Search results

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.

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.

The papers evidence the value of CHMS, and provide insight into the benefits of broadening theoretical and methodological approaches in pursuit of critical insights.

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.

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.

The paper contributes to an emerging stream of CHMS research, and works to consolidate next steps for the field.

This article has been withdrawn as it was published elsewhere and accidentally duplicated. The original article can be seen here: 10.1108/09513559710156706. When citing the article, please cite: Martin Kitchener, Richard Whipp, (1997), “Tracks of change in hospitals: a study of quasi-market transformation”, International Journal of Public Sector Management, Vol. 10 Iss: 1/2, pp. 47 - 61.

An emerging trend in Australian workplaces is to appoint staff trained in mental health first aid as mental health first aid officers (MHFAOs), similar to physical first aid officers (PFAOs) focused on physical health emergencies. The purpose of this paper is to better understand the nature of MHFAO roles in workplaces and develop recommendations for other workplaces.

A case study methodology was used, with semi-structured qualitative interviews conducted with multiple individuals within five diverse organisations.

The results indicated that organisations tended to differ in their approach to implementation, based on their level of experience. There was a strong agreement across organisations on the benefits and challenges they have experienced with the role.

Organisational representatives highlighted some important differences between PFAO and MHFAO roles. Respondents across all organisations agreed that MHFA training should ideally be offered to all staff if feasible, not only MHFAOs. The greatest challenge experienced by respondents was inadequate support to, and internal resourcing for, MHFAO roles. Respondents suggested that workplaces provide more support and training to MHFAOs.

This is the first study to explore and describe the experiences of workplaces with MHFAOs. Recommendations are made to assist interested organisations in these efforts.

Attention to the realities of developing a market orientation has increased as managers endeavour to cope with the increasingly competitive contexts within which they operate. This paper considers, at the levels of organisation and individual, the transformation process within the industrial Research and Development and National Health Service sectors.

The election of the Conservative Government in 1979 heralded a diversion from the post‐war, Keynesian public policy model which envisaged incrementally expanding, centrally‐funded service provision (Hall, 1988). Largely in response to mounting financial crises, and building on earlier managerialist initiatives (eg. Griffiths, 1983), a new public sector management paradigm began to emerge at the beginning of the 1990s (Booth, 1993). This new paradigm, which was informed by the New Right's ‘public choice theory’ emphasised: fiscal re‐organisation, privatisation, the separation of purchaser and provider roles within quasi‐markets and the sovereignty of the customer (Butler and Vaile, 1991; Thompson, 1992). These ideological and structural changes are now recognised as a significant break with the past (Fitzgerald, 1993), and even John Major acknowledges the programme as a ‘revolution in progress’ (Major, 1989:1). Importantly, the reformers have often ritualistically, cast aside traditional, public sector and professional values (Pollitt, 1990a; Hood, 1991). In their place, a diffuse set of management ideas have been imported from the private sector. These have subsequently been aggregated and termed the “New Public Management” by commentators such as Harrow and Wilcocks (1990) and Steward and Walsh (1992).

Within discussions of the “new public management” (NPM) it is suggested that professionals increasingly face managerial initiatives that are designed to reduce their autonomy and monitor their work. This paper draws on study data from the local authority children’s homes sector to assess Power’s predictions regarding the “colonisation” and “decoupling” of management audits within professional state agencies. The findings suggest that the introduction of a managerial audit in children’s residential social work has involved a complex, negotiated and uneven process in which older patterns of autonomy have proved to be resilient. A key outcome has been the sometimes ritualistic and partial implementation of the audit process.

Examines the process of change in hospitals that has emerged following the introduction of the health quasi‐market in 1991. Blends empirical evidence with Greenwood and Hinings’ archetype and tracks of change concepts to analyse the process which is labelled quasi‐market transformation (QMT). Argues that, before 1991, hospitals tended to operate within structures and systems underpinned by an interpretive scheme. Represents these similarities of configuration as the directly‐managed (DM) hospital archetype. When change initiatives challenged this configuration, the outcomes were negotiated and resulted in “adjustmental” change. In contrast, shows the introduction of the quasi‐market to have involved the first transformation of the DM archetype’s interpretive scheme, systems and structures. Analyses four years of transition to reveal that QMT has been interpreted differently within hospitals. However, presents data to suggest that many hospitals now display significant similarities in terms of configuration. Represents these similarities within the emerging Trust hospital archetype.

The purpose of this paper is to explore the process of evolution of medical autonomy as an analytic and historical aspect of the medical work organization in a public bureaucracy.

The authors draw on the analytic concept of organizational contradictions (Heydebrand, 1977) to inform a dialectical approach in organizational analysis. Semi-structured interviews with 20 doctors of a Greek general public hospital were conducted and archival data were collected.

The findings suggest that the historical development of two contradictions characterize the process of medical autonomy evolution. The first contradiction tends to develop between medical autonomy, as a self-control relation, and the established division of labour through which bureaucratic control is exercised over the allocation of resources and over the distribution of healthcare service. The second contradiction tends to develop between those reified aspects of the medical work organization and the ongoing organizing activity, i.e. activity towards extending, intensifying and centralizing organizational control over labour, resources and the distribution of healthcare services. These contradictions indicate a pressure towards constraining health professionals’ power to self-define their relationship with patients and towards curtailing their discretionary domain over the use of resources.

This paper offers an empirical approach to materialist dialectics for organizational analysis towards conceptualizing change as a historical process.

This paper aims to develop a model that supports public organisations in making informed strategic decisions as to which public services are most suitable to be improved through co-creation. Thus, it first identifies the features that make public services (un)suitable for co-creation and then applies this knowledge to develop a multi-criteria decision support model for the assessment of their co-creation readiness.

The decision support model is the result of design science research. While its structure is determined by a qualitative multi-criteria decision analysis, its substance builds on a content analysis of Web of Science papers and over a dozen empirical case studies.

The model is comprised of 13 criteria clustered into two groups: service readiness criteria from the perspective of service users and service readiness criteria from the perspective of a public organisation.

The model attributes rely on a limited number of empirical cases and references from the literature review. The model was tested by only one public organisation on four of its services.

The paper shifts the research focus from organisational properties and capacity, as the key co-creation drivers and barriers, to features of public services as additional factors that affect the prospect of co-creation. Thus, it makes a pioneering step towards the conceptualisation of the idea of “service readiness for co-creation” and the development of a practical instrument that supports co-creation in the public sector.

What does the intersection of food gardening and public librarianship look like? This chapter examines the question through a close analysis of three case studies that represent the spread of this phenomenon in the United States and Canada. This is a first step toward identifying areas for further research that will contribute to a more comprehensive understanding of how food gardening in and around public libraries addresses community-level health disparities. Although it is the case that food gardens and related programming are no strangers to public libraries, this topic has not received sustained attention in the LIS research literature. Public libraries have long been framed as key institutions in increasing consumer health literacy, but a more recent trend has seen them also framed as key institutions in promoting public and community health, particularly through the use of the public library space. This chapter examines food gardens at public libraries with this more expansive understanding of how public libraries address health disparities, by considering how this work occurs through novel partnerships and programs focused on transforming physical space in local communities. At the same time, public interest in food gardens parallels increased awareness of food in society; food and diet as key aspects of health; food justice activism; and a long history of community empowerment in the face of the proliferation of food deserts through myriad activities, including community food gardens. The authors consider how food gardening in public libraries parallels these trends.