Journal of Health Organisation and Management (J Health Organisat Manag)

Publications in this journal

• Article: Understanding the work done by NHS commissioning managers: an exploration of the microprocesses underlying day-to-day sensemaking in UK primary care organisations.

  Checkland K, Harrison S, Snow S, Coleman A, McDermott I
  Journal of Health Organisation and Management 05/2013; 27(2):149.
• Article: Structuring Agency: Examining Healthcare Management in the U.S. and Australia Using Organizational Theory

  Julianne Payne, Jeffrey Leiter
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  ABSTRACT: Purpose: Since the 1970s, the healthcare industry has undergone significant changes. Using neoinstitutional and resource dependency theories, this paper explores how managers perceive constraint and enact agency amidst these historic challenges – perhaps most significantly, declining funding and increasing regulation. Design/methodology/approach: Our data come from ten interviews with healthcare managers, spanning for-profit, nonprofit, and government legal forms and hospital and nursing home sub-industries in both Queensland, Australia and North Carolina, U.S.A. We look for patterns across the interviews. Findings: We show that governments and umbrella “parent” organizations force managers to adhere to institutional expectations in exchange for resource investment. Managers navigate these environmental obstacles using a shared business-minded approach and competitive differentiation. Yet various interest groups – including front-line workers, physicians, and patients – challenge this paradigm as they demand a focus on quality of care. Managers’ efforts are likewise curbed by the very resource and institutional pressures they resist. Originality/value: We understand changes in the healthcare industry as resulting from an increasingly powerful managerial logic, at odds with traditional professional and societal values. Interest groups are best positioned to challenge this logic.
  Journal of Health Organisation and Management 01/2013; 27(1):106-126.
• Article: Social values in health priority setting: a conceptual framework.

  Sarah Clark, Albert Weale
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  ABSTRACT: It is commonly recognized that the setting of health priorities requires value judgements and that these judgements are social. Justifying social value judgements is an important element in any public justification of how priorities are set. The purpose of this paper is to review a number of social values relating both to the process and content of priority-setting decisions. A set of key process and content values basic to health priority setting is outlined, and normative analysis applied to those values to identify their key features, possible interpretations in different cultural and institutional contexts, and interactions with other values. Process values are found to be closely linked, such that success in increasing, for example, transparency may depend on increasing participation or accountability, and "content" values are found often to be hidden in technical criteria. There is a complex interplay between value and technical components of priority setting, and between process and content values. Levels of economic development, culture and need will all play a part in determining how different systems balance the values in their decisions. Technical analyses of health priority setting are commonplace, but approaching the issues from the perspective of social values is a more recent approach and one which this paper seeks to refine and develop.
  Journal of Health Organisation and Management 01/2012; 26(3):293-316.
• Article: Social values and healthcare priority setting in Korea.

  Jeonghoon Ahn, Gaeun Kim, Hae Sun Suh, Sang Moo Lee
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  ABSTRACT: The purpose of this paper is to present the role of social values in setting healthcare priorities in Korea. Using Clark and Weale's draft framework, Korean healthcare priority setting was analysed. The process values used were transparency, accountability, and participation, and the content values used were clinical effectiveness, cost effectiveness, justice/equity, solidarity and autonomy. In the Korean health priority setting, it was found that multiple factors influence the decision-making process. Effectiveness and safety are the two most important values mentioned in the process. Cost-effectiveness is also considered in reimbursement decisions for new drugs since 2007. Recently, health technology assessment (HTA) has begun to change the social value system traditionally used in the Korean healthcare priority setting. The paper extends understanding of health priority setting in Korea, and how the interpretation and use of social values has changed over recent years.
  Journal of Health Organisation and Management 01/2012; 26(3):343-50.
• Article: Universal health coverage and litigation in Latin America.

  Leonardo Cubillos, Maria-Luisa Escobar, Sebastian Pavlovic, Roberto Iunes
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  ABSTRACT: Over the last five years many middle-income Latin American countries have seen a steep increase in the number of cases litigating access to curative services. The purpose of this paper is to explore this complex phenomenon and outline some of its roots and impacts. The authors use an interdisciplinary approach based on a literature review and workshops convened to discuss the issue. A range of reasons can explain this increased legal activity. These include: a renewed judicial approach to the enforcement of the right to health; a more demanding public interest; an increased prevalence of non communicable diseases; and limited capacity for fair benefit package. The findings in this paper argue for the need to incorporate a rights-based approach to health policy as a foundation of societal efforts to achieve universal health coverage in Latin America.
  Journal of Health Organisation and Management 01/2012; 26(3):390-406.
• Article: A systems perspective on nursing productivity.

  Nicola North, Frances Hughes
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  ABSTRACT: Recent New Zealand reports have identified the nursing workforce for its potential to make a significant contribution to increased productivity in health services. The purpose of this paper is to review critically the recent and current labour approaches to improve nursing productivity in New Zealand, in a context of international research and experience. An examination of government documents regarding productivity, and a review of New Zealand and international literature and research on nursing productivity and its measurement form the basis of the paper. It is found that productivity improvement strategies are influenced by theories of labour economics and scientific management that conceptualise a nurse as a labour unit and a cost to the organisation. Nursing productivity rose significantly with the health reforms of the 1990s that reduced nursing input costs but impacts on patient safety and nurses were negative. Current approaches to increasing nursing productivity, including the "productive ward" and reconfiguration of nursing teams, also draw on manufacturing innovations. Emerging thinking considers productivity in the context of the work environment and changing professional roles, and proposes reconceptualising the nurse as an intellectual asset to knowledge-intensive health organisations. Strategies that take a systems approach to nursing productivity, that view nursing as a capital asset, that focus on the interface between nurse and working environment and measure patient and nurse outcomes are advocated. The paper shows that reframing nursing productivity brings into focus management strategies to raise productivity while protecting nursing and patient outcomes.
  Journal of Health Organisation and Management 01/2012; 26(2):192-214.
• Article: Motivation and retention of health workers in Ghana's district hospitals: addressing the critical issues.

  Francis A Adzei, Roger A Atinga
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  ABSTRACT: This study seeks to undertake a systematic review to consolidate existing empirical evidence on the impact of financial and non-financial incentives on motivation and retention of health workers in Ghana's district hospitals. The study employed a purely quantitative design with a sample of 285 health workers from ten district hospitals in four regions of Ghana. A stepwise regression model was used in the analysis. The study found that financial incentives significantly influence motivation and intention to remain in the district hospital. Further, of the four factor model of the non-financial incentives, only three (leadership skill and supervision, opportunities for continuing professional development and availability of infrastructure and resources) were predictors of motivation and retention. A major limitation of the study is that the sample of health workers was biased towards nurses (n = 160; 56.1 percent). This is explained by their large presence in remote districts in Ghana. A qualitative approach could enrich the findings by bringing out the many complex views of health workers regarding issues of motivation and retention, since quantitative studies are better applied to establish causal relationships. The findings suggest that appropriate legislations backing salary supplements, commitment-based bonus payments with a set of internal regulations and leadership with sound managerial qualities are required to pursue workforce retention in district hospitals.
  Journal of Health Organisation and Management 01/2012; 26(4-5):467-85.
• Article: Social values and health policy: a new international research programme.

  Peter Littlejohns, Albert Weale, Kalipso Chalkidou, Ruth Faden, Yot Teerawattananon
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  ABSTRACT: This editorial aims to outline the context of healthcare priority-setting, and summarise each of the other ten papers in this special edition. It introduces a new multidisciplinary research programme drawing on ethics, philosophy, health economics, political science and health technology assessment, out of which the papers in this edition have arisen. Key normative concepts are introduced and policy and research context provided to frame subsequent papers in the edition. Common challenges of health priority-setting are faced by many countries across the world, and a range of social value judgments is in play as resource allocation decisions are made. Although the challenges faced by different countries are in many ways similar, the way in which social values affect the processes and content of priority-setting decisions means that those challenges are resolved very differently in a variety of social, political, cultural and institutional settings, as subsequent papers in this edition demonstrate. How social values affect decision making in this way is the subject of a new multi-disciplinary research programme. Technical analyses of health priority setting are commonplace, but approaching the issues from the perspective of social values and conducting comparative analyses across countries with very different cultural, social and institutional contexts provides the content for a new research agenda.
  Journal of Health Organisation and Management 01/2012; 26(3):285-92.
• Article: Clinical managers in the primary care sector: do the benefits stack up?

  Chris O'Riordan, Aoife McDermott
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  ABSTRACT: The purpose of this paper is to explore the nature and value of the clinical management role undertaken by primary care doctors in Ireland. To date, a majority of research has focused on clinical management roles in the acute sector. The paper presents a sub-set of data from a mixed methods study. In total, 14 semi-structured interviews are drawn upon to identify the nature and value of the clinical management role in primary care. Comparison with acute sector research identifies considerable differences in the nature of the clinical management role across sectors--and in the associated value proposition. Structural and role-related contingencies affecting the potential value of clinical management roles in Irish primary care are discussed. Structural influences include the private ownership structure, low complexity and limited requirement for cross-professional coordination. Role-related influences include the primacy of the clinical identity, time constraints and lack of managerial training. The findings provide a limited basis for generalisation, premised on 14 interviews in one national context. However, given the international shift towards the provision of health services in primary care, they provide a research agenda for an important healthcare context. The findings draw attention to the need for policy consideration of the value of the clinical manager role in primary care; how policy can support effective primary care management; and the need for specialised management training, which takes account of the small-firm context. The paper identifies that primary-care clinical-management roles focus on operational management and oversight and discusses the structural and role-related factors which affect their efficacy.
  Journal of Health Organisation and Management 01/2012; 26(4-5):621-40.
• Article: Reforms and clinical managers' responses: a study in Norwegian hospitals.

  Inger Johanne Pettersen, Kari Nyland
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  ABSTRACT: This paper seeks to explore the legitimacy of budgets as management control processes in hospitals after comprehensive reforms were implemented in the Norwegian hospital sector in 2002. The paper employs qualitative interviews with top level clinical managers in three large hospitals. The study shows a variety of practices among the clinical managers as to management control adjustments. The managers use different strategies in order to cope with the budget frames. This paper contributes to the current debate and research relating to the budgeting and performance management practices in hospital settings. These findings contribute to contextual knowledge that is relevant in understanding the diverse practices of clinical managers in hospitals as complex service producing organizations. SOCIAL IMPLICATIONS: The findings give information to decision makers as to the diversity in management practices within knowledge intensive organizations. The paper challenges the idea that the strategies used by managers can be understood by the concepts of the means-end rationality prescribed in most of the reforms introduced into the hospital sector.
  Journal of Health Organisation and Management 01/2012; 26(1):15-31.
• Article: A proposal for a new social values research program and policy network.

  Peter Littlejohns, Kai Yeung, Sarah Clark, Albert Weale
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  ABSTRACT: The purpose of this paper is to demonstrate that the social values framework developed by Clark and Weale could be applied to publicly available data and to explore the concordance between the framework values and those present in the statements of decision-making protocols of Health Technology Assessment Agencies. The web sites of the National Institute for Health and Clinical Excellence (NICE); the All Wales Strategy Medicines Group; and the Scottish Medicines Consortium were searched for references to social value statements and assessed according to the social values framework. The framework was easy to apply and demonstrated that it is possible to find statements of operational expression of a range of social values in the description of the decision protocols used by the public agencies. Most of the framework's values find some expression in the statements of the decision protocols, but there are differences. For example, the All Wales Group, when discussing clinical effectiveness, explicitly refers to an assessment via "pathways of care" in a way that neither of the other two do. The value of autonomy is explicitly mentioned by NICE but not by the other two, whereas the value of solidarity (a value most typically associated with European social insurance systems) finds only indirect expression in the guidance notes of all. The paper provides further information that will be useful in revising the framework in preparation for its role in future data collection. This is the initial step in developing a social values instrument that will support health policy decisions. While there are other check lists of social values, this is the first time that an approach to creating a framework is being tested empirically.
  Journal of Health Organisation and Management 01/2012; 26(3):407-21.
• Article: Social values and health priority setting in England: "values" based decision making.

  Peter Littlejohns, Tarang Sharma, Kim Jeong
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  ABSTRACT: The purpose of this paper is to provide an overview of the organisational and procedural arrangements for priority setting in England and Wales. It describes the role of social values in the decision-making process. The processes and content of decisions made by the National Institute for Health and Clinical Excellence are analysed using the framework developed by Clark and Weale for identifying social values in health priority-setting. While countries are seeking to achieve similar outcomes from their health prioritisation processes, each country has established different systems that reflect the social and legal framework underpinning their health systems. England is somewhat unique in being explicit about assessing "value for money" and using formal cost-effectiveness in developing policy. Many countries are now considering the use of formal health economic methodologies to assess the value and prioritise health care interventions. However there is increasing recognition of the importance of values other than efficiency (cost effectiveness) in making acceptable decisions. This is manifest in the range of potential new approaches being developed including multiple criteria decision analysis.
  Journal of Health Organisation and Management 01/2012; 26(3):363-73.
• Article: Consideration of social values in the establishment of accountable care organizations in the USA.

  Ron Keren, Peter Littlejohns
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  ABSTRACT: The purpose of this paper is to introduce the new US health organizations called accountable care organizations (ACOs) which are expected to improve the quality and reduce the cost of healthcare for Medicare enrolees. It assesses the importance of ACOs, defining and articulating the values that will underpin their strategic and clinical decision making. This paper uses a social values framework developed by Clark and Weale to consider the values relevant to ACOs. It is likely that social values could be made more explicit in a US setting than they have ever been before, via the new ACOs. Social values could start to form part of a local health economy's marketing strategy. ACOs are very new. This paper identifies that they will need to be very explicit about the values relevant to them. The development of ACOs and the articulation of social values therein may even form the basis of a meaningful dialogue on the importance of assessing value for money or cost-effectiveness in the wider US health policy environment.
  Journal of Health Organisation and Management 01/2012; 26(3):384-9.
• Article: Role of innovative institutional structures in integrated governance. A case study of integrating health and nutrition programs in Chhattisgarh, India.

  Anuska Kalita, Shinjini Mondal
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  ABSTRACT: The aim of this paper is to highlight the significance of integrated governance in bringing about community participation, improved service delivery, accountability of public systems and human resource rationalisation. It discusses the strategies of innovative institutional structures in translating such integration in the areas of public health and nutrition for poor communities. The paper draws on experience of initiating integrated governance through innovations in health and nutrition programming in the resource-poor state of Chhattisgarh, India, at different levels of governance structures--hamlets, villages, clusters, blocks, districts and at the state. The study uses mixed methods--i.e. document analysis, interviews, discussions and quantitative data from facilities surveys--to present a case study analyzing the process and outcome of integration. The data indicate that integrated governance initiatives improved convergence between health and nutrition departments of the state at all levels. Also, innovative structures are important to implement the idea of integration, especially in contexts that do not have historical experience of such partnerships. Integration also contributed towards improved participation of communities in self-governance, community monitoring of government programs, and therefore, better services. As governments across the world, especially in developing countries, struggle towards achieving better governance, integration can serve as a desirable process to address this. Integration can affect the decentralisation of power, inclusion, efficiency, accountability and improved service quality in government programs. The institutional structures detailed in this paper can provide models for replication in other similar contexts for translating and sustaining the idea of integrated governance. This paper is one of the few to investigate innovative public institutions of a and community mobilisation to explore this important, and under-researched, topic.
  Journal of Health Organisation and Management 01/2012; 26(6):758-77.
• Article: The impact of team empowerment on proactivity: The moderating roles of leader's emotional intelligence and proactive personality

  Erkutlu, Hakan, Chafra, Jamel
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  ABSTRACT: Purpose – The purpose of this study is to investigate the relationship between team empowerment and team proactivity and the moderating roles of a team leader's emotional intelligence (EI) and a team member's proactive personality. Design/methodology/approach – To provide a rigorous test of the hypotheses, a field study from a sample of 910 certified nurses in 82 teams from 12 university hospitals in Turkey was conducted. Findings – The results reveal that proactivity is positively associated with team empowerment. In addition, team leader's EI and team members' proactive personality influence the relationship between team empowerment and team proactivity. Specifically, teams exhibit the highest proactivity when team leaders' EI and team members' proactive personality are high. Research limitations/implications – The main strength of the investigation in this study was its multilevel research design. Most research on proactivity and empowerment has been conducted within single organizations, precluding an assessment of the way in which individual difference variables influence empowerment or proactivity. The multilevel design incorporated in this study, however, was capable of capturing the complexity of individual behaviors by considering different contexts. Practical implications – In encouraging team proactivity, leadership and team members' personality characteristics do matter. Identifying individual difference variables such as team leader's EI, leader-member exchange, locus of control or team members' personality help to advance the theoretical understanding of the team proactivity. This study provides evidence of the positive relationship between team empowerment and team proactivity. Such knowledge may help to search for continuous improvement and innovative solutions to work problems employed by healthcare administrators and potentially reduce the costs associated with losing high-potential nurses. Originality/value – This is one of the first studies to provide evidence of the moderating roles of the team leader's EI and team members' proactive personality levels on the relationship between team empowerment and team proactivity in university hospitals that formally implement work teams.
  Journal of Health Organisation and Management 01/2012; 26(5):560 - 577.
• Article: Building effective clinical teams in healthcare.

  Zoheir Ezziane, Mahiben Maruthappu, Lynsey Gawn, Emily A Thompson, Thanos Athanasiou, Oliver J Warren
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  ABSTRACT: This article aims to review teamwork and the creation of effective teams within healthcare. By combining research material found in management, psychology and health services research the article explores the drivers increasing the importance of teamwork, reviews the current knowledge base on how to build a team and focuses on some of the barriers to effective team performance. The simultaneous inflation of healthcare costs and necessity to improve quality of care has generated a demand for novel solutions in policy, strategy, commissioning and provider organisations. A critical, but commonly undervalued means by which quality can be improved is through structured, formalised incentivisation and development of teams, and the ability of individuals to work collectively and in collaboration. Several factors appear to contribute to the development of successful teams, including effective communication, comprehensive decision making, safety awareness and the ability to resolve conflict. Not only is strong leadership important if teams are to function effectively but the concept and importance of followership is also vital. Building effective clinical teams is difficult. The research in this area is currently limited, as is the authors' understanding of the different requirements faced by those working in different areas of the health and social care environment. This article provides a starting place for those interested in leading and developing teams of clinicians.
  Journal of Health Organisation and Management 01/2012; 26(4-5):428-36.
• Article: Discursive construction of polyphony in healthcare management.

  Anneli Hujala, Sari Rissanen
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  ABSTRACT: The aim of the paper is to understand and define how the polyphony of management is constructed in interaction and to describe this through concrete management meeting cases. Polyphony refers to the diverse voices of various organization members, and how these voices are present, disclosed and utilized in management. The study is based on the social constructionist and discursive perspectives of management, which question the traditional, individualistic approaches of management. The issue was examined through a qualitative case study by analysing the micro-level management discourse in three healthcare organizations. Discursive practices that enhance or inhibit polyphony are often unnoticed and unconscious. Key moments of management discourse are an example of unconscious mundane practices through which members of organizations construct the reality of management. The empirical results are locally contextual. In the future, research will be able to apply the approach to diverse contexts as well as link micro-level discourses to the construction of broader health and social management discourses. The paper increases the understanding of how to enhance participation and staff contribution, and how to utilize the knowledge of all members of the organization. SOCIAL IMPLICATIONS: Both managers and other staff members are fully involved in the social construction of management. Micro-level discourse should be paid attention to in management work as well as in the education of managers and staff. The study increases the understanding of micro-level issues of management and challenges the conventional, taken-for-granted assumptions behind organization and management theories.
  Journal of Health Organisation and Management 01/2012; 26(1):118-36.
• Article: Managerialism and professional strategies: a case from nurses in Portugal.

  Teresa Carvalho
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  ABSTRACT: There have been profound changes in the Portuguese national health system (NHS), instigated under the influence of managerialism and the new public management (NPM) "philosophy". These changes have been in line with what has happened in other developed countries. At the beginning of the new century, important reforms that emphasised the efficient use of scarce resources were implemented. The objective of this study is to understand how nurses are adapting to a more managerial environment, one in which economic rationalism and market-driven initiatives are the key principles behind the health reforms. A qualitative study was developed, based on semi-structured interviews with 83 nurses with managerial duties in ten hospitals in Portugal. All interviews were tape-recorded and each interviewee's discourses were subjected to content analysis. Data analysis led to the conclusion that under the new logic of the market and managerialism, these professionals have tried to (re)define their professionalisation route by emphasising the importance of care but also by trying to incorporate management as their dominant role in the social division of work. In reconfiguring their notion of professionalism, nurses were incorporating new practices in their day-to-day activities. This empirical study confirms that professionalism can also be conceptualised as a technology of self-control being able to discipline professionals at the micro level. This research is an empirical study based on the effects of managerialism on nurses with managerial duties in Portugal. This study contributes to a better understanding of the complex process of the professionalisation of nurses in a context of institutional change.
  Journal of Health Organisation and Management 01/2012; 26(4-5):524-41.
• Article: Leadership, clinician managers and a thing called "hybridity".

  Liz Fulop
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  ABSTRACT: In many countries leadership theories and leadership development programs in healthcare have been dominated by individualistic and heroic approaches that focus on developing the skills and competencies of health professionals. Alternative approaches have been proffered but mainly in the form of post-heroic and distributed forms of leadership. The notion of "hybridity" has emerged to challenge the assumptions of distributed leadership. The paper seeks to explore how the concept of hybridity can be used to re-theorize leadership in healthcare as it relates to clinician managers (or hybrid-professional managers). The theoretical developments are explored and empirical material is presented from research in Australian public hospitals to support the case for the existence of hybridized forms of leadership in healthcare. The paper discusses whether hybridity needs re-theorizing to adequately account for clinician leadership. It contributes to debates surrounding the role of clinician leadership in healthcare reform particularly in relation to those doctors who occupy management positions at the division or unit levels as distinct to CEOs. The study uses qualitative research, i.e. interactive interviews to present accounts of how healthcare professionals describe leadership. It undertakes both deductive and inductive theme analysis of the interview material. There is support for hybridized configurations of leadership in interview materials of healthcare professionals but other aspects were also noted that cannot be explained by this approach alone. The paper is the first to examine the concept of hybridity in the context of clinician leadership. Many approaches to leadership in healthcare fail to address the complexity of leadership within the ranks of clinician managers and thus are unable to deal adequately with the role of leadership in healthcare reform and change.
  Journal of Health Organisation and Management 01/2012; 26(4-5):578-604.
• Article: Sensemaking: a driving force behind the integration of professional practices.

  Chantal Sylvain, Lise Lamothe
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  ABSTRACT: There has been considerable effort in recent years to link and integrate professional services more closely for patients with comorbidities. However, difficulties persist, especially at the clinical level. This study aims to shed light on these difficulties by examining the process of sensemaking in professionals directly involved in this integration. The authors conducted an eight-year longitudinal case study of an organization specializing in mental health and substance abuse. Different data collection methods were used, including 34 interviews conducted between 2003 and 2009, observations and document analysis. The authors performed a qualitative analysis of the data using a processual perspective. This paper provides empirical insights about the nature of the sensemaking process in which professionals collectively participate and the effects of this process on the evolution of integrated services. It suggests that the development of integrated practices results from an evolutional and collective process of constructing meanings that is rooted in the work activities of the professionals involved. By drawing attention to the capacity of professionals to shape the projects they are implementing, this study questions the capacity of managers to actually manage such a process. In order to obtain the expected benefits of integration projects, such emergent dynamics must first be recognized and then supported. Only then can thought be given to mastering them. The fact that this is a single case study is not a limitation per se, although it does raise the issue of the transferability of results. Replicating the study in other contexts would verify the applicability of the authors' conclusions. This study offers a fresh perspective on the difficulties generally encountered at the clinical level when trying to integrate services. It makes a significant contribution to work on the dynamics of sensemaking in organizational life.
  Journal of Health Organisation and Management 01/2012; 26(6):737-57.