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The purpose of this paper is to present lessons learnt through the development of an evaluation framework for a clinical redesign programme – the aim of which was to improve the patient journey through improved discharge practices within an Australian public hospital.

The development of the evaluation framework involved three stages – namely, the analysis of secondary data relating to the discharge planning pathway; the analysis of primary data including field-notes and interview transcripts on hospital processes; and the triangulation of these data sets to devise the framework. The evaluation framework ensured that resource use, process management, patient satisfaction, and staff well-being and productivity were each connected with measures, targets, and the aim of clinical redesign programme.

The application of business process management and a balanced scorecard enabled a different way of framing the evaluation, ensuring measurable outcomes were connected to inputs and outputs. Lessons learnt include: first, the importance of mixed-methods research to devise the framework and evaluate the redesigned processes; second, the need for appropriate tools and resources to adequately capture change across the different domains of the redesign programme; and third, the value of developing and applying an evaluative framework progressively.

The evaluation framework is limited by its retrospective application to a clinical process redesign programme.

This research supports benchmarking with national and international practices in relation to best practice healthcare redesign processes. Additionally, it provides a theoretical contribution on evaluating health services improvement and redesign initiatives.

Employee loyalty is generally a very positive trait. However, when loyal employees are confronted with dysfunctionality in the workplace the impact on their well-being can be significant. The purpose of this paper is to assess the interaction of employee loyalty and employee experience of inter-professional dysfunction in a hospital setting to predict employee job tension.

The paper is based on the analysis of a cross-sectional attitudinal survey of employees within a hospital setting in Australia. The authors use OLS regression and an SPSS macro (by Hayes, 2013) to assess the regions of significance of the interaction effects.

The authors find, as anticipated, significant direct effects for employee loyalty and inter-professional dysfunction on employee job stress. The authors further find significant interaction effects that suggest that highly loyal employees who experience inter-professional dysfunction also experience disproportionately high levels of job tension.

The main research implication of this research relates to the confirmation of the presence of an interaction effect between loyalty and inter-professional dysfunction in predicting employee job stress. Further, the zone of significance analysis (following Johnson and Neyman) suggests that this effect is evident at even low levels of inter-professional dysfunction.

Organisations should appreciate employee loyalty but should also be aware that loyal employees are more vulnerable to the negative consequences of organisational dysfunction than are employees with limited organisational loyalty.

The paper confirms the importance of managing organisational cooperation between groups in organisations as a precursor to positive employee outcomes.

This is the first paper to investigate this interaction and to apply Johnson-Neyman analysis to confirm the regions of significance for the interaction effects noted.

This purpose of this paper is to examine the application and outcomes of applying all of the seven lean flows to pathology laboratory remodelling as part of a lean rapid improvement event (RIE).

Longitudinal case study of a lean RIE linking emergency and pathology departments focusing on the systematic application of lean's seven flows to the physical environment.

Following the lean RIE, changes improving patient specimen, technician, supplies and information flows avoided 187 km and eight days of unnecessary walking each year.

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

This research provides evidence that applying lean design concepts in a laboratory can make substantial improvements, particularly if the expertise of the people working in the laboratory is trusted to determine the most appropriate changes. Significant amounts of time and motion were saved by just one, easily quantifiable change.

The laboratory staff is processing increased numbers of time-critical tests, yet report a calmer working environment, without any increase in the pace of work. Laboratory personnel also experienced satisfaction in exercising control over their work environment.

To the best of the authors’ knowledge this is the first comprehensive report applying lean flows to pathology laboratory remodelling and one of the few applications of Lean Systems Thinking between departments and between separate health services organisations.

This article aims to examine tensions between hybrid clinician managers' professional values and health care organisations' management objectives.

Data are from interviews conducted with, and observation of, 14 managerial participants in a Cancer Therapy Unit set in a large teaching hospital in New South Wales, Australia, who participated in a Clinical Leadership Development Program.

The data indicate that there are tensions experienced by members of the health care organisation when a hybrid clinician manager appears to abandon the managerial role for the clinical role. The data also indicate that when a hybrid clinician manager takes on a managerial role other members of the health care organisation are required concomitantly to increase their clinical roles.

Although the research was represented by a small sample and was limited to one department of a health care organisation, it is possible that other members of health care organisations experience similar situations when they work with hybrid clinician managers. Other research supports the findings. Also, this paper reports on data that emerged from a research project that was evaluating a Clinical Leadership Development Program. The research was not specifically focused on organisational professional conflict in health care organisations.

This paper shows that the role of the hybrid clinician manager may not bring with it the organisational effectiveness that the role was perceived to have. Hybrid clinician managers abandoning their managerial role for their clinical role may mean that some managerial work is not done. Increasing the workload of other clinical members of the health care organisation may not be optimal for the health care organisation.

Organisational professional conflict, as a result of hybridity and divergent managerial and clinical objectives, can cause conflict which affects other organisational members and this conflict may have implications for the efficiency of the health care organisation. The extension or duality of organisational professional conflict that causes interpersonal or group conflict in other members of the organisation, to the authors' knowledge, has not yet been researched.

The purpose of the paper is to show that free flowing teamwork depends on at least three aspects of team life: functional diversity, social cohesion and superordinate identity.

The paper takes the approach of a discussion, arguing for a strong need to understand multidisciplinary and cross‐functional barriers for achieving team goals in the context of health care. These barriers include a strong medically dominated business model, historically anchored delineations between professional identities and a complex organisational environment where individuals may have conflicting goals.

The paper finds that the complexity is exacerbated by the differences between and within health care teams. It illustrates the differences by presenting the case of an operating theatre team.

Whilst the paper recommends some ideas for acquiring these skills, further research is needed to assess effectiveness and influence of team skills training on optimising multidisciplinary interdependence in the health care environment.

The paper shows that becoming a team member requires team membership skills.

The purpose of this paper is to call for strong medical co-leadership in transforming the Australian health system. The paper discusses how Health LEADS Australia, the Australian health leadership framework, offers an opportunity to engage medical clinicians and doctors in the leadership of health services.

The paper first discusses the nature of medical leadership and its associated challenges. The paper argues that medical leaders have a key role in the design, implementation and evaluation of healthcare reforms, and in translating these reforms for their colleagues. Second, this paper describes the origins and nature of Health LEADS Australia. Third, this paper discusses the importance of the goal of Health LEADS Australia and suggests the evidence-base underpinning the five foci in shaping medical leadership education and professional development. This paper concludes with suggestions on how Health LEADS Australia might be evaluated.

For the well-being of the Australian health system, doctors need to play an important role in the kind of leadership that makes measurable differences in the retention of clinical professions; improves organisational cultures; enhances the engagement of consumers and their careers; is associated with better patient and public health outcomes; effectively addresses health inequalities; balances cost effectiveness with improved quality and safety; and is sustainable.

This is the first article addressing Health LEADS Australia and medical leadership. Australia is actively engaging in a national approach to health leadership. Discussions about the mechanisms and intentions of this are valuable in both national and global health leadership discourses.

The purpose of this paper is to use a systems lens to assess the comparative performance of healthcare supply chains and provide guidance for their improvement.

A well-established and rigorous multi-method audit methodology, based on the uncertainty circle model, yields an objective assessment of value stream performance in eight Australasian public sector hospitals. Cause-effect analysis identifies the major barriers to achieving smooth, seamless flows. Potentially high-leverage remedial actions identified using systems thinking are examined with the aid of an exemplar case.

The majority of the healthcare value streams studied are underperforming compared with those in the European automotive industry. Every public hospital appears to be caught in the grip of vicious circles of system uncertainty, in large part being caused by problems of their own making. The single exception is making good progress towards seamless functional integration, which has been achieved by elevating supply chain management to a core competence; having a clearly articulated supply chain vision; adopting a systems approach; and, managing supplies with accurate information.

The small number of cases limits the generalisability of the findings at this time.

Hospital supply chain managers endeavouring to achieve smooth and seamless supply flows should attempt to elevate the status of supplies management within their organisation to that of a core competence, and should use accurate information to manage their value streams holistically as a set of interwoven processes. A four-level prism model is proposed as a useful framework for thus improving healthcare supply delivery systems.

Material flow concepts originally developed to provide objective assessments of value stream performance in commercial settings are adapted for use in a healthcare setting. The ability to identify exemplar organisations via a context-free uncertainty measure, and to use systems thinking to identify high-leverage solutions, supports the transfer of appropriate best practices even between organisations in dissimilar business and economic settings.

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

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

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

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

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

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