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Organization Theory and Health Services Management
... Shortell and Kaluzny [7] enumerate the oft-mentioned attributes that serve to make healthcare organizations unique: ...
... Little effective organizational or managerial control exists over the group most responsible for generating work and expenditures: physicians. Dual lines of authority exist in many health care organizations, particularly hospitals, that create problems of coordination and accountability and confusion of roles" [7], p. 10. ...
... Although they logically refute the uniqueness of each attribute to healthcare, they note that healthcare organizations may be unusual "in that many of them possess all of the characteristics … in combination" [7], p. 11. In fact, Wiersinga and Levi suggest, it may "be that the complexity of hospital organizations in which patient care, and often research and education, are fully integrated is too immense or unique to merely duplicate ideas from other industries" [8], p. 425. ...
... The urgent need for innovative management methods and business-type models in public healthcare organisations could create tensions between the contradictory aims and values of public healthcare and business. Moreover, reputation and legitimacy concerns together with constraints related to public healthcare provision further increase the complexity and the potential for dilemmas (see also Shortell & Kaluzny 2006;Kuoppakangas et al. 2013;Tevameri & Virtanen 2013, 251-269;Tevameri & Kallio 2009). A further significant factor concerns the political influences that inevitably affected the decision-making in the three publicly owned and taxfunded case organisations (see also Virtanen & Stenvall 2010). ...
... Hence, working on external and internal branding simultaneously could be beneficial in terms of strengthening external and internal legitimacy, successfully bringing about organisational change, ensuring high-quality customer service and promoting employee wellbeing. On the practical level, it seems that insufficient internal branding constituted a barrier in terms of preventing employees from "living the brand" (Ind 2001), and created potential dilemmas related to the brand promise, customer expectations, financial and efficiency gains, and professional values in healthcare (see also Shortell & Kaluzny 2006). These potential dilemmas, in turn, could threaten external and internal legitimacy. ...
... Second, the goals related to efficient and independent managerial decision-making were not included fully in the negotiations preceding the organisational transformation, or defined explicitly in the contract of establishment. Third, the overall values, ethics and aims in the public sector, in this case healthcare (see also Shortell & Kaluzny 2006;Virtanen & Stenvall 2010;Lane 2009), are to some extent at odds with private-sector organisations' aims such as maximising profits. Thorough pre-evaluation and planning would make it easier to reconcile contradictory values and goals arising from the different institutional logics and the contradictory goals arising from the pressure of different institutional isomorphic forces, as found in this study, and thereby to find a suitable organisational form for public healthcare provision (see also Suomi et al. 2014;Tevameri 2012;Tevameri 2014, 53-54;Waeraas 2008). ...
SUMMARY
Decision-making and choice in the adoption of a municipal enterprise form in
public healthcare organisations
– Reasoning, goals, legitimacy and core dilemmas
This doctoral thesis concerns the transformation of publicly owned organisations
into municipal enterprises during the 1990s and late 2000s, with specific
reference to the bandwagoning effect. The aim is to explore the decision-making
processes behind the phenomenon in three case organisations, all of which are
publicly owned healthcare providers. The focus is on the reasoning and rationale
behind the choices, the core goals of the adoption of the municipal enterprise
form, and the extent to which the transformation met the expectations of the three
organisations. Thus, it is the outcomes of earlier decision-making and change
processes in terms of attainments and failures that are under explicit scrutiny.
The results are further scrutinised and discussed from the three research
perspectives.
In order to give a rich description of the decision-making in the three
organisations, the reasoning and rationale related to the choices made, and how
the transformation met expectations and goals, it was essential to construct a
multi-dimensional interlocked analytical framework comprising interdependent
elements. The research questions require the integration of theory and practice in
recognising the significance of the major theoretical issues and concerns, while
also addressing practical arrangements. This blending of theory and practice, as
manifest in the findings of the study, is essential to the structure and efficacy of
the research and analysis. The theory is presented as an integrated framework
that serves to structure, guide and inform the empirical analysis. The
interdependent theoretical elements of this integrated framework relate to
institutions, institutionalism, legitimacy, reputation, dilemmas, and public- sector
branding. The thesis comprises two parts: the synthesis (Part I) and four original
research articles (Part II).
Article 1 investigates the reasoning behind the decision to transform into a
municipal enterprise. Article 2 establishes the theoretical background on which
Articles 3 and 4 are based, defines the municipal enterprise form and introduces
dilemma reconciliation as an approach. Article 3 builds on the analyses in
Articles 1 and 2, and develops them further by mapping the principle reputation
risks and threats to legitimacy that arose in connection with the identified core
dilemmas. Article 4 further develops the empirical analysis by combining
branding theory with the dilemma approach and discursive institutionalism and
discourse analysis.
The choice of qualitative methods and the data analysis applied in Articles 1,
2, 3 and 4 is in line with the philosophical background assumptions of the study.
In ontological terms, reality is a result of social interaction thorough which
meanings are given to things. The interest is in the issues the informants talk
about. Further, on the epistemological level which relates to grounds of
knowledge, the study is positioned as interpretivist.
The main contributions of this thesis to the academic discourse are the
following. 1) It delineates the tensions within institutional isomorphic forces and
shows how the tensions between the various forces (mimetic, normative and
coercive) of institutional theory operate. The addition of the dilemma approach to
institutional theory illustrates the competing pressures that are at work. 2) The
study contributes to the discussion on institutional organisational theory in
suggesting that institutional forces diminish and strengthen one another, and
thereby create tensions that may end up as dilemmas posing reputation risks. 3)
Although institutional isomorphic forces may have an existing legitimating
status, the ultimate outcome may be the opposite: failure to gain normative and
coercive acceptance. 4) The novel interlocked framework for exploring decisionmaking
and transformation in organisations. In terms of managerial implications,
managers and leaders responsible for organisational change would benefit from
knowing how intended outcomes may differ from actual outcomes, and from
understanding why this happens. A further practical contribution relates to the
organisational learning aspect of change, which could be enhanced by internal
branding in connection with the adoption of new organisational forms.
KEYWORDS: Decision-making, change management, knowledge-intensive
organisation, institutionalism, dilemma approach, reputation, legitimacy, public
branding, public healthcare organisation, municipal enterprise
... Responding to such escalating need is not possible, but through innovation, and entrepreneurship in these organizations. However, despite the fact that most of Iranian politicians and health care managers are aware of such burning need in this society, and are pointing out the importance and necessity of entrepreneurship for the organization such as hospitals, yet little attention has been paid to this issue so far, and there are so many obstacles on the way [12, 13] . Shortell and kaluzny [12] presented environmental parameters effecting managers performance and delivering health care services. ...
... However, despite the fact that most of Iranian politicians and health care managers are aware of such burning need in this society, and are pointing out the importance and necessity of entrepreneurship for the organization such as hospitals, yet little attention has been paid to this issue so far, and there are so many obstacles on the way [12, 13] . Shortell and kaluzny [12] presented environmental parameters effecting managers performance and delivering health care services. These factors include: environmental resources, payment by performance, new technologies advancement, population aging, increasing cultural and ethnic variety of population, and changes in supplying and training health experts, change in diseases patterns, information, manufacturing, management, and globalization. ...
... Complexity of the business environment is the major source and factor of environmental fluctuations. This complexity may be due to the increase in the number of organizations in an innovative industry, frequency of enterprise components, Changes in the disease patterns, diversity of different groups of customers' needs, Changes in stakeholder's expectations [12, 25, 36, 37] . To confirm the conceptual model of environment effect on Organizational entrepreneurship an exploratory factor analysis and, confirmatory factor analysis (structural equation modeling technique) were used. ...
One of the important issue regarding the study of change in the organizations is "organization's environment"; the territory in which an organization form and change during its life cycle. Among other factors, environmental dimensions and features are the important indices being used to estimate and understand the environment surrounding an organization. The main purpose of the present study was to identify the effective environmental factors (dimensions and features) on the organizational entrepreneurship in the Iranian Public hospitals. The sample contained 500 operating managers, supervisors, head nurses, nurses and head officers various affairs offices in hospitals such as affirmative action office and so on. A stratified random sampling technique was utilized to select the sample. The criteria for selection of the subjects were having at least a bachelor's degree, and three years of working experience. The data was collected via a self-report questionnaire. The exploratory and confirmatory factor analyses were used to identify the environmental factors affecting organizational entrepreneurship's development in the Iranian public hospitals. The amount of KMO of environmental features was 83%, with p-value less than 0.05. The extracted factors explained 89 percent of the variance of environmental factors affecting organizational entrepreneurship's development in the Iranian public hospitals. The amounts of CFI, NFI, RFI and IFI for the fitted model were all above 0.99, GFI was 0.99, and RMSEA was 0.05 which all verified impact of environmental factor effect on the organizational entrepreneurship. The dimensions such as dynamism, complexity, munificence, struggle and their features in were observed in the external environment of Iran public hospitals, and they had direct and significant effect on organizational entrepreneurship. Therefore, the existing circumstances in the external environment of the stated hospital are ready for persuading, and generating motivation in employees and also leading hospital toward entrepreneurial action to encounter the existing challenges.
... Therefore, this study builds on the use of the interpretative paradigm to provide a more complete and deeper understanding and description of the role of health managers and the world in which they operate. This interpretative approach is favoured in this study because health management is practiced within a number of often disconnected theoretical frames (Legge, Stanton, & Smyth 2006) and, the practice of management is often contingent and situated (Shortell & Kaluzny, 2006). Berg (2004, p. 9) suggests that meaning is given 'by and through human interaction' which is central to the management role that is infl uenced by a widely diverse group of health professions, stakeholders and interest groups. ...
... Ethical approval of the study was given by the University of New England in lieu. Research Ethics Committee (HE03/205) and participants and has an important sensemaking role and is contingent on environmental and operating circumstances (Shortell & Kaluzny, 2006). In these contexts the ontological approach of Heidegger is a highly relevant philosophical concept that involves 'being in the world, forestructures, time and space' (Mackey, 2004, p. 181), that requires the researcher to identify descriptions within those contexts that emerge as themes (Diekelmann, 2001;Mackey, 2004). ...
This qualitative study was undertaken with a diverse sample of Australian health managers to examine their perceptions regarding the health system and to understand how they learned to become health managers. The findings showed that they viewed the health system as one of constant change, mostly non-adaptive, and a system of parts controlled by bureaucrats and political interests. While the respondents enjoyed their managerial role, they see it as contested between the professions. This study concluded that greater emphasis on the education and training of health managers and their continuing professional development is required if they are to manage increasingly complex, dynamic and changing health systems. In Australia, the health debate continues with the recently announced national health reform agenda. The perceptions of health managers in health reform and change management are important given that they are said to be central to the implementation of health reform and the management of change.
... Sağlık çalışanlarının günün önemli bir bölümünü işte geçirmesi, doktor-hemşirehasta arasındaki etkileşimin yoğun olması, özellikle hemşirelerin hasta ve hasta yakınları ile yoğun teması ve iletişimi, sağlık hizmetlerinin hata kabul etmez yapısı gereği oluşan stres ve gerginlik ortamı sağlık hizmetlerinin kendine has özelliklerini oluşturmaktadır (Kavuncubaşı ve Yıldırım, 2010, s. 128-129; Shortell ve Kaluzny, 1997, s. 13-14). Bu özellikler göz önüne alındığında, çalışanların davranışlarının şekillenmesi ve zamanla değişmesi mümkün olmakta ve böylece sağlık sektörü gibi hizmet sunumunun gerçekleştiği örgütlerde sapma davranışının olabileceği düşünülmektedir. ...
... Sağlık kurumları; her bireyin sorun ve gereksinimlerine özel hizmet sunan, iş yükü ve yapılış biçimleri farklılık gösteren ve işin gereklerinin önceden belirlenemez ve çoğunlukla ertelenemez olduğu kurumlardır (Kavuncubaşı ve Yıldırım, 2010, s. 127; Tengilimoğlu, Işık ve Akbolat, 2012, s. 73). Emek yoğun, karmaşık, uzmanlaşmanın ve riskin yüksek, gerçekleştirilen faaliyetlerin birçoğunun acil ve ertelenemez olduğu, hatalara karşı oldukça duyarlı olan ve çalışanlar arasında işlevsel bağlılığın yüksek görüldüğü bir sektörde faaliyet göstermektedirler (Kavuncubaşı ve Yıldırım, 2010, s. 128-129; Shortell ve Kaluzny, 1997, s. 13-14). Dolayısıyla, birden çok profesyonel disiplin ve profesyonel olmayan çalışanların faaliyetlerinin koordine edilmesini gerekli kılmaktadır (Kelly and Tazbir, 2013, s. 140). ...
... More specifically, the successful implementation of change seems to be influenced by a series of characteristics involving (1) organizational attributes like size, centralization, formalization, level of expertise, etc. (Bennis 1966;Burns and Stalker 1961;Hage 1985;Hage and Aiken 1970;Harvey and Mills 1970;Moos 1983;Pierce and Delbecq 1977;Thompson 1965;Zaltman, Duncan and Holbeck 1973); (2) the organizational context, i.e. environmental uncertainty, competitiveness, organizational affluence, degree of urbanization, etc. (Harvey and Mills 1970;Pierce and Delbecq 1977;Shortell 1983); (3) managerial attributes like "locus of control," attention to innovation, and cosmopolitan or local focus (Shortell 1983;Miller 1983;Pierce and Delbecq 1977;Thompson 1965). ...
... More specifically, the successful implementation of change seems to be influenced by a series of characteristics involving (1) organizational attributes like size, centralization, formalization, level of expertise, etc. (Bennis 1966;Burns and Stalker 1961;Hage 1985;Hage and Aiken 1970;Harvey and Mills 1970;Moos 1983;Pierce and Delbecq 1977;Thompson 1965;Zaltman, Duncan and Holbeck 1973); (2) the organizational context, i.e. environmental uncertainty, competitiveness, organizational affluence, degree of urbanization, etc. (Harvey and Mills 1970;Pierce and Delbecq 1977;Shortell 1983); (3) managerial attributes like "locus of control," attention to innovation, and cosmopolitan or local focus (Shortell 1983;Miller 1983;Pierce and Delbecq 1977;Thompson 1965). ...
... Interorganizational relationships (IORs) have been defined as "the relatively enduring transactions, flows, and linkages that occur among or between an organization and one or more organizations in its environment" (Oliver, 1990: 241). Given the rapid change and increased complexity in the health care environment, organizations are increasingly forming linkages or relationships with other organizations (Shortell and Kaluzny, 1997). Developing and maintaining IORs has become an important component of the strategy of health care organizations with several potential benefits: improved financial performance, access to resources and new markets, innovation, and organizational learning (Rakish, Longest, and Darr, 1992;Shortell and Kaluzny, 1997). ...
... Given the rapid change and increased complexity in the health care environment, organizations are increasingly forming linkages or relationships with other organizations (Shortell and Kaluzny, 1997). Developing and maintaining IORs has become an important component of the strategy of health care organizations with several potential benefits: improved financial performance, access to resources and new markets, innovation, and organizational learning (Rakish, Longest, and Darr, 1992;Shortell and Kaluzny, 1997). IORs represent a continuum from "tightly coupled" arrangements, such as ownership, to "loosely coupled" arrangements, such as affiliations. ...
... Countries which use this model of EMA delivery include the United States, Canada, New Zealand, the Sultanate of Oman, and Australia. Based on the views of scientists (e.g., Kaluzny & Shortell, 2006;Hodkinson & Walis, 2010), one can state that none of the individual health care management models is able to provide all the opportunities, however, different models offer various useful insights into the objectives, contexts, and management functions. A conclusion follows that, in the future provision of the EMA services, the key role will be played not by doctors, but by other health care specialists. ...
This article discusses an improvement of the emergency medical assistance system in Lithuania. Health care reform in Lithuania has been going on for three decades, but despite the understanding that the health care manage- ment has to be effective and methodologically sound it cannot be characterised as consistent, comprehensive, and well-coordinated. The authors explore the methods of how to adapt emergency medical assistance system in Lithuania to the changing environmental factors, the advances of science and information technologies, and to the legal WHO and EU requirements.
... In the healthcare industry, the environment is composed of: providers (such as hospitals or doctors), suppliers (pharmaceutical companies, suppliers of medical equipment and so on) competitors, patients and other stakeholders, such as central or local authorities. The healthcare industry, similarly to the automobile, telecommunication and computer industries, has been presented as being very turbulent and highly competitive (Shortell andKaluzny 2000, see also Guo, 2003), meaning that it is defined by complex changes that happen at a very fast rate. The industry is further complicated by the multitude of direct and indirect interests involved in the supply of medical assistance (internal and external stakeholders). ...
The objective of this paper is to emphasize the link between entrepreneurial spirit and the wellbeing of the healthcare system. Based on a model constructed on empirical observations and built around the concept of entrepreneurial spirit, this paper aims to show that this spirit needs stimulate both the private and the public components of a healthcare system. The paper presents the dynamic of the healthcare market, private practices and private hospitals in Romania, starting from the early ‘90s and up until the present, showing the problems that have been encountered and a short analysis of some key indicators relevant to entrepreneurial initiatives in the private healthcare system. A special section is dedicated to the comparison between the scale of the activity in private and public Romanian hospitals, as shown by contracts and payments made by the National Health Insurance House. At the same time, the article postulates a potential practical impact that entrepreneurial activities might have on the future development of the public healthcare system.
... 2005; Scott ym. 2000; Shortell & Kaluzny 2006). Organisaatioiden samankaltaistuminen (isomorrismi) tapahtuu kolmen eri mekanismin kautta. ...
Artikkelissa kysytään, miten ajallisten kehysten muutokset vaikuttavat terveydenhuollon ja sosiaalialan hoivatyöntekijöiden toimijuuteen. Ajallisten
orientaatioiden ja toimijuuden välisiä suhteita analysoidaan inhimillisen toiminnan ajallisia ulottuvuuksia koskevien sosiologisten teorioiden, hoivatyön käytäntöjen ja hoivatyöntekijöiden kertomien kokemusten näkökulmasta. Aineistona on 25 sosiaalialan ja terveydenhuollon työntekijöiden teemahaastattelua. Haastateltavien kertomukset kiireen lisääntymisestä ja jatkuvasta rutiinien rikkoutumisesta ovat aineistossa hyvin yleisiä. Hyvinvointivaltion uudelleenorganisoinnin tuloksena vahvistunut taloudellis-hallinnollinen aikakehys edellyttää hoivatyöntekijöiltä jatkuvaa päällekkäisten tehtävien suorittamista ja ennakoimattomien tilanteiden ratkaisemista sekä aiheuttaa kokemuksia mielekkään toimijuuden mahdollisuuksien vähenemisestä. Taloudellis-hallinnollinen ajan määrittämisen tapa ja hoivatyölle ominainen relationaalis-prosessuaalinen aikakäsitys ovat siten keskenään ristiriidassa. Tästä syystä työn ajallisiin kehyksiin – ja niiden merkitykseen inhimillisessä toiminnassa – tulisi kiinnittää enemmän huomiota työn organisoinnissa.
... Many failed and others reversed their trajectory towards integration favouring instead to operate more loosely bound partnerships (Burns & Pauly, 2002;Dubbs, Bazzoli, Shortell, & Kralovec, 2004). Others such as Kaiser Permanente, Veteran's Affairs and InterMountain Health have improved their productivity and quality of care, attributing much of their success to their integration and innovative use of information technology (Shortell & Kaluzny, 2005). For these models, both vertical and horizontal integration of services generally involve organizational mergers and consolidation of ownership. ...
BACKGROUND
Integrated healthcare systems are believed to be enabled by the electronic exchange of clinical information. Canada and other national health systems are making substantial investments in information technology, in order to liberate and share clinical information between providers, improve the quality and safety of care, and reduce costs, yet we currently have no way of measuring these information flows, nor of understanding whether they contribute to the integration of care delivery.
METHODS
A literature review and consensus development process (nominal group) were used to provide guidance on system integration measures which are enabled by electronic information exchange. In order to conceptualize the components of electronic information exchange, establish a reference vocabulary for terminology, and guide the development of a questionnaire to gather field data, a formal ontology was developed. Validation of a sub-group of the survey data quality was achieved using the ontology and an unrelated database, demonstrating how ontologies may be used to adapt performance measurement methodologies to systems where constraints such as time- compression, lack of resources or access to needed information are prevalent.
RESULTS
The survey tool gathered cross-sectoral data from a regional health system which populated a summary measure of inter-provider electronic health information exchange (the eHIE), and measured perceptions of system integration from a single health region. The eHIE indicated that 7 -12% of clinical information that could be shared, was being shared electronically in the health region. ANOVA confirmed a significant correlation between the amount of information being exchanged electronically in this system and respondent perceptions of system integration suggesting that the eHIE may be used as a leading indicator for healthcare system integration.
CONCLUSIONS
It is possible to conceptualize and quantify inter-provider electronic health information exchange. As complex adaptive systems, healthcare systems are dynamic and open to correction; the use of a leading or proximal indicator such as the eHIE may inform effective policy-making and resource allocation in our pursuit of the goal of seamlessly integrated care.
iii
... More governments around the world are focusing on the lack of innovation in public policy debates around patient satisfaction with services and the increasing internationalisation of health service providers that is facilitating medical tourism (Ratten, 2014aRatten, , 2014b). This has lead to patients wanting different health services based on the increased ethnic and diversity of the population that has the economic and intellectual resources to find the best health provider (Shortell and Kaluzny, 1997). In addition, changes to government financial positions about funding better health services and more advanced medical technology has also influenced patient decisions (Conklin and McLeod, 2010). ...
Healthcare organisations are adopting innovation and entrepreneurial management strategies as a way to compete and succeed in the global marketplace. Increasing numbers of healthcare providers are utilising innovative technologies and services that have a direct impact upon patient's physical and mental health. In addition, individuals, businesses and governments in the healthcare industry are becoming more entrepreneurial in the way they access and give services to patients as a mechanism to improve success rates and be more financially savvy. This paper will discuss the role of innovation and entrepreneurship for healthcare organisations as a way of adapting to change. The importance of creativity in healthcare organisations by placing importance on user-innovation and entrepreneurial ideas is examined in the literature review. Healthcare innovation and entrepreneurship are then discussed as a mode to increase the performance of management strategies. Managerial implications for healthcare organisations are stated that highlight the evolution of hospitals, primary care providers and community practitioners in utilising innovative and entrepreneurial techniques. Suggestions for future research are included, which stress the importance of continual innovation and entrepreneurship in healthcare organisations.
... The current form of P4P offered through CMS is termed value-based purchasing (VBP). Value has been defined as being created "when for a given cost or price to the purchaser additional quality features desired by the purchaser are provided or, conversely, when a given level of quality services can be provided at a lower cost or price relative to others from whom purchasers can obtain services" [19]. The VBP program is offered to acute care hospitals and are dispersed based on how well the hospital is able to meet performance measures. ...
To determine if the Value-Based Purchasing Performance Scoring system correlates with hospital acquired condition quality indicators.
This study utilizes the following secondary data sources: the American Hospital Association (AHA) annual survey and the Centers for Medicare and Medicaid (CMS) Value-Based Purchasing and Hospital Acquired Conditions databases.
Zero-inflated negative binomial regression was used to examine the effect of CMS total performance score on counts of hospital acquired conditions. Hospital structure variables including size, ownership, teaching status, payer mix, case mix, and location were utilized as control variables.
The secondary data sources were merged into a single database using Stata 10.
Total performance scores, which are used to determine if hospitals should receive incentive money, do not correlate well with quality outcome in the form of hospital acquired conditions.
Value-based purchasing does not appear to correlate with improved quality and patient safety as indicated by Hospital Acquired Condition (HAC) scores. This leads us to believe that either the total performance score does not measure what it should, or the quality outcome measurements do not reflect the quality of the total performance scores measure.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
... Institutional theory contends that the institutional environment strongly influences the development of formal structures in an organization, and that in the face of environmental pressures organizations will adopt practices that conform to the expectations of key stakeholders (Ashworth, Boyne & Delbridge, 2007;Corcoran & Shackman, 2007;Meyer & Rowan, 1977;Shortell & Kaluzny, 2000). Environmental forces and/or actors may exert three types of pressures on an organization: 1) normative 2) mimetic, and 3) coercive. ...
We use an institutional theory framework to examine the impact of a newly adopted university-wide Writing in the Disciplines (WID) initiative on writing in courses offered by three undergraduate programs housed in an interdisciplinary department at a major land-grant University in the southeastern United States. We identify and describe three types of institutional pressure on departments and individual faculty members to adopt changes in writing: Normative, mimetic, and coercive. A systematic review of 97 discipline-specific course syllabi from Fall 2009-Spring 2012 was conducted to determine if there were significant changes in the quantity and types of writing assignments in courses before and after the development and submission of a department writing plan as required by the newly implemented university writing initiative. Our results show significant positive changes in the following measures of relevance of writing in discipline-specific courses: the weight of writing assignments as a proportion of final course grades, the level of sophistication of the intended audience identified in writing assignments, and the level of course engagement with writing as evidenced by the inclusion of course objectives specific to writing outcomes. We attribute these changes to specific aspects of the writing initiative as well as the influence of accrediting organizations and the University that fit within each of the three categories of institutional pressure identified in the paper.
... This explains why change management is a central task in organizations, and a vital branch of organization theory. (1,4) This also links to a fundamental insight from systems theory, what Berwick calls the "indissoluble bond between improvement and change. Not all change is improvement, but all improvement is change."((5) ...
... En virtud de lo anterior cabe preguntarse: ¿qué sucedió?, ¿qué fue lo que cambió para justificar este cambio de denominación? Lo cierto es que difícilmente podría decirse que lo que tenemos en México mínimamente se apega a cualquiera de las definiciones disponibles del sistema, mismas que implican un quehacer coordinado, con interacciones bien definidas entre sus partes, para lograr un resultado que de otra manera no podría obtenerse 12 . ...
In this article we review the need for the transformation of the Mexican health care system given the deformities that the system developed in the last 60 years. We start by the discussion of two main deformities: the segmented answer to the health right, and the development of a segmented health care system based on the method of payment (formal workers contributions); and the development of a health care model based on specialties and hospital care. These deformities have resulted in a health care system characterized by high costs and low effectiveness. Even though the correction of the deformities imply complex modifications that involve political economic and legal aspects, in the short term we have the conditions in Mexico for the creation of a universal primary health care system, given the human and financial resources available in the country.
... The (private) Supplementary Health System (SHS) accounts for more than 50% of health care expenditure in Brazil, although it serves less than 30% of the population (8). Evidence suggests the two systems compete unfairly for resources and, therefore, priority setting in either system will have an impact on the other (13,14). Specifically, the private system will draw human resources from the public system and will not necessarily allocate according to considerations of medical need, legitimate process, or health equity (15). ...
... The health organizations management has three important cornerstones that are fundamental for organizational performance: quality; accessibility and costs (AL-ASSAF, 1997). They are, hence, fundamental for its evaluation, resulting in a perspective for healthcare organizations more incisive based in performance (SHORTELL; KALUZNY, 2000). These issues related to healthcare organizations management are shown necessary before the perception that great part of healthcare professionals point out that management where they work is inefficient (VLASTARAKOS; NIKOLOPOULOS, 2007). ...
... The (private) Supplementary Health System (SHS) accounts for more than 50% of health care expenditure in Brazil, although it serves less than 30% of the population (8). Evidence suggests the two systems compete unfairly for resources and, therefore, priority setting in either system will have an impact on the other (13,14). Specifically, the private system will draw human resources from the public system and will not necessarily allocate according to considerations of medical need, legitimate process, or health equity (15). ...
The purpose of this paper is to describe the national priority setting process for the public health system in Brazil, evaluating the process using the ethical framework Accountability for Reasonableness, and equity considerations highlighted in the 2008 WHO Commission on Social Determinants of Health. We searched the Brazilian Ministry of Health website for documents that described priority setting within the Brazilian Universal Health Care System (SUS). The National Health Conference (CNS) has been defined by the Ministry of Health as the democratic priority setting forum for SUS. The most recent such conference (13(th) CNS, 2007) is the subject of this paper. Our analysis suggests that the process of priority setting within SUS has not yet achieved the ethical standards of legitimacy and fairness, and that inequitable distribution of decision making power under-represents users in poor areas. The unmet need for hospital care for children in Brazil, which reflects a remarkable inequality of opportunity for human development, may be a product of poor priority setting processes and inequity in representation.
... Administrative and management systems closely coordinate the activities and resources of collaborative partnerships (Lasker & Committee on Medicine and Public Health, 1997), providing the "glue" that enables multiple, independent people and groups to work together (Lasker et al., 2001, p. 194). These systems organize, direct, and oversee all of the functions in a partnership (Shortell & Kaluzny, 1994). Given the evolving needs of partners and ever-changing environments, partnerships are constantly shifting and adjusting, making them particularly difficult to manage compared to traditional bureaucracies (Forrest, 1992). ...
This paper explores contributors of partnership synergy evident in the formation stage of the Families First Edmonton (FFE) Partnership, a large, multi-sectored collaborative partnership that was established to determine the best health and recreation service delivery model for families with low incomes. Partnership characteristics that influence synergy are examined through an analysis of qualitative interviews with partners that focused on the collaborative effort. This analysis is guided by the Determinants of Partnership Synergy framework developed by Lasker, Weiss, & Miller (2001). The analysis explores how some of these determinants of synergy are manifested in partners' experiences of the partnership. The analysis reveals themes within four partnership characteristics that are relevant to the creation of partnership synergy. This research contributes to the understanding of the process of large, multi-sectored collaborative partnerships in the formation stage of development as it describes how the FFE partnership characteristics of leadership, administration and management, governance, and efficiency influenced partnership synergy.
This article aims to identify dimensions of internal service quality (ISQ) which can be operationalized to deliver healthcare services. This article conceptualizes and assesses the relationship among ISQ, internal customer satisfaction and organizational performance. A 41-item questionnaire has been circulated among the Indian healthcare service providers including doctors, nurses and system staff and 237 valid responses had been received. Structural equation modelling (SEM) has been used to assess the interrelationship among constructs. Results show that high performance work environment, professionalism and collaboration, accountability and commitment and knowledge and competence are the specific dimensions that affect the ISQ. Among these dimensions, high performance work environment comes out to be the most important. It is inferred that ISQ influences organizational performance with the mediating role of internal customer satisfaction. The article highlights the autopoietic nature of the system where knowledge dissemination becomes the most relevant prerequisite for delivering quality care.
This study examines entrepreneurship and assesses its relevance to health care organizations through a detailed description of the optimal environment, organizational factors, and managerial roles in the entrepreneurship process. The article finds entrepreneurship processes to be especially useful to health care organizations as they struggle to survive in the competitive managed care environment.
Araştırmanın amacı, örgütsel güven boyutları ve örgütsel bağlılık boyutlarının
işten ayrılma niyeti üzerindeki etkisinin incelenmesidir. Örgütsel güven ile örgütsel
güven yaklaşımları, örgütsel bağlılık ile örgütsel bağlılık boyutları ve işten ayrılma
niyeti teorik olarak incelenmiştir. Anket çalışması, 2015 yılında Ankara’da bir eğitim
araştırma hastanesinde çalışan, memur ve hizmet alım personeli olan 461 işgören
üzerinde yapılmıştır. Korelâsyon analizinde, işten ayrılma niyeti, bilişsel güven ve
duygusal bağlılık arasında pozitif ilişki bulunmuştur. Tüm katılımcılar için yapılan
regresyon analizinde normatif bağlılık, bilişsel güven ve kadro durumunun işten ayrılma
niyeti üzerinde negatif yönde etkili olduğu bulunmuştur.
The purpose of the study is to analyze the effect of organizational trust and
organizational commitment dimensions on intention to quit of employment.
Organizational trust and organizational trust approaches, organizational commitment
and organizational commitment dimensions and intention to quit of employment have
been theoretically examined. The questionnaire study was conducted on 461 wage
earners, service procurement personnel and civil servant working in a training research
hospital in Ankara in 2015. Considering the correlation analysis, a positive relationship
between intention to quit of employment, cognitive trust and emotional commitment has
been determined. In the regression analysis made for all participants, it has been found
that normative commitment, cognitive trust and staff status are effective on intention to
quit of employment negatively.
Many countries need to be concerned with the effects of demographic change on various levels in the coming years, both in the economy and within society. Hospitals, as one component of health care service organizations, have recognized the pressures to control costs and to demonstrate the value of the services delivered.
The covariance structure model overcomes certain weaknesses of both factor analysis and structural equation models by merging them into a single model that simultaneously estimates latent variables from observed variables and the structural relations among the latent variables.
Guidelines for optimal cancer screening in older adults remain unclear, particularly for adults over the age of 75. While cancer screening in older adults may benefit some in good health, it may cause unnecessary burdens in others with limited life expectancy. Thus, a systematic approach to enable individualized cancer screening decisions in older adults is needed. We suggest a framework that guides such decisions through evidence-based approaches from multiple interactions, and that involves the patient, clinician, and healthcare system. An individualized approach considers differences in disease risk rather than the chronological age of the patient. This paper presents a comprehensive framework that depicts the independent and converging levels of influences on individualized cancer screening decisions in older adults. This Individualized Decisions for Screening (IDS) framework recognizes the reality of these interrelationships, including the tensions that arise when behaviors and outcomes are valued differently at the patient, clinician, and healthcare organization levels. Person-centered approaches are essential to advancing multilevel research of individualized cancer screening decisions among older adults.
Organizational deviant behavior is defined as intentionally behavior
which is damaging both employees and organization and unsuitable to organization rules, norms, values, expectations and legal regulations.The aim of this study is to determine the level of organizational deviance of nurses, to expose differentiates of
this level. according to the descriptive characteristics, to detect the dimensions of organizational deviance and to evaluate the relationship between these dimensions. Population of the
study is nurses working at a University Hospital in Ankara. The sample is not selected and tried to reach all the nurses working at this hospital. However, 244 nurses were reached (%48,12). To measure organizational deviance, “Measure of Workplace
Deviance Items”which was developed by Bennett and Robinson
(2000)was used. This scale consists from 15 expressions and 2 dimensions and its’ Cronbach's alpha coefficient was 0,94. As a result of the study, the mean score of nurses’ organizational
deviance was found 1.85 ± 0.718. In addition, statistically significant, positive and moderately strong correlation was found between the two dimensions of organizational
deviance (R= 0.701
). It can be suggested that health care managers should identify
reasons and the ways of preventing of individual deviant
behaviour. Thus, managers may prevent behaviour of deviation to the organization.
Sağlık hizmeti sunumunda önemli bir yere sahip olan sağlık insan gücünün
örgüte ilişkin sorunlar karşısında sessiz kalma davranışı göstermeleri örgütün
faaliyetlerini etkileyebilmektedir. Çalışanların örgütsel konu ve sorunlar hakkında
nasıl bir tutum izleyeceklerini bilmek, davranışlarını analiz etmek ve sessiz kalma
davranışı gösterdiklerinde bunun nedenlerini tespit edebilmek sağlık kurumları için
önem arz etmektedir. Araştırma, Trabzon’da faaliyet gösteren bir özel hastanedeki
sağlık çalışanlarının sessiz kalma nedenlerini belirlemek amacıyla yapılmıştır.
Araştırma kapsamında ayrıca katılımcıların tanımlayıcı özelliklerine göre farklılaşıp
farklılaşmadığı ortaya konulmuş ve nedenler arasındaki ilişki tespit edilmiştir.
Araştırmanın örneklemini 180 sağlık personeli oluşturmaktadır. Araştırmada Çakıcı
(2008) tarafından geliştirilen “Örgütsel Sessizlik Nedenleri” anketi kullanılmıştır.
Araştırma sonucunda çalışanların en fazla “yönetsel ve örgütsel nedenler”; en az
ise “tecrübe eksikliği” alt boyutlarında sessiz kaldıkları; örgütsel sessizlik boyutları
ile cinsiyet, yaş ve meslek arasında istatistiksel olarak anlamlı bir fark olmadığı
saptanmıştır.
The Gulf Cooperation Council's (GCC) countries healthcare service sector is likely to witness a major transition in the quality of services provided, and in competitiveness on a global basis. The region’s attempts to setting up integrated healthcare facilities in the form of healthcare cities and medical hubs, along with continuous improvement in technology and infrastructure, will significantly improve the availability and quality of healthcare provision in the region. However, an efficient institutional framework and effective regulatory environment need to be prioritized to encourage private sector participation in the sector. This paper presents a comparative analysis of the main indicators of the GCC healthcare systems, mostly using secondary data from the World Health Organization, and Saudi Ministry of Health database, and attempts to provide some recommendations for healthcare policy makers.
The aim of this study is to identify the decision-making and problem-solving skill levels of hospital administrators and to determine these skills’ interrelations with other administrative skills. The study comprised a population of 494 hospital administrators (head doctors, hospital managers, head nurses and their assistants) and was carried out in 26 hospitals affiliated to the Ministry of Health in the city centre of Ankara. Three hundred and thirty-four administrators (67 per cent of the population) participated in the study. To identify the decision-making, problem-solving and other administrative skill levels of the hospital administrators, a scale developed by Sperry (2003) and adapted into Turkish by Şimşek (2006) was used.
As a result of the study; a weak, positive and statistically significant relationship has been found between the decision-making and problem-solving skills of hospital administrators and their motivation, loyalty and team performance skills. However, it was determined that there is a moderate, positive and statistically significant relationship between the skills of the delegation and empowerment, effective and strategic communication, conflict management, coaching, consulting and negotiating, the fit of organizational resources with human resources, and time and stress management.
It could be suggested that more research be carried out into the reasons why other management skills are at moderately developed levels and that training programmes be organized to develop these skills.
A large body of literature uses the "doctor-patient relationship" (DPR) is if it were a discrete phenomenon with positive effects on patient satisfaction and clinical outcomes. This paper examines the three assumptions made by this literature: 1) that the DPR is a discrete dichotomous variable, rather than a poorly inter-correlated cluster of attributes; 2) that this cluster of attributes are the most significant predictors of the variables they are purported to effect; and 3) that the beneficial influence of a primary care relationship requires a physician rather than a paraprofessional. First the components of the DPR addressed in the literature are specified: total physician-patient contact, the comprehensiveness of relationship, patient participation diagnosis and treatment, affectivity of communication, and the intensity of interaction. Since these components are not necessarily co-linear, it is suggested that DPRs are not a discrete, unidimensional variable. Next, the paper discusses the particular task involved in medical care, and whether these are best carried out by one worker with a medical degree; history-taking; information synthesis; education and counseling; diagnostic and treatment procedures; case-management; and diagnostic and treatment decision-making. The complexity of medical practice, cost-containing managerial efforts at rationalization, and mobilization of non-physician health workers threaten to disaggregate these tasks and assign them to non-physicians. Next, the paper examines some of the outcomes attributed to the DPR, such as physician and patient satisfaction, compliance with treatment regime, clinical outcomes, and lowered costs. It is argued that the DPR itself appears to make only a minor contribution to determining any of these outcomes. Finally, the paper asserts that the organized power of the medical profession has supported a black-box approach to the DPR in order to defend physician autonomy against organizational and technological control. A reinterpretation of the DPR literature may suggest that organizational and technological innovations could reduce the role of the physician, and achieve or surpass all the desired outcomes of medicine.
The profitability of a hospital refers to business administration results achieved through its medical care and other management activities during applicable fiscal year. This study focused on operating margin as a measurement index of hospital profitability, which is a genuine medical return obtained by subtracting medical expenses from medical profits achieved during business administration of hospital. Based on the index, this study could deduce certain factors on hospital profitability in terms of various indices affecting profitability. And based on those factors, this study sought to provide more useful reference materials which allow us to devise possible ways to improve hospital profitability. As a result, it was found that public hospitals attained lower profitability than private ones. To analyze profitability depending on each index, this study divided hospitals broadly into deficit group and surplus group. As a result, it was found that there were significant differences in hospital profitability between two groups depending upon relevant indices such as labor cost ratio, maintenance expense ratio, number of operations per medical specialist and medical instrument turnover. According to analysis on potential effects of relevant indices upon profitability, it was found that each index had its explanatory power ranging from 25% to 74.5% depending on given model.
The need to rapidly improve health care value is unquestioned, but the means to accomplish this task is unknown. Improving performance at the level of the health care organization frequently involves multiple interventions, which must be coordinated and sequenced to fit the specific context. Those responsible for achieving large-scale improvements are challenged by the lack of a framework to describe and organize improvement strategies. Drawing from the fields of health services, industrial engineering, and organizational behavior, a simple framework was developed and has been used to guide and evaluate improvement initiatives at an academic health center. The authors anticipate that this framework will be helpful for health system leaders responsible for improving health care quality.
Purpose
The purpose of this paper is to explore the process of cultural learning during the briefing process, to enable facilities managers to move into more strategic roles in the health sector.
Design/methodology/approach
Using a new hospital as an in depth case study the authors use comparative cause mapping to illustrate the cultural learning processes between actors in the briefing process.
Findings
The focus during the briefing process is primarily on the mechanical transfer of explicit technical knowledge about building requirements rather than the cognitive learning of tacit cultural knowledge. This results in the omission of important strategic information in the briefing process.
Research limitations/implications
This research is limited to a single case study. Although this results in a high level of validity, more research is needed in other contexts to test the generalisability of the findings.
Practical implications
The new strategic model produced should help facility managers reconceptualise briefing as a cyclical process where project actors can arrive at a shared meaning of each other's values, beliefs and needs over time.
Social implications
More effective hospital facilities can significantly contribute to better health outcomes in communities.
Originality/value
This is the first time that briefing has been explored using cognitive cause mapping. It is also the first time that cultural learning has been explored in this context.
Purpose
This paper sets out to continue exploration of the process‐performance linkage by positing several relationships between a multidimensional operationalization of the strategy development process and firm performance, specifically identifying a strategy process configuration that is complementary to constrained environmental conditions.
Design/methodology/approach
Hypotheses and empirical results from a survey of practicing senior managers are presented.
Findings
The results infer that, in conjunction, the enforced choice and political strategy development process modes are superior to other strategy‐making archetypes in generating return on assets within constrained environments in for‐profit firms. No significant differences in firm performance were found for not‐for‐profit firms or for firms employing four other strategy development process modes prevalent in the current strategy process literature.
Practical implications
When assessing their strategic management process, organizations must give consideration to its qualitative nature. Senior managerial perception of the strategic management process has influence during strategy formulation and implementation and eventually on firm performance.
Originality/value
The paper builds on previous work, but highlights two new findings. Namely, a multidimensional operationalization of the strategy development process generates greater ROA than a one‐dimensional process and organizational performance in this configuration varies by firm profit status in some constrained organizational environments.
As a result of a drastic increase in new patients, two major shifts are occurring in the US hospice care industry: an increase in the number of for-profit providers, and hospices are increasing in size through acquisitions and mergers. Hospices are trying to both increase the number of innovative programs they offer and decrease their operating expenses to improve their margins and attract more patients. This study seeks to investigate if strategic groups exist within the industry as hospices try to become more innovative and efficient, which grouping factors are most significant, and to determine whether there is a relationship between group membership and performance.
Cluster analysis and ANOVA are used to analyze data from 93 California hospices.
Three strategic groups exist within the market, innovative practices significantly affect group membership, and innovation-oriented groups outperform others in terms of quality of care.
Many hospices focus on innovation, and evidence suggests that continued pursuit of innovative practices is critical, whereas efficiency does not appear to have a significant impact on quality of care. Focus on such evidence-based practices is important for long-term success.
This is the first study to investigate strategic group formation in the hospice care industry.
A new hospital building represents a rare opportunity to align the physical environment of healthcare with contemporary healthcare needs and models of healthcare delivery to help ensure optimal health outcomes. The effectiveness of interaction between project stakeholders from the hospital and design teams during the briefing process of any hospital project is critical in ensuring this alignment occurs. Therefore it is important to explore the process of knowledge sharing during this project briefing stage. Using thematic content analysis to explore communication exchanges between these project stakeholders, we show that knowledge exchanged during the briefing process is acquired not only explicitly but implicitly through social processes whereby participants attempt to socially construct a common understanding of the project. In particular, the importance of constructive conflict in driving this process is critical. This has implications for health planners, project managers, facilities managers and health professions engaged in the briefing process of hospital projects. In particular, it highlights the importance of providing the correct environment and enough time for culturally conducive social interaction and knowledge sharing to occur between the many stakeholders involved.
In the context of a major hospital redevelopment project, briefing is conceived as an organic and cyclical process of cultural learning whereby project and hospital representatives gradually converge upon a shared meaning of each other’s values, beliefs and needs over time. Using a comparative cause mapping that draws on a case study approach and interviews, it was found that the clinicians’ understanding of the key cultural concepts differed significantly from all other groups and that clinicians’ ability to influence hospital design outcomes is constrained by their relative social marginalization in the briefing process. It follows that hospital facilities would better meet client needs if the briefing process is managed as a process through which project participants interact to socially construct a common understanding of project objectives and requirements; and if knowledge about facility requirements is not merely ‘given’ information but is the result of cultural learning involving social processes among the briefing participants.
If an organization engages in effective strategic planning—performing an accurate situational assessment, developing a clear
sense of direction, and achieving consensus on appropriate overall strategies—then it should produce a plan suitable for motivating
and guiding its actions for at least a few years into the future. Because many variables in the health care field are surrounded
by uncertainty and defy precise prediction, strategic plans typically focus on a planning horizon of 3 to 5 years. It is appropriate
for an organization to apply a mechanism for at least a cursory review,and revision as necessary, of its strategic plan on
an annual or biannual basis.
Because planning is an adapting and ongoing activity, it can accurately be presented as a circular process—one that is never
really finished because the end of one planning process signals the beginning of the next cycle (Day, 1984). During intervals
when planning is not occurring on a formal or intensive basis, organizations must nevertheless maintain systems for monitoring
compliance with plans, assessing impact, and determining whether the assump- tions underlying strategies remain valid. Given
that change is constant and that change will affect the delivery of health care around the world, organizations must be prepared
to change as well. Strategic planning must be used to determine what changes are required to promote organizational survival
and to provide the organization (system, state, or nation) with the benefits of functioning proactively, not simply reactively.
This paper identifies the key organizational and environmental characteristics that affect the performance of community mental health centers (CMHCs). Performance is conceptualized on both effectiveness and efficiency dimensions. Community length of stay of clients was used as an effectiveness measure, and utilization of mandated CMHC services as an efficiency measure for the study of 40 community mental health care organizations. Results for community length of stay indicate that client age, median income of the community, rural location, management type and board composition all affect both community length of stay and utilization of day support services and residential services. Furthermore, the relationship between utilization and community length of stay is identified.
Health care in the United States is notoriously expensive while often failing to deliver the care recommended in published guidelines. There is, therefore, a need to consider our approach to health-care delivery. Cancer care is a good example for consideration because it spans the continuum of health-care issues from primary prevention through long-term survival and end-of-life care. In this monograph, we emphasize that health-care delivery occurs in a multilevel system that includes organizations, teams, and individuals. To achieve health-care delivery consistent with the Institute of Medicine's six quality aims (safety, effectiveness, timeliness, efficiency, patient-centeredness, and equity), we must influence multiple levels of that multilevel system. The notion that multiple levels of contextual influence affect behaviors through interdependent interactions is a well-established ecological view. This view has been used to analyze health-care delivery and health disparities. However, experience considering multilevel interventions in health care is much less robust. This monograph includes 13 chapters relevant to expanding the foundation of research for multilevel interventions in health-care delivery. Subjects include clinical cases of multilevel thinking in health-care delivery, the state of knowledge regarding multilevel interventions, study design and measurement considerations, methods for combining interventions, time as a consideration in the evaluation of effects, measurement of effects, simulations, application of multilevel thinking to health-care systems and disparities, and implementation of the Affordable Care Act of 2010. Our goal is to outline an agenda to proceed with multilevel intervention research, not because it guarantees improvement in our current approach to health care, but because ignoring the complexity of the multilevel environment in which care occurs has not achieved the desired improvements in care quality outlined by the Institute of Medicine at the turn of the millennium.
ResearchGate has not been able to resolve any references for this publication.