Sara Tolf, Monica E. Nyström, Carol Tishelman, Mats Brommels and Johan Hansson
The purpose of this paper is to contribute to increased understanding of the concept agile and its potential for hospital managers to optimize design of organizational structures…
Abstract
Purpose
The purpose of this paper is to contribute to increased understanding of the concept agile and its potential for hospital managers to optimize design of organizational structures and processes to combine internal efficiency and external effectiveness.
Design/methodology/approach
An integrative review was conducted using the reSEARCH database. Articles met the following criteria: first, a definition of agility; second, descriptions of enablers of becoming an agile organization; and finally, discussions of agile on multiple organizational levels. In total, 60 articles qualified for the final analysis.
Findings
Organizational agility rests on the assumption that the environment is uncertain, ranging from frequently changing to highly unpredictable. Proactive, reactive or embracive coping strategies were described as possible ways to handle such uncertain environments. Five organizational capacities were derived as necessary for hospitals to use the strategies optimally: transparent and transient inter-organizational links; market sensitivity and customer focus; management by support for self-organizing employees; organic structures that are elastic and responsive; flexible human and resource capacity for timely delivery. Agile is portrayed as either the “new paradigm” following lean, the needed development on top of a lean base, or as complementary to lean in distinct hybrid strategies.
Practical implications
Environmental uncertainty needs to be matched with coping strategies and organizational capacities to design processes responsive to real needs of health care. This implies that lean and agile can be combined to optimize the design of hospitals, to meet different variations in demand and create good patient management.
Originality/value
While considerable value has been paid to strategies to improve the internal efficiency within hospitals, this review raise the attention to the value of strategies of external effectiveness.
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Anna Westerlund, Rickard Garvare, Elisabet Höög and Monica Elisabeth Nyström
The purpose of this paper was to investigate the role of an intra-organizational change facilitating function (CFF) in relation to a multi-level development initiative in a health…
Abstract
Purpose
The purpose of this paper was to investigate the role of an intra-organizational change facilitating function (CFF) in relation to a multi-level development initiative in a health care organization. Involved actors’ views on factors in need of attention and how the CFF related to these factors were studied.
Design/methodology/approach
A longitudinal case study design was used, combining data from questionnaires, process diaries and interviews with employees at the CFF, managers and clinic staff.
Findings
Factors on micro, meso and macro levels, crucial to attend to, were highlighted by respondents at staff and managerial levels. The CFF related to some of these factors by acting upon them, or by developing plans to handle them, while other factors were unattended to. The CFF activities also had indirect influence on other factors. The CFF role and responsibilities were not clearly defined beforehand, and a need to clarify a division of roles and responsibilities is highlighted.
Research limitations/implications
Our study contributes to current knowledge on facilitation of change by relating it to an organizational dimension of implementation.
Practical implications
The description of important factors to handle during a large organizational change process and issues a CFF can encounter may aid others involved in designing and managing large organizational development initiatives.
Originality/value
The study elaborates on less studied functions and roles of an intra-organizational CFF in relation to factors of vital importance for organizational change and development in health-care organizations.
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Monica Elisabeth Nyström, Elisabet Höög, Rickard Garvare, Lars Weinehall and Anneli Ivarsson
The study identifies the variation of change strategies used in a complex large scale change program in health and social services in Sweden, aimed at changing professionals'…
Abstract
Purpose
The study identifies the variation of change strategies used in a complex large scale change program in health and social services in Sweden, aimed at changing professionals' health promoting practices. The purpose is to investigate the change strategies used over time and describe the potential variation in key change agent views, using a framework inspired by De Caluwé and Vermaak's multi paradigm change typology.
Design/methodology/approach
The first six years of the regional multi-sector program are examined. Results are based on content analyses of interviews with key change actors, and archival data describing program activities. Respondents belonged to either the strategic or the operational program management team, representing different sectors of health and social services in a region.
Findings
Multiple strategy paradigms showed varying influence over the program's different phases, partly due to program progress, change agent influence and/or varying contextual demands. Respondents' views on strategies and program focus varied depending on their program roles. Respondents expressed insights about the varying conditions for change and on the conflicting expectations within and between program management teams.
Originality/value
This study introduces the application of a new framework on a large scale, complex change program. The framework sheds light on a number of basic assumptions and change strategies that can be further compared with content and context factors, barriers, facilitators, outcomes, and in turn with other programs.
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Monica Elisabeth Nyström, Rickard Garvare, Anna Westerlund and Lars Weinehall
Competing activities and projects can interfere with implementing new knowledge and approaches. The purpose, therefore, was to investigate processes and impact related to…
Abstract
Purpose
Competing activities and projects can interfere with implementing new knowledge and approaches. The purpose, therefore, was to investigate processes and impact related to implementing two concurrent quality initiatives in a Swedish hospital. These were a regionally initiated, system-wide organizational learning programme called the Dynamic and Viable Organization (DVO) and a national initiative on stopping healthcare-associated and hospital-acquired infections (SHAI). Both undertakings aspired to increase staff competence in systematic improvement approaches.
Design/methodology/approach
Multiple methods were applied including surveys, observations, interviews, process diaries, documents and organizational measurements. Respondents were unit managers, change facilitators and improvement team members.
Findings
Even though both initiatives shared the same improvement approach, there was no strong indication that they were strategically combined to benefit each other. The initiatives existed side by side with some coordination and some conflict. Despite absent management strategies to utilize the national SHAI initiative, positive developments in QI culture and communication were reported. The current study illustrates the inherent difficulties coordinating change initiatives, even in favourable circumstances.
Orginality/value
This article addresses the lesser studied but common situation of coinciding and competing projects in organizations.
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Elisabet Höög, Jack Lysholm, Rickard Garvare, Lars Weinehall and Monica Elisabeth Nyström
The purpose of this paper is to investigate the obstacles and challenges associated with organizational monitoring and follow-up (M & F) processes related to health care…
Abstract
Purpose
The purpose of this paper is to investigate the obstacles and challenges associated with organizational monitoring and follow-up (M & F) processes related to health care quality improvement (QI) and development.
Design/methodology/approach
A longitudinal case study of a large health care organization during a system-wide QI intervention. Content analysis was conducted of repeated interviews with key actors and archival data collected over a period of four years.
Findings
The demand for improved M & F strategies, and what and how to monitor were described by the respondents. Obstacles and challenges for achieving M & F strategies that enables system-wide and coherent development were found in three areas: monitoring, processing, and feedback and communication. Also overarching challenges were found.
Practical implications
A model of important aspects of M & F systems is presented that can be used for analysis and planning and contribute to shared cognition of such systems. Approaches for systematic analysis and follow-up of identified problems have to be developed and fully incorporated in the organization’s measurement systems. A systematic M & F needs analytic and process-oriented competence, and this study highlights the potential in an organizational function with capacity and mandate for such tasks.
Originality/value
Most health care systems are flooded with a vast amount of registers, records, and measurements. A key issue is how such data can be processed and refined to reflect the needs and the development process of the health care system and how rich data can be used for improvement purposes. This study presents key organizational actor’s view on important factors to consider when building a coherent organizational M & F strategy.
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Elisabet Höög, Rickard Garvare, Anneli Ivarsson, Lars Weinehall and Monica Elisabeth Nyström
The purpose of this paper is to investigate program management teams' views on issues and challenges in managing a large, multi-sectoral child health promotion program in Sweden…
Abstract
Purpose
The purpose of this paper is to investigate program management teams' views on issues and challenges in managing a large, multi-sectoral child health promotion program in Sweden.
Design/methodology/approach
In total, 17 participants representing two autonomous program management teams, one strategic and one operational, were interviewed. Analysis of interview data was complemented with reviews of program documents.
Findings
Program management teams identified important issues concerning the program's formal structure, goals, role distribution, and change and dissemination processes, but lacked a shared mental model of the situation. Inter and intra group communication, long- and short-term strategic planning were further areas in need of improvement. While issues and challenges might seem to be agreed upon by the program's change agents, closer inspection reveals variation in key characteristics as well as in perspectives on solutions.
Originality/value
Health promotion programs are challenging. Researchers trying to understand program success have focused on particular interventions, contextual factors and program recipients. Less research has focused on the internal processes of teams tasked with wide-ranging change mandates and the effects such processes can have on program outcomes. This study contributes to a deeper understanding on internal processes and mental models of change agent teams.
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The critical nature of diffusion in understanding the link between individual competency and collective competency is often underconceptualized. Organizational learning involves…
Abstract
The critical nature of diffusion in understanding the link between individual competency and collective competency is often underconceptualized. Organizational learning involves diffusion of knowledge and/or skill from the individual to members of the collective, and expansion of the collective's capacity to take effective action. Three types of individual and collective competency are identified, ranging on a continuum from explicit‐and‐quickly‐diffused to tacit‐and‐slowly‐diffused Patterns of diffusion can occur in stages: by critical mass, in cycles, or in a synthesis of styles. A model illustrating these dynamics is presented. Criteria for evaluating successful collective learning are introduced.
Hugo D. Asencio, Fynnwin Prager, José N. Martínez and John Tamura
This paper examines the relationship between government economic development programming and entrepreneurial activity, by examining evidence in Southern California cities. While…
Abstract
Purpose
This paper examines the relationship between government economic development programming and entrepreneurial activity, by examining evidence in Southern California cities. While numerous studies explore this relationship between government institutions and entrepreneurship at the level of countries and states, significant questions remain at the level of city government, and the influence of local government economic development programs on city-level entrepreneurial activity.
Design/methodology/approach
This paper uses regression analysis of data from all 215 Southern California cities to decompose the complex relationships between economic development programming and different types of entrepreneurial activity.
Findings
Results suggest startups are attracted to cities with higher crime rates, more diversity, and older populations, yet not those with higher levels of economic development programming. There is evidence that some types of economic development programming may influence entrepreneurship, especially for the level of minority-owned businesses.
Originality/value
The paper makes three important contributions to the literature. First, it is among the first to use local (city-level) entrepreneurship as an outcome variable to measure the effect of government economic development programming. Many scholars have instead chosen to look at outcomes relating to general economic growth (e.g. new jobs) rather than outcomes specific to local entrepreneurship. Second, it explores city-wide entrepreneurial activity with respect to numerous measures, such as start-ups, minority and female ownership, and self-employment. Third, it examines the potential influence of economic development programming, both on aggregate and decomposed into economic development program clusters.
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The study investigated the relationship of career instrumental and expressive intra‐organizational network resources with extrinsic and intrinsic career success and with the…
Abstract
The study investigated the relationship of career instrumental and expressive intra‐organizational network resources with extrinsic and intrinsic career success and with the Big‐Five of personality in a sample of 264 white‐collar workers. Total network resources were associated with extrinsic and intrinsic career success above the contribution of human capital, demographics and mentoring received. And instrumental network resources contributed more strongly than expressive network resources to extrinsic career success. Furthermore, instrumental network resources emerged as important for intrinsic evaluations of hierarchical and interpersonal career success while expressive network resources emerged as important for intrinsic evaluations of job and interpersonal career success. There was limited support for the influence of personality on the accumulation of network resources. As hypothesized, conscientiousness was negatively associated with instrumental network resources; however, extra‐version, openness and agreeableness failed to make significant contributions to network resources over and above the contribution of human capital and demographics. The implications of the findings for individual career tactics and for organizational practices are discussed and the limitations of the study are considered along with directions for future research.