Martin Kitchener, Aoife M. McDermott and Simon Cooper
While critical approaches have enriched research in proximate fields, their impact has been less marked in studies of healthcare management. In response, the 2016 Organizational…
Abstract
Purpose
While critical approaches have enriched research in proximate fields, their impact has been less marked in studies of healthcare management. In response, the 2016 Organizational Behaviour in Health Care Conference hosted its first-ever session dedicated to the emergent field of critical healthcare management studies (CHMSs). The purpose of this paper is to present five papers selected from that conference.
Design/methodology/approach
In this introductory paper, the authors frame the contributions as “green shoots” in a field of CHMS which contains four main furrows of activity: questioning the taken-for-granted; moving beyond instrumentalism; reflexivity and meanings in research; and challenging structures of domination (Kitchener and Thomas, 2016). The authors conclude by presenting an agenda for further cultivating the field of CHMS.
Findings
The papers evidence the value of CHMS, and provide insight into the benefits of broadening theoretical and methodological approaches in pursuit of critical insights.
Research limitations/implications
CHMS works to explicate the multiple and competing ideologies and interests inherent in healthcare. As pragmatic imperatives push the provision of health and social care out of the organisational contexts and into private space, there is a particular need to simultaneously understand, and critically interrogate, the implications of new, as well as existing, forms of care.
Practical implications
This paper reviews, frames and details practical next steps in developing CHMS. These include: enhanced engagement with a wider range of actors than is currently the norm in mainstream healthcare management research; a broadening of theoretical and methodological lenses; support for critical approaches among editors and reviewers; and enhanced communication of critical research via its incorporation into education and training programmes.
Originality/value
The paper contributes to an emerging stream of CHMS research, and works to consolidate next steps for the field.
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Aoife M. McDermott and Anne Reff Pedersen
The purpose of this paper is two-fold. First, it sets the context for the special issue by considering conceptions of patients and their roles in service delivery and improvement…
Abstract
Purpose
The purpose of this paper is two-fold. First, it sets the context for the special issue by considering conceptions of patients and their roles in service delivery and improvement. Second, it introduces the contributions to the special issue, and identifies thematic resonance.
Design/methodology/approach
The paper utilises a literature synthesis and thematic analysis of the special issue submissions. These emanated from the Ninth International Organisational Behaviour in Healthcare Conference, hosted by Copenhagen Business School on behalf of the Learned Society for Studies in Organizing Healthcare.
Findings
The articles evidence a range of perspectives on patients’ roles in healthcare. These range from their being subject to, a mobilising focus for, and active participants in service delivery and improvement. Building upon the potential patient roles identified, this editorial develops five “ideal type” patient positions in healthcare delivery and improvement. These recognise that patients’ engagement with health care services is influenced both by personal characteristics and circumstances, which affect patients’ openness to engaging with health services, as well as the opportunities afforded to patients to engage, by organisations and their employees.
Originality/value
The paper explores the relationally embedded nature of patient involvement in healthcare, inherent in the interdependence between patient and providers’ roles. The typology aims to prompt discussion regarding the conceptualisation patients’ roles in healthcare organisations, and the individual, employee, organisational and contextual factors that may help and hinder their involvement in service delivery and improvement. The authors close by noting four areas meriting further research attention, and potentially useful theoretical lenses.
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Jennifer Creese, John-Paul Byrne, Anne Matthews, Aoife M. McDermott, Edel Conway and Niamh Humphries
Workplace silence impedes productivity, job satisfaction and retention, key issues for the hospital workforce worldwide. It can have a negative effect on patient outcomes and…
Abstract
Purpose
Workplace silence impedes productivity, job satisfaction and retention, key issues for the hospital workforce worldwide. It can have a negative effect on patient outcomes and safety and human resources in healthcare organisations. This study aims to examine factors that influence workplace silence among hospital doctors in Ireland.
Design/methodology/approach
A national, cross-sectional, online survey of hospital doctors in Ireland was conducted in October–November 2019; 1,070 hospital doctors responded. This paper focuses on responses to the question “If you had concerns about your working conditions, would you raise them?”. In total, 227 hospital doctor respondents (25%) stated that they would not raise concerns about their working conditions. Qualitative thematic analysis was carried out on free-text responses to explore why these doctors choose to opt for silence regarding their working conditions.
Findings
Reputational risk, lack of energy and time, a perceived inability to effect change and cultural norms all discourage doctors from raising concerns about working conditions. Apathy arose as change to working conditions was perceived as highly unlikely. In turn, this had scope to lead to neglect and exit. Voice was seen as risky for some respondents, who feared that complaining could damage their career prospects and workplace relationships.
Originality/value
This study highlights the systemic, cultural and practical issues that pressure hospital doctors in Ireland to opt for silence around working conditions. It adds to the literature on workplace silence and voice within the medical profession and provides a framework for comparative analysis of doctors' silence and voice in other settings.
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Jennifer Cowman and Mary A. Keating
The purpose of this paper is to explore the nature of industrial relations (IR), and IR conflict in the Irish healthcare sector.
Abstract
Purpose
The purpose of this paper is to explore the nature of industrial relations (IR), and IR conflict in the Irish healthcare sector.
Design/methodology/approach
The paper is based on a thematic analysis of Labour Court cases concerning hospitals over a ten‐year period.
Findings
The findings of the paper indicate that the nature of IR conflict is changing in healthcare. The paper suggests that alternative manifestations of IR conflict evident in the Irish healthcare sector include: absenteeism as a form of temporary exit; and resistance. The key groups in the sector are discussed in the context of their contrasting disputes. The themes which characterise negotiations are identified as precedent, procedure and partnership.
Research limitations/implications
The research was conducted in the healthcare sector, and thus its transferability is limited. Caution is also required as the research pertains to one national setting, which despite sharing some structural similarities with other health and IR systems, is a unique context. The paper highlights the importance of recognising IR conflict in its various forms. It is further suggested that managing the process of IR conflict may be significant in furthering change agendas.
Originality/value
The value of the paper centres on the investigation of alternative manifestations of IR conflict in the healthcare sector.
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The purpose of this paper is to investigate the process and impact of patient involvement in locally defined improvement projects in two hospital clinics. The paper particularly…
Abstract
Purpose
The purpose of this paper is to investigate the process and impact of patient involvement in locally defined improvement projects in two hospital clinics. The paper particularly aims to examine how patient narratives, in the form of diaries and radio montage, help to create new insights into patient experience for healthcare professionals, and support professionals’ enrolment and mobilisation in innovation projects.
Design/methodology/approach
Two case studies were undertaken. These drew upon qualitative interviews with staff and participant observation during innovation workshops. Patient diaries and a recorded montage of patient voices were also collected.
Findings
The findings illuminate translation processes in healthcare innovation and the emergence of meaning making process for staff through the active use of patient narratives. The paper highlights the critical role of meaning making as an enabler of patient-centred change processes in healthcare via: local clinic mangers defining problems and ideas; collecting and sharing patient narratives in innovation workshops; and healthcare professionals’ interpretation of patient narratives supporting new insights into patient experience.
Practical implications
This study demonstrates how healthcare professionals’ meaning making can be supported by articulating, constructing, listening and interpreting patient narratives. The two cases demonstrate how patient narratives serve as reflective devices for healthcare professionals.
Originality/value
This study presents a novel demonstration of the importance of patient narratives for translating healthcare innovation in a clinical practice setting.
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Denise L. Anthony and Timothy Stablein
The purpose of this paper is to explore different health care professionals’ discourse about privacy – its definition and importance in health care, and its role in their…
Abstract
Purpose
The purpose of this paper is to explore different health care professionals’ discourse about privacy – its definition and importance in health care, and its role in their day-to-day work. Professionals’ discourse about privacy reveals how new technologies and laws challenge existing practices of information control within and between professional groups in health care, with implications not only for patient privacy, but also for the role of information control in professions more generally.
Design/methodology/approach
The authors conducted in-depth, semi-structured interviews with n=83 doctors, nurses, and health information professionals in two academic medical centers and one veteran’s administration hospital/clinic in the Northeastern USA. Interview responses were qualitatively coded for themes and patterns across groups were identified.
Findings
The health care providers and the authors studied actively sought to uphold the protection (and control) of patient information through professional ethics and practices, as well as through the use of technologies and compliance with legal regulations. They used discourses of professionalism, as well as of law and technology, to sometimes accept and sometimes resist changes to practice required in the changing technological and legal context of health care. The authors found differences across professional groups; for some, protection of patient information is part of core professional ethics, while for others it is simply part of their occupational work, aligned with organizational interests.
Research limitations/implications
This qualitative study of physicians, nurses, and health information professionals revealed some differences in views and practices for protecting patient information in the changing technological and legal context of health care that suggest some professional groups (doctors) may be more likely to resist such changes and others (health information professionals) will actively adopt them.
Practical implications
New technologies and regulations are changing how information is used in health care delivery, challenging professional practices for the control of patient information that may change the value or meaning of medical records for different professional groups.
Originality/value
Qualitative findings suggest that professional groups in health care vary in the extent of information control they have, as well in how they view such control. Some groups may be more likely to (be able to) resist changes in the professional control of information that stem from new technologies or regulatory policies. Some professionals recognize that new IT systems and regulations challenge existing social control of information in health care, with the potential to undermine (or possibly bolster) professional self-control for some but not necessarily all occupational groups.
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Mirjam Körner, Corinna Lippenberger, Sonja Becker, Lars Reichler, Christian Müller, Linda Zimmermann, Manfred Rundel and Harald Baumeister
Knowledge integration is the process of building shared mental models. The integration of the diverse knowledge of the health professions in shared mental models is a precondition…
Abstract
Purpose
Knowledge integration is the process of building shared mental models. The integration of the diverse knowledge of the health professions in shared mental models is a precondition for effective teamwork and team performance. As it is known that different groups of health care professionals often tend to work in isolation, the authors compared the perceptions of knowledge integration. It can be expected that based on this isolation, knowledge integration is assessed differently. The purpose of this paper is to test these differences in the perception of knowledge integration between the professional groups and to identify to what extent knowledge integration predicts perceptions of teamwork and team performance and to determine if teamwork has a mediating effect.
Design/methodology/approach
The study is a multi-center cross-sectional study with a descriptive-explorative design. Data were collected by means of a staff questionnaire for all health care professionals working in the rehabilitation clinics.
Findings
The results showed that there are significant differences in knowledge integration within interprofessional health care teams. Furthermore, it could be shown that knowledge integration is significantly related to patient-centered teamwork as well as to team performance. Mediation analysis revealed partial mediation of the effect of knowledge integration on team performance through teamwork.
Practical/implications
In practice, the results of the study provide a valuable starting point for team development interventions.
Originality/value
This is the first study that explored knowledge integration in medical rehabilitation teams and its relation to patient-centered teamwork and team performance.
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Yseult Freeney and Martin R. Fellenz
Against a backdrop of increased work intensification within maternity hospitals, the purpose of this paper is to examine the role of work engagement in the quality of care…
Abstract
Purpose
Against a backdrop of increased work intensification within maternity hospitals, the purpose of this paper is to examine the role of work engagement in the quality of care delivered to patients and in general health of the midwives delivering care, as reported by midwives and nurses.
Design/methodology/approach
Quantitative questionnaires consisting of standardised measures were distributed to midwives in two large maternity hospitals. These questionnaires assessed levels of work engagement, supervisor and colleague support, general health and quality of care.
Findings
Structural equation modelling analysis revealed a best‐fit model that demonstrated work engagement to be a significant partial mediator between organisational and supervisor support and quality of care, and as a significant predictor of self‐reported general health. Together, supervisor support, social support and organisational resources, mediated by work engagement, explained 38 per cent of the variance in quality of care at the unit level and 23 per cent of variance in general health among midwives (χ2(67)=113; p<0.01, CFI=0.961, RMSEA=0.06).
Research limitations/implications
The study is limited in that it uses self‐report measures of quality of care and lacks objective indicators of patient outcomes. The cross‐sectional design also does not allow for causal inferences to be drawn from the data.
Practical implications
This study provides evidence for the links between individual levels of work engagement and both health and self‐reports of unit level quality of care. The results support the importance of health services organisations and managers deploying organisational resources to foster employee work engagement. The results also highlight the significant role of the immediate nurse manager and suggest training and development for such roles is a valuable investment.
Originality/value
These results are the first to link work engagement and performance in health care contexts and point to the value of work engagement for both unit performance and for individual employee well‐being in health organisations.
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Hanna Augustsson, Agneta Törnquist and Henna Hasson
The purpose of this paper is to evaluate the outcomes of a workplace learning intervention on organizational learning and to identify factors influencing the creation of…
Abstract
Purpose
The purpose of this paper is to evaluate the outcomes of a workplace learning intervention on organizational learning and to identify factors influencing the creation of organizational learning in residential care of older people.
Design/methodology/approach
The study consisted of a quasi‐experimental intervention for outcome evaluation. In addition, a case study design was used to identify factors influencing organizational learning. Outcomes were evaluated using the validated Dimensions of the Learning Organization Questionnaire at three time points, and interviews were conducted with nursing staff and managers.
Findings
The intervention had some effects on the individual level, but no improvements in organizational learning were found. Hindering factors for creating organizational learning were poor initial learning climate, managers' uncertainty about their role, lack of ownership and responsibility among staff and managers, managers' views of personality being a more important component than staff development in older people's care, and a lack of systems for capturing acquired knowledge.
Originality/value
The study offers suggestions for the transfer of individual‐level learning to organizational learning in older people's care.