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Drawing on normal accident and high-reliability organizational theories, this study examines the impact of magnitude and likelihood of disruptions on surgical procedure performance. More importantly, the authors investigate the moderating role played by information exchange and risk management infrastructure in mitigating the negative effect of disruption on performance.

A nationwide multi-respondent survey was administered to operating room personnel to collect information on their experiences with disruptions experienced in surgeries. The survey data are analyzed to examine the relationship between operational disruptions and procedure performance. Additionally, the moderating roles of risk management infrastructure and information exchange on the relationship between disruptions and performance are investigated. The results obtained from the empirical analysis are validated using data from an ethnographic investigation of surgeries at a major hospital.

The results show that both the magnitude and the likelihood of a disruption adversely impact procedure performance. Interestingly, the authors find that risk management infrastructure and information exchange play different roles in mitigating the effect of disruptions on performance. The authors find that while risk management infrastructure helps mitigate the effect of magnitude of service disruptions, information exchange helps reduce the effects of likelihood of disruptions. The findings lend strong support to the theoretical assertions. By means of the participant–observer data collected from over 100 surgeries as part of the ethnographic investigation, the authors validate the key findings. The findings suggest that disruptions are common occurrences in surgical settings, but their performance impact may be lessened or altogether avoided with the proper information and risk management mechanisms in place.

This survey research extends the understanding of risk management by considering a context that is highly prone to disruptions. The authors adopt existing constructs pertaining to supply chain disruptions within this context and find new insights. The findings of the study show differential roles played by information exchange and risk management infrastructure in mitigating disruptions. This nuanced understanding provides directions for aligning efforts towards risk mitigation in surgical settings in a more focused way. This study supplements findings from survey data analysis with an examination of data collected by means of ethnographic investigation.

Healthcare networks are becoming ubiquitous, yet it is unclear how hospitals with varying quality capabilities would fare by being affiliated with large healthcare networks. The purpose of this paper is to first consider the deductive configuration perspective and distinguish high and low quality hospitals by using clinical and experiential quality as two dimensions of quality capability. Next, it examines the impact of healthcare network size on operating costs of hospitals. Additionally, the paper investigates the interaction effect of hospital demand and healthcare network size on operating costs.

The paper uses a dataset that was created by combining five separate sources. Cluster analysis technique is used to classify hospitals into four groups – holistic quality leaders (high clinical and experiential quality capability), experiential quality focusers (low clinical quality capability and high experiential quality capability), clinical quality focusers (high clinical capability and low experiential quality capability), and quality laggards (low clinical and experiential quality capability). The authors test the research hypotheses by means of regression analyses after controlling for several contextual characteristics.

The results show that affiliation with large healthcare networks reduces operating costs for quality laggards, but increases these costs for experiential quality focusers and clinical quality focusers. The hypothesized positive relationship between healthcare network size and costs is not supported for holistic quality leaders. The authors find that clinical quality focusers and holistic quality leaders can complement higher utilization levels in their operations due to increased demand and healthcare network size to reduce their operating costs per day.

There has been increasing evidence suggesting that hospitals must carefully manage both clinical and experiential quality. By focusing on both clinical and experiential quality, unlike experiential quality focusers and clinical quality focusers, holistic quality leaders are not adversely affected by the size of their network. The results suggest that experiential quality focusers and clinical quality focusers should either embrace holistic quality management or restrict the size of their networks to maintain their quality level and to reduce coordination costs.

It seems necessary to consider the functioning of biological systems on the basis of agonistic and antagonistic actions of a couple of elements. Here, the adrenal postpituitary system is considered. We show how such a view allowed us to give an account of diverse phenomena, noticeably the lack of response to Cortisol. It gave also rise to “paradoxical” therapies in the sense that both hormones had to be administered in case of an imbalance. A mathematical model helps one to become accustomed to these notions and, perhaps, is able to directly improve therapeutical strategies.

The recent managerial literature on the development of corporate infrastructures to deliver sophisticated and flexible IT capabilities is based on a set of assumptions concerning the role of management in strategy formulation, planning and control; the role of IT as a tool; the linkages between infrastructure and business processes; the implementation process. This paper deconstructs such assumptions by gradually enriching the conventional management agenda with new priorities stemming from other styles of taking care of infrastructures. The original, straightforward management agenda appears to be lacking: its foundations are irremediably shaken. The paper finally evokes a philosophy‐based agenda, the only one valuable in the uncharted territory where the usual foundations do not deliver any longer. Such an agenda speaks a language of weak agency: releasement; dwelling with mystery; capacity to drop the tools; valuing marginal practices. Will the last agenda play a key role in coping with the information infrastructures of the next millennium?

It is difficult to replicate evidence-informed models of psychosocial and assertive care interventions in non-research settings, and means to determine workforce capability for psychosocial therapies have not been readily available. The purpose of this paper is to describe and provide a rationale for the Therapy Capability Framework (TCF) which aims to enhance access to, and quality of, evidence-informed practice for consumers of mental health services (MHSs) by strengthening workforce capabilities and leadership for psychosocial therapies.

Guided by literature regarding the inadequacies and inconsistencies of evidence-informed practice provided by publicly-funded MHSs, this descriptive paper details the TCF and its application to enhance leadership and provision of evidence-informed psychosocial therapies within multi-disciplinary teams.

The TCF affords both individual and strategic workforce development opportunities. Applying the TCF as a service-wide workforce strategy may assist publicly-funded mental health leaders, and other speciality health services, establish a culture that values leadership, efficiency, and evidence-informed practice.

This paper introduces the TCF as an innovation to assist publicly-funded mental health leaders to transform standard case management roles to provide more evidence-informed psychosocial therapies. This may have clinical and cost-effective outcomes for public MHSs, the consumers, carers, and family members.

Addresses what “management” means in a multidisciplinary professional team. Looks at one particular profession – psychiatry – in which multidisciplinary teams are common and often problematic. Considers some of the issues that arise in the management of such teams, and particularly the tendency for competing professionals to wish to colonize each others′ area of operation. Proposes that the key to managing such teams is to have a clear role of problem definition within the team; someone needs to ensure that the most suitable care is provided for each patient, even if that care is outside their own competence. This activity is similar to that of senior management in other sectors, where problem definition tends to be associated with senior management. The management of professionals in multidisciplinary teams requires someone to be given a role as “wise generalist”.