Managing people to manage care: from patient to people-centredness at OBHC 2012

Citation

McDermott, A.M. and Keating, M.A. (2013), "Managing people to manage care: from patient to people-centredness at OBHC 2012", Journal of Health Organization and Management, Vol. 27 No. 3. https://doi.org/10.1108/jhom.2013.02527caa.001

Managing people to manage care: from patient to people-centredness at OBHC 2012

Article Type: Guest editorial From: Journal of Health Organization and Management, Volume 27, Issue 3

About the Guest Editors

Aoife M. McDermott is a Lecturer in Human Resource Management at Cardiff Business School. Her research interests concern the role of people management and leadership in supporting health care service organisation, delivery and improvement. She is a former secretary of SHOC, the Society for Studies in Organising Healthcare, and helped to organise the Organisational Behaviour in Healthcare Conference (OBHC) 2012. Aoife M. McDermott is the corresponding author and can be contacted at: mcdermotta@cardiff.ac.uk

Mary A. Keating is an Associate Professor in Human Resource Management at Trinity College Dublin. An occupational psychologist, she is a Fellow of Trinity College and a Research Fellow of the International Institute for Integration Studies (IIIS) at TCD. Her research interests concern leadership, cross-cultural management and health service organisation and delivery. She was Conference Chair of OBHC 2012 and successfully worked to internationalise the conference.

This Special Issue of the journal draws on selected papers presented at the 8th International Organisational Behaviour in Healthcare Conference (OBHC), hosted by Mary A. Keating of Trinity College Dublin from 15-17 April 2012. The interdisciplinary conference theme focused on “Patient-centred healthcare teams: achieving collaboration, communication and care”. The conference attracted a record number of full-paper submissions, with more than 130 delegates from 17 countries, representing schools of healthcare management, nursing, medicine, business and social sciences. Full papers were peer reviewed by the Scientific Organising Committee and more than 40 international reviewers. Over three days the international cohort presented, debated and discussed international perspectives on the range of ways in which patient-centred healthcare can be conceptualised, enhanced and delivered. Patient-centred care (PCC) is a rising policy priority internationally, and one of the six dimensions of quality care identified by the Institute of Medicine in 2001. During the course of the conference, delegates gave a warm and appreciative welcome to our distinguished keynote speakers:

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  Kathleen Montgomery, Professor of Organizations and Management at the University of California, Riverside and Honorary Associate at the University of Sydney spoke on the “paradoxes of delivering patient-centred care to the seriously ill”.

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  Mike Nolan, Professor of Gerontological Nursing at the University of Sheffield spoke on “creating an enriched care environment for older people, staff and family carers: relational practice and organisational culture change”.

Of particular note was the response to Kathleen’s talk, by Alexis Donnelly, Assistant Professor at the School of Computer Science and Statistics at Trinity College Dublin. Alexis is a patient advocate for the Neurological Alliance of Ireland and for Ireland’s Neurological Rehabilitation Strategy. He has lived with a progressive condition for 21 years and enabled the conference to embrace, in a small way, the values of patient-centredness by giving a formidable voice to a patient perspective.

Unsurprisingly, a strong core of the papers presented at the conference dealt with conceptualisations of PCC, how to improve patient-centredness and innovations in the design and delivery of PCC. As healthcare services and service-improvement are ultimately delivered through people, the conference saw sustained focus on the role of collaboration between professions and professionals, within and across organisational boundaries, in supporting PCC. Communication was another, related, strong theme. This included service-related communication among care providers involved in service delivery and service redesign, provider-patient and between-patient interactions. But discussions didn’t end there. As with any attempt to improve health service organisation and delivery – to whatever end – significant attention focused on how to attain, sustain and spread service-improvement. It also led to a hugely diverse range of contributions considering challenges and opportunities in managing people to improve health service delivery. It is this latter theme that we develop within this Special Issue.

Managing people to manage care

While our focus on managing people is undoubtedly a reflection of our own professional backgrounds and research interests, people are the true drivers of performance in healthcare. Healthcare services are complex human-capital intensive environments in which the interdisciplinary lens of the OBHC community is particularly valuable. Papers have been selected to showcase huge diversity in the methods adopted to explore empirical and theoretical perspectives on managing people in healthcare, across a range of national contexts including Australia, Europe and North America. Our rationale is further supported by pragmatic and academic imperatives.

Healthcare organisations work to provide good quality, safe and increasingly patient-centred services through the recruitment, retention and management of high-calibre employees. This is challenging to achieve, due to the complexity of health services, and the increasingly globalised market for healthcare professionals. Beyond quality concerns, salary costs can account for up to 70 per cent of healthcare expenditure. Managing people is therefore a cornerstone component of delivering effective and efficient healthcare. This means that interventions to improve people management are of sustained and significant interest to national and organisational stakeholders – as well as to patients and employees.

Academic consideration of people management in healthcare has, to date, predominantly entailed a theoretical focus on whether the adoption of HR practices is associated with enhanced performance across clinical, employee and financial outcomes; the influence of organisational climate on similar performance outcomes and; the role of the hospital HR function. Whilst of huge importance, the papers in this Special Issue broaden this focus. In our first paper, Paula Hyde, Paul Sparrow, Ruth Boaden and Claire Harris draw on focus groups and an innovative card-sort exercise to provide qualitative insights into employee perspectives regarding how high performance HR practices influence performance. This is a hugely significant contribution, as much prior research has utilised managerial perceptions of HR practices to analyse performance effects. Their work draws attention to three bundles of HR practices which shape health service employees’ mental models of service delivery, performance and their expectations in the employment relationship. Their insights into how and why employees perceive and react to HR practices will help inform the design of effective HR strategies for the healthcare context.

The theme of high performance work systems is further developed by Sandra Leggat and Cathy Balding in our second paper. Their inductive, qualitative analysis draws attention to perceptions of the organisational and individual factors contributing to competence in clinical leadership. They emphasise that while individual clinical leadership competencies are important, the success of leaders is also influenced by support from their organisational contexts. As a result, their analysis identifies a range of organisational factors facilitating clinical leadership including selective recruitment, teamwork and decentralised decision-making. The seven identified organisational factors align with the characteristics of high performance work systems. Although previously empirically neglected, this congruence is perhaps unsurprising as both people management and leadership function by sending signals to employees about what is expected and valued in employees, and what employees should expect to receive from the organisation in return for their performance. On this basis, the authors suggest that clinical leadership is partly an organisational property, requiring proactive management and integration into people management practices.

Our third paper returns to adopt an employee focus, albeit adopting a more quantitative orientation. Specifically, Yseult Freeney and Martin R. Fellenz apply structural equation modelling to employees’ survey responses, to consider the role of employee engagement in delivering quality care at unit level and in supporting employees’ general health and well-being. Their analysis suggests the importance of developing investment in organisational resources to support employees’ work engagement and, in turn unit, employee health and the quality of care provided. Their analysis explicitly links managing employees, to managing care. This suggests that, despite resource constraints, organisations should work to invest in and support their work environments and employee engagement. This focus dovetails neatly with our fourth paper, where Denis Chênevert, Geneviève Jourdain, Nina Cole and Brigitte Banville examine factors contributing to short and long-term absence among healthcare workers in the Canadian public sector. Their issue-based approach highlights the huge drain on service delivery capacity associated with absenteeism and details managerial implications including managing employee involvement and perceived justice, to reduce exhaustion, enhance commitment and avoid employee absence. In our fifth paper, Jennifer Cowman and Mary Keating build on the theme of discordance in the employment relationship – using thematic analysis of labour court cases to address a deficit in research pertaining to “industrial relations” in healthcare. Their exploration of how industrial relations conflict manifests identifies the role of absenteeism as a temporary form of exit (though fortunately Chênevert et al. provide some suggestions regarding how to address this), and employee resistance.

Our sixth and final paper considers the HR focus of translating individual to organisational learning – an issue of rising interest across health care organisations and within academic theory. Hanna Augustsson, Agneta Törnquist and Henna Hasson’s present an evaluative case-study of a quasi-experimental intervention, undertaken in the context of the residential care of older people in Sweden. Their paper identifies a range of considerations for the design and content of workplace learning initiatives to enhance staff skills and support organisational learning.

Together these papers demonstrate the value of utilising a range of methods – from structural equation modelling to focus groups; from card-sorting to case-classifying, to illuminate challenges and opportunities in managing people to manage care. They also emphasise the huge scope for further research contributions to enhance people performance in healthcare including, but not limited to: integrating people management with other management practices; supporting leadership and employee development; enhancing employee well-being and engagement; understanding and managing the employment relationship, resultant conflict and mitigating employee withdrawal. However, in spite of the centrality of human capital to service delivery in healthcare, there is a paucity of research in this area. The complex and increasingly resource constrained context for health service delivery, combined with increasing emphasis on PCC, makes managing people an ever more pressing imperative – and research in this area ever more valuable.

Looking to the future: OBHC 2014 in Copenhagen

We look forward to revisiting and developing these themes among others at the 9th Biennial Organisational Behaviour in Healthcare Conference, which will be hosted by Copenhagen Business School in 2014. Our Danish colleagues invite us to join in “A search for new ways of organising healthcare after new public management”. We have no doubt that the health services research community will rise to this challenge – and that Copenhagen will provide as warm a welcome and as exciting an environment as Dublin, Birmingham, Sydney, Aberdeen, Alberta, Banff, Oxford, Keele and Middlesex have before. We very much hope to see you in Copenhagen.

Aoife M. McDermottHuman Resource Management Section, Cardiff Business School, Cardiff, UK

Mary A. KeatingSchool of Business, Trinity College Dublin, Dublin, Ireland