals are constantly challenged to match the configuration of care delivery to suit the dynamics of the whole of a patient’s bio‐medical, social and spiritual situations as they change during the end of life process. In such an environment these teams need to engage in ongoing interaction between different professional disciplines, incremental improvement in care delivery, learning and radical innovation. This is aimed at combining operational effectiveness and strategic flexibility, exploitation and exploration in a way that ensures the best possible end of life experience for the patient. This paper examines previous research on the management competences and the organisational capabilities necessary for continuous innovation, and analyses evidence emerging from a study of palliative care. Work on the relationships between innovation capacities, organisational capabilities and team‐based competence is drawn together. Evidence is presented from research into the management of innovation in palliative care.

This paper is the second in a series that will examine the management of innovation by cross‐functional, multidisciplinary patient care teams in palliative care. Two further outcomes of this research are reported here. The first is that within palliative care a number of distinct individual behaviours are identified that act as foundations for the successful development and application of innovative practices by multidisciplinary teams. The second is that interviews with multidisciplinary palliative care teams in case studies in Australia confirm the existence and use of these behaviours. Individual behaviours within these teams are found to fall into two groups: those used by palliative care professionals when working with patients and patient‐based carers; and those used by professionals when dealing with each other away from patients. The purpose of both groups is to generate useful valid information, knowledge and learning that can be transferred across boundaries regardless of boundary type or location.

The implementation of Total Quality Management (TQM) principles and practices in continuous‐process manufacturing operations is described from initial consideration through to TQM becoming part of the normal operations of the company. The importance of management‐led project teams in the early phases of implementation and the subsequent shift to operator‐initiated and ‐controlled quality improvements is detailed. Accreditation to international quality system standards (ISO 9002) and the interaction of such accreditation with the cultural change required for successful TQM implementation is discussed. Problems confronting effective TQM implementation or quality‐system accreditation are discussed such as: relationships between the multinational parent company and the domestic subsidiary, and the geographical separation of sections of the company between head offices and manufacturing site. A detailed examination is made of the organisational structure utilised to develop a TQM culture within the company, and the dynamic nature of such an organisational structure in the early phases of implementation is observed. The major requirement for increasing employee involvement in quality‐improvement activities is found to be an increasing commitment to employee training in the areas of: TQM principles; statistical tools; group problem‐solving skills; and leadership skills.

Palliative care is a complex environment in which teams of healthcare professionals are constantly challenged to match the configuration of care delivery to suit the dynamics of the patient's bio‐medical, social and spiritual situations as they change during the end‐of‐life process. In such an environment these teams need to engage in ongoing interaction between different professional disciplines, incremental improvement in care delivery, learning and radical innovation. This is aimed at combining operational effectiveness, strategic flexibility, exploitation and exploration, in a way that ensures the best possible care for the patient. This paper examines previous research on the management competences and the organisational capabilities necessary for continuous innovation, and analyses evidence emerging from a study of palliative care. Work on the relationships between innovation capacities, organisational capabilities and team‐based competence is drawn together. Evidence is presented from research into the management of innovation in palliative care.

Much has been made of the need to empower employees at all levels of an organisation. There must be a genuine willingness on the part of management and workers to work together to ensure that empowerment will be accepted and succeed. Among those organisations which are prepared to bear the cost of training and multiskilling their employees, training is often ineffective and firms do not realise benefits from their investment. How can training be delivered to maximise the probability that the workers will learn and be able to implement new skills? Reports on a success story in a multi‐site manufacturing organisation which was able to train operations workers on the job, and by using active learning techniques demonstrate to the organisation the benefits of training. The reasons behind these changes, the effectiveness of the training programme, and the views of workers on the factory floor are examined. Interviews indicate that the success of the training programme, combined with other tactics, has seen real cultural change taking pace in the organisation, and workers believe they have been empowered.

Over a period of nearly five years a large number of technology oriented employees in an Australian aerospace company were exposed to a wide variety of post‐graduate coursework modules intended to add a business management perspective to the technology background of those employees. Not all of the students had prior experience with university education, but some of these people completed Masters degrees. Their experience is also discussed. Over the duration of the program the company was in a constant state of significant change. The number of employees initially increased, adding a further training load, but later on the number of employees decreased and the program was wound back. This paper looks at how the program was integrated with work, the perceived upsides and downsides several years down the track, and the influence of organisational culture on the learning styles of the participants.

The purpose of this paper is to provide a retrospective analysis of computer simulation’s role in accelerating individual innovation adoption decisions. The process innovation examined is Lean Systems Thinking, and the organizational context is the imaging department of an Australian public hospital.

Intrinsic case study methods including observation, interviews with radiology and emergency personnel about scheduling procedures, mapping patient appointment processes and document analysis were used over three years and then complemented with retrospective interviews with key hospital staff. The multiple data sources and methods were combined in a pragmatic and reflexive manner to explore an extreme case that provides potential to act as an instructive template for effective change.

Computer simulation of process change ideas offered by staff to improve patient-flow accelerated the adoption of the process changes, largely because animated computer simulation permitted experimentation (trialability), provided observable predictions of change results (observability) and minimized perceived risk.

The difficulty of making accurate comparisons between time periods in a health care setting is acknowledged.

This work has implications for policy, practice and theory, particularly for inducing the rapid diffusion of process innovations to address challenges facing health service organizations and national health systems.

The research demonstrates the value of animated computer simulation in presenting the need for change, identifying options, and predicting change outcomes and is the first work to indicate the importance of trialability, observability and risk reduction in individual adoption decisions in health services.