Maude Laberge, André Côté and Angel Ruiz
The purpose of this paper is to define a clinical pathway for total joint replacement (TJR) surgery, estimate the effect of delays between steps of the pathway on wait time for…
Abstract
Purpose
The purpose of this paper is to define a clinical pathway for total joint replacement (TJR) surgery, estimate the effect of delays between steps of the pathway on wait time for surgery and to identify factors contributing to more efficient operations and challenges to their implementation.
Design/methodology/approach
This is a case study with a mixed methods approach. The authors conducted interviews with hospital staff. Data collected in the interviews and through on-site observation were analyzed to map the TJR process and identify the steps of the care pathway. The authors extracted and analyzed data (time stamps) from 60 hospital patient records for each step in the pathway and ran a regression on the duration of the whole trajectory.
Findings
There were wide variations in the delays observed between the seven steps identified. The delay between Step 1 and Step 2 was the only significant variable in predicting the total wait time to surgery. In one hospital, one delay explained 50 percent of the variation. There was misalignment between findings from the qualitative data in terms of strategies implemented to increase efficiency of the clinical pathway to the quantitative data on delays between the steps.
Research limitations/implications
The study identified the clinical pathway from the consultation with an orthopaedic surgeon to the surgery. However, it did not go beyond the surgery. Future research could investigate the relationship between specific processes and delays between steps of the process and patient outcomes, including length of stay, mobilization and functionality in activities of daily living, as well as potential complications from surgery, readmission and the services required after the patient was discharged.
Practical implications
Wait times can be addressed by implementing strategies at the health system level or at the organizational level. The authors found and discuss areas where there could be efficiency gains for health care organizations.
Social implications
Stakeholders in care processes are diverse and they each have their preferences in how they practice (in the case of providers) and how they perceive and wish to respond adequately to patients’ needs in contexts that have different norms and approaches. The approach in this study enables a better understanding of the processes, the organizational culture and how these may affect each other.
Originality/value
Our mixed methods enabled a process mapping and the identification of factors that significantly affected the efficiency of the TJR surgery process. It combines methods from process engineering with health services and management research. To some extent, this study demonstrates that although managers can define and enforce processes, organizational culture and practices are harder to influence.
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Maude Brunet and Daniel Forgues
The purpose of this paper is to investigate a case of collective sensemaking about the project success of the multifunctional amphitheater of Quebec (Canada).
Abstract
Purpose
The purpose of this paper is to investigate a case of collective sensemaking about the project success of the multifunctional amphitheater of Quebec (Canada).
Design/methodology/approach
For this explorative and qualitative research, the authors started from the post-mortem document and complemented their comprehension with six semi-structured interviews with the main project actors and other public documents regarding this project.
Findings
According to the respondents, the main success factors of this project can be attributed to: a clear governance structure; proven project management and construction methods; the use of emerging collaborative practices in construction (such as building information modeling (BIM) and lean construction); an adapted policy for procurement; as well as a code of values and ethics shared by all stakeholders.
Originality/value
The sensemaking perspective has been scarcely mobilized in project management studies, emerging from a constructivist view of reality and being sensitive about material-discursive practices. This exploratory study explores a case of collective sensemaking of a major project success and suggests avenues for major and megaprojects research. Lessons learned and implications for practice are also outlined. The conclusion allows a synthesis and an opening to consider how practitioners and researchers can build on this (and other successful) case(s) for future projects and research.
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The aims of this paper are to mobilize project management concepts in order to draw parallels with the doctoral project and to share the author’s experience and lessons learned.
Abstract
Purpose
The aims of this paper are to mobilize project management concepts in order to draw parallels with the doctoral project and to share the author’s experience and lessons learned.
Design/methodology/approach
This paper is based on a qualitative inquiry using an autoethnographic approach.
Findings
This paper contributes a self-reflexive examination of the doctoral project experience that incites current and future doctoral students and early-career researchers to take advantage of opportunities that make the experience satisfying, lay the foundations of an academic career and help ensure the thesis is completed in a timely and orderly manner.
Originality/value
Examining the doctoral project through the lens of one of the highest standards in project management, developed by the Project Management Institute (PMI), this paper enables PhD students in project management and other fields of study to understand the basics of a project and take action to structure their doctoral journey in a way that enhances both their experience and chances of success.