Search results

This paper outlines a theoretical framework for studying the integration of ethnically diverse workforces in public service organizations. Individual and work group characteristics are viewed as determinants of social identity and organizational identification. Social Identity theory suggests that individuals develop self‐concept through identification with salient groups, including ethnic groups and organizational roles. The extent to which these identifications are competitive or synergistic may depend upon organizational and work group characteristics and on organizational policies concerning selection, performance appraisal, and rewards. Cross‐functional teamwork may provide an integrative mechanism which can promote intergroup relations and encourage greater organizational commitment among an ethnically diverse workforce. Cross‐functional teams can contribute to reduced intergroup conflict and promote the development of organizational identification. The benefits of cross‐functional teams will be particularly important in situations where the workforce is diverse, but work groups are ethnically homogeneous.

Few will complain that 1974 has not been an eventful year; in a number of significant respects, it has made history. Local Government and National Health Services reorganizations are such events. This is indeed the day of the extra‐large authority, massive monoliths for central administration, metropolitan conurbations for regional control, district councils corresponding to the large authorities of other days; and in a sense, it is not local government any more. As in other fields, the “big batallions” acquire greater collective power than the total sum of the smaller units, can wield it more effectively, even ruthlessly, but rarely appearing to take into account the masses of little people, the quiet people, who cannot make themselves heard. As expected, new names of authorities are replacing the old; new titles for departments and officers, ambitious and high‐sounding; a little grandiose for the tongues of ordinary folk. Another history‐making event of 1974, in the nature of a departmental transfer but highly significant for the course of future events as far as work in the field is concerned, was handing over of the personal health services—health of expectant mothers, babies, children, domiciliary midwifery, the school health services and their mainly medical and nursing personnel—from local health authorities to the newly created area health authorities. The public health departments over fifty years and more had created them, built them up into the highly efficient services they are. If anything can be learned from the past, new authorities are always more expensive than those they replace; they spend freely and are lavish with their accommodation and furnishings. In their first few months of existence, the new bodies have proved they are no exception. News of their meetings and activities in many areas is now scanty; even local newspapers which usually thrive on Council news—or quarrels—seem to have been caught on the wrong foot, especially in the small towns now merged into larger units. The public are relatively uninformed, but this doubtless will soon be rectified.

To examine the evolution of health care integration strategies and associated conceptualization and practice through a review and synthesis of over 25 years of international academic research and literature.

A search of the health sciences literature was conducted using PubMed and EMBASE. A total of 114 articles were identified for inclusion and thematically analyzed using a strategy content model for systems-level integration.

Six major, inter-related shifts in integration strategies were identified: (1) from a focus on horizontal integration to an emphasis on vertical integration; (2) from acute care and institution-centered models of integration to a broader focus on community-based health and social services; (3) from economic arguments for integration to an emphasis on improving quality of care and creating value; (4) from evaluations of integration using an organizational perspective to an emerging interest in patient-centered measures; (5) from a focus on modifying organizational and environmental structures to an emphasis on changing ways of working and influencing underlying cultural attitudes and norms; and (6) from integration for all patients within defined regions to a strategic focus on integrating care for specific populations. We propose that underlying many of these shifts is a growing recognition of the value of understanding health care delivery and integration as processes situated in Complex-Adaptive Systems (CAS).

This review builds a descriptive framework against which to assess, compare, and track integration strategies over time.

Large-scale change involves modifying not only the structures and functions of multiple organizations, but also the mindsets and behaviours of diverse stakeholders. This paper focuses on the latter: the informal, less visible, and often neglected psychological and social factors implicated in change efforts. The purpose of this paper is to differentiate between the concepts of organizational culture and mental models, to argue for the value of applying a shared mental models (SMM) framework to large-scale change, and to suggest directions for future research.

The authors provide an overview of SMM theory and use it to explore the dynamic relationship between culture and cognition. The contributions and limitations of the theory to change efforts are also discussed.

Culture and cognition are complementary perspectives, providing insight into two different levels of the change process. SMM theory draws attention to important questions that add value to existing perspectives on large-scale change. The authors outline these questions for future research and argue that research and practice in this domain may be best served by focusing less on the potentially narrow goal of “achieving consensus” and more on identifying, understanding, and managing cognitive convergences and divergences as part of broader research and change management programmes.

Drawing from both cultural and cognitive paradigms can provide researchers with a more complete picture of the processes by which coordinated action are achieved in complex change initiatives in the healthcare domain.

Health service organizations and professionals are under increasing pressure to work together to deliver integrated patient care. A common understanding of integration strategies may facilitate the delivery of integrated care across inter‐organizational and inter‐professional boundaries. This paper aims to build a framework for exploring and potentially aligning multiple stakeholder perspectives of systems integration.

The authors draw from the literature on shared mental models, strategic management and change, framing, stakeholder management, and systems theory to develop a new construct, Mental Models of Integrated Care (MMIC), which consists of three types of mental models, i.e. integration‐task, system‐role, and integration‐belief.

The MMIC construct encompasses many of the known barriers and enablers to integrating care while also providing a comprehensive, theory‐based framework of psychological factors that may influence inter‐organizational and inter‐professional relations. While the existing literature on integration focuses on optimizing structures and processes, the MMIC construct emphasizes the convergence and divergence of stakeholders' knowledge and beliefs, and how these underlying cognitions influence interactions (or lack thereof) across the continuum of care.

MMIC may help to: explain what differentiates effective from ineffective integration initiatives; determine system readiness to integrate; diagnose integration problems; and develop interventions for enhancing integrative processes and ultimately the delivery of integrated care.

Global interest and ongoing challenges in integrating care underline the need for research on the mental models that characterize the behaviors of actors within health systems; the proposed framework offers a starting point for applying a cognitive perspective to health systems integration.

The purpose of this paper is to explore involving doctors in shared leadership. It examines the policies that have led to the focus on shared leadership and the implications for practice.

This is a conceptual paper, examining policy developments and key literature to understand the move towards shared leadership. It focuses on UK NHS, and in particular doctors, although the concepts will be relevant to other disciplines in healthcare, and healthcare systems in other countries.

This paper suggests that the shared-leadership approach for doctors has potential given the nature of clinical practice, the inherently collaborative nature of healthcare and the demands of new healthcare organisations. Health policy reform, generally, will mean that all doctors need to be engaged with leadership, albeit, perhaps, at different levels, and with different degrees of formality. Leadership will remain an important precondition for the success of the reforms. This is likely to be the case for other countries involved in healthcare reform.

To highlight the benefits and barriers to shared leadership for doctors.

Offers an alternative to traditional approaches to leadership.

Discusses the value, workings and effectiveness of international project teams. Proposes a model to enable the creation of an effective team and process. Points out the need to manage diversity, intercultural differences and different nationalities. Uses a case study from Raleigh International to illustrate.