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Article
Publication date: 6 March 2017

Marcela Porporato, Peter Tsasis and Luz Maria Marin Vinuesa

The purpose of this paper is to investigate whether first level measures in the Balanced Scorecard (BSC) declaring a cause-effect relationship by design are composite indices of…

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Abstract

Purpose

The purpose of this paper is to investigate whether first level measures in the Balanced Scorecard (BSC) declaring a cause-effect relationship by design are composite indices of lower measures, and if they converge into a single factor as is traditionally accepted in the BSC literature.

Design/methodology/approach

This study reports results of a quantitative case study that focusses on an Ontario (Canada) community hospital that has been using the BSC.

Findings

The results of this study challenge the cause-effect assumption of the BSC, particularly in a cascading context, and suggest that a lack of attention of how composite indices of lower measures converge into a single higher level measure may be the reason for ineffective use of the BSC.

Research limitations/implications

The BSC is a dynamic tool; as such there are several measures that have a very short history, thus limiting the observations available to be used in statistical models.

Practical implications

A key recommendation for practice that emerges from this study is the need to test if lower level metrics do merge naturally in the upper level measure of the BSC; if not, the upper level measure might not be linked to other measures rendering the BSC ineffective in the context of causality.

Originality/value

Although several studies have argued in favour of the cause-effect relationship of the BSC, none of those found in the literature have paid attention to the way in which first level measures are constructed. This may explain why certain measures are linked, while others are not, to those that are calculated as composite indices of several lower level indicators.

Details

International Journal of Productivity and Performance Management, vol. 66 no. 3
Type: Research Article
ISSN: 1741-0401

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Article
Publication date: 28 May 2021

Narender Nalajala and Rachel Craig

Financial constraints, an increase in the demand for health-care from an ageing population, multiple comorbidities in both mental and physical health and delivering care closer to…

371

Abstract

Purpose

Financial constraints, an increase in the demand for health-care from an ageing population, multiple comorbidities in both mental and physical health and delivering care closer to the community, are amongst the factors creating a need for innovation in the NHS. The purpose of this paper is to explore leader behaviours that promote innovation in a multidisciplinary musculoskeletal (MSK) service.

Design/methodology/approach

Qualitative semi-structured interviews were conducted to explore the experience and views of the multidisciplinary team (MDT) members on leadership and innovation. A total of 13 MDT members participated in the study.

Findings

Inter-professional collaboration and the absence of hierarchical behaviours are associated with a positive experience. Traditionally established hierarchy and inter-professional barriers for interaction were associated with challenging experience in MDT. There was an expression of fear of and vulnerability to being “taken over” or “eaten up” by other professions. Supportiveness, consulting behaviour, provision of time, vision and inspiring and risk-taking behaviours are associated with innovation. Target drove and monitoring behaviours or hierarchical expression of authority, directive or supervisory behaviours are negatively associated with innovation.

Practical implications

Day to day leader’s behaviours and interactions influences the work environment for innovation. Knowledge gained through Informal interaction, understanding each other’s professional strengths and weaknesses are implicit strengths of an MDT but when a member perceives their skills as less valuable to that of another member, they hold less power and influence. Therefore, a flat hierarchy provides a more effective structure for knowledge translation and maximising MDT productivity.

Originality/value

MSK services are complex adaptive systems with several pathways and interactions flowing between various specialities. For improving innovation and effective functioning of the MSK MDT, it is important to provide informal training for team leads on self-awareness of the behaviours associated with innovation.

Details

Leadership in Health Services, vol. 34 no. 2
Type: Research Article
ISSN: 1751-1879

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Article
Publication date: 4 April 2023

Narender Nalajala, Mitesh Panchal and Laura Gotting

Orthopaedics, rheumatology, pain management, specialist radiology and therapy services were brought under one umbrella to form Northwest Surrey integrated musculoskeletal (IMSK…

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Abstract

Purpose

Orthopaedics, rheumatology, pain management, specialist radiology and therapy services were brought under one umbrella to form Northwest Surrey integrated musculoskeletal (IMSK) services and introduced advance clinical practice, a multi-disciplinary team triage with a formalised straight to test (STT) process defined in 2018. Historically, prior to these services' integration, there were a primary and second care triage systems within individual specialities. The aim of this service evaluation is to assess the impact of a single IMSK multidisciplinary triage (MDT) system and the efficacy of STT from triage, which allows patients to be sent for diagnostics based on the cluster of symptoms and past medical history in order to achieve early identification of serious pathologies. This is a complex adaptive system with pathways spanning into the core areas of orthopaedics, rheumatology, therapies, pain management services, radiology and some less frequent specialities such as neurology, oncology, vascular and gynaecology. One of the objectives of this study was to identify how many referrals were triaged to consultants, Advance practice and therapies. In addition, the authors wanted to highlight the proportion of referrals that were sent straight to test from triage and the percentage of these that had sinister pathology identified. This information would then be compared against existing red flag literature to identify common themes. This study aims to discuss the aforementioned objectives.

Design/methodology/approach

Data were extracted retrospectively from a hospital database from January to December 2019 for all the adult musculoskeletal service referrals. The data collected were analysed on a Microsoft Excel sheet with information including date of triage, hospital number, ordering clinician, body part, type of diagnostic, indications for scanning, outcome for STT, serious pathology findings (named code 5 within our trust) and outcome of appointment.

Findings

A total of 47,039 referrals were received into the IMSK service. Of these referrals 19,967 were directly referred to therapies, with 27,072 referrals received into the IMSK service MDT process. Within triage, 718 patients were directed to STT to rule out serious pathology. A total of 28 patients (3.9%) had sinister pathology identified on their investigation. A total of 46% of patients were discharged from their first consultation following STT. Overall, 50% of the total number of referrals into the IMSK service was seen by advanced practitioners with 16% of patients directed to consultants with pre-consultation diagnostic work up.

Originality/value

This service evaluation highlights that STT allows early access to diagnostics, resulting in quicker access to identification of sinister pathology. A one stop MDT system has been shown to be effective in guiding the referral to the right place with increased referrals into allied health advance practice clinics and access to therapies directly. It has resulted in a reduction of unwarranted referrals to consultant care, duplication of investigations and identified patients on multiple pathways.

Details

Journal of Integrated Care, vol. 31 no. 2
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 19 July 2013

Anand Gurumurthy, Prasoon Mazumdar and Sowmiya Muthusubramanian

A literature review revealed that in recent times, many companies have attempted organization‐wide change management through the philosophy and principles of Lean Thinking (LT)…

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Abstract

Purpose

A literature review revealed that in recent times, many companies have attempted organization‐wide change management through the philosophy and principles of Lean Thinking (LT). Although some organizations have transformed and reaped significant benefits in this endeavour, many organizations have failed in this attempt. One of the reasons can be attributed to the fact that not many organizations are attempting to “assess the organizational readiness” before implementing/adapting LT. This paper aims to address this issue.

Design/methodology/approach

Hence in this paper, an attempt has made to address this problem by presenting a hypothetical case study of an Indian organization to comprehensively assess organizational readiness of the case organisation using a graph theoretic approach (GTA), which has the ability to integrate and model multiple inter‐related factors.

Findings

From the obtained results, it was found that the case organization is not fully ready to embrace LT. It needs to work on different factors under the categories of suppliers, customers, etc. in addition to employees, organisation and top management for smooth and successful adaptation.

Originality/value

According to the authors' knowledge, no paper exists either in the literature of organizational analysis or in the field of LT literature that demonstrates the application of GTA, specifically for assessing the readiness of an organization in adapting LT. Furthermore, various factors which need to be considered were identified apart from modelling them by incorporating the relationship/dependency that exists between these factors, which is unique.

Details

International Journal of Organizational Analysis, vol. 21 no. 3
Type: Research Article
ISSN: 1934-8835

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Article
Publication date: 13 February 2017

Christine Phillips, Sally Hall, Nicholas Elmitt, Marianne Bookallil and Kirsty Douglas

Services for refugees and asylum seekers frequently experience gaps in delivery and access, poor coordination, and service stress. The purpose of this paper is to examine the…

577

Abstract

Purpose

Services for refugees and asylum seekers frequently experience gaps in delivery and access, poor coordination, and service stress. The purpose of this paper is to examine the approach to integrated care within Companion House (CH), a refugee primary care service, whose service mix includes counselling, medical care, community development, and advocacy. Like all Australian refugee and asylum seeker support services, CH operates within an uncertain policy environment, constantly adapting to funding challenges, and changing needs of patient populations.

Design/methodology/approach

Interviews with staff, social network analysis, group patient interviews, and service mapping.

Findings

CH has created fluid links between teams, and encouraged open dialogue with client populations. There is a high level of networking between staff, much of it informal. This is underpinned by horizontal management and staff commitment to a shared mission and an ethos of mutual respect. The clinical teams are collectively oriented towards patients but not necessarily towards each other.

Research limitations/implications

Part of the service’s resilience and ongoing service orientation is due to the fostering of an emergent self-organising form of integration through a complex adaptive systems approach. The outcome of this integration is characterised through the metaphors of “home” for patients, and “family” for staff. CH’s model of integration has relevance for other services for marginalised populations with complex service needs.

Originality/value

This study provides new evidence on the importance of both formal and informal communication, and that limited formal integration between clinical teams is no bar to integration as an outcome for patients.

Details

Journal of Integrated Care, vol. 25 no. 1
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 12 February 2018

Ilias Vlachos and Evangelia Siachou

The purpose of this paper is to identify workplace factors with an impact on lean performance (LP). This can lead to better LP outcomes, thus facilitating organizations to…

1096

Abstract

Purpose

The purpose of this paper is to identify workplace factors with an impact on lean performance (LP). This can lead to better LP outcomes, thus facilitating organizations to smoothly move from the conventional to lean management.

Design/methodology/approach

The direct effects of training, knowledge acquisition and organizational culture are empirically investigated using data from 126 managers employed at a global company, which recently has improved its LP. Study’s hypotheses were analyzed with hierarchical regression models.

Findings

The findings suggest that not all of the aforementioned workplace factors holistically affect LP. Only organizational culture is associated to the four LP variables (i.e. continuous improvement, waste, ergonomy and product quality). Training and knowledge acquisition offer partially effects on LP with training to contribute mostly to predicting continuous improvements. Knowledge acquisition alone, has significant yet negative impact on both continuous improvement and ergonomy. Even more, when training is combined with knowledge acquisition the results are different.

Originality/value

As this study highlights the impact of workplace practices on LP, attributes mainly importance to the distinct effects that each of the aforementioned factors has on the four distinct LP variables. Although the study results reflect a particular case, its recommendations could facilitate practitioners to achieve better lean outcomes.

Details

International Journal of Productivity and Performance Management, vol. 67 no. 2
Type: Research Article
ISSN: 1741-0401

Keywords

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