Justin Avery Aunger, Ross Millar and Joanne Greenhalgh
Inter-organisational collaboration (IOC) across healthcare settings has been put forward as a solution to mounting financial and sustainability challenges. Whilst ingredients for…
Abstract
Purpose
Inter-organisational collaboration (IOC) across healthcare settings has been put forward as a solution to mounting financial and sustainability challenges. Whilst ingredients for successful IOC have been explored, there remains limited understanding of the development of IOCs over time.
Design/methodology/approach
The authors systematically reviewed the literature to identify models applied to IOCs in healthcare across databases such as Healthcare Management Information Consortium (HMIC) and MEDLINE, identifying 2,763 titles and abstracts with 26 final papers included. The authors then used a “best fit” framework synthesis methodology to synthesise fourteen models of IOC in healthcare and the wider public sector to formulate an applied composite model describing the process through which collaborations change over time. This synthesis comprised extracting stages and behaviours from included models, selecting an a priori framework upon which to code these stages and behaviours and then re-coding them to construct a new composite model.
Findings
Existing models often did not consider that organisations may undergo many IOCs in the organisations' lifetime nor included “contemplation” stages or those analogous to “dissolution”, which might negatively impact papers using such models. The formulated' composite model utilises a life-cycle design comprising five non-linear phases, namely Contemplating, Connecting, Planning, Implementation and Maintenance or Dissolution and incorporates dynamic elements from Complex Adaptive Systems thinking to reflect the dynamic nature of collaborations.
Originality/value
This is the first purpose-built model of the lifecycles of IOCs in healthcare. The model is intended to inform implementers, evaluators and researchers of IOCs alike.
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Justin Avery Aunger, Ross Millar, Joanne Greenhalgh, Russell Mannion, Anne Marie Rafferty and Hugh McLeod
The National Health Service (NHS) is facing unprecedented financial strain. These significant economic pressures have coincided with concerns regarding the quality and safety of…
Abstract
Purpose
The National Health Service (NHS) is facing unprecedented financial strain. These significant economic pressures have coincided with concerns regarding the quality and safety of the NHS provider sector. To make the necessary improvements to performance, policy interest has turned to encouraging greater collaboration and partnership working across providers.
Design/methodology/approach
Using a purposive search of academic and grey literature, this narrative review aimed (1) to establish a working typology of partnering arrangements for improvement across NHS providers and (2) inform the development of a plausible initial rough theory (IRF) of partnering to inform an ongoing realist synthesis.
Findings
Different types of partnership were characterised by degree of integration and/or organisational change. A review of existing theories of partnering also identified a suitable framework which incorporated key elements to partnerships, such as governance, workforce, leadership and culture. This informed the creation of an IRF of partnerships, which proposes that partnership “interventions” are proposed to primarily cause changes in governance, leadership, IT systems and care model design, which will then go on to affect culture, user engagement and workforce.
Research limitations/implications
Further realist evaluation, informed by this review, will aim to uncover configurations of mechanisms, contexts and outcomes in various partnering arrangements and limitations. As this is the starting point for building a programme theory, it draws on limited evidence.
Originality/value
This paper presents a novel theory of partnering and collaborating in healthcare with practical implications for policy makers and practitioners.
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Robbie Millar, Daniel Plumley, Rob Wilson and Geoff Dickson
The purpose of this study is to critically examine the financial health and performance of the English and Australian cricket networks. This includes the county cricket clubs…
Abstract
Purpose
The purpose of this study is to critically examine the financial health and performance of the English and Australian cricket networks. This includes the county cricket clubs (CCC) and state and territory cricket associations (STCA) affiliated to the England and Wales Cricket Board (ECB) and Cricket Australia (CA) respectively, as well as the ECB and CA themselves. The authors apply resource dependency theory to understand if there are any financial dependencies within the networks of cricket in England and Australia.
Design/methodology/approach
The data for this research was obtained from the financial statements of the ECB, the 18 affiliated CCCs, CA and the six affiliated STCAs. This sample covers the last 5 years of financial information (2014–2019) for all the organisations at the time of writing. Ratio analysis was conducted on all organisations within the sample to assess financial health and performance.
Findings
Both CCCs and STCAs show signs of poor financial health. There is a clear dependence on the financial support they receive from the ECB and CA respectively and this dependence appears more prominent in Australia. The ECB and CA have better financial health which ultimately allows them to financially support the CCCs and STCAs.
Originality/value
The ECB and CA are facing difficult financial decisions to remain financially secure themselves due to the impact of COVID-19 but also to support their affiliated clubs. The affiliated clubs do not generate sufficient revenues and must diversity their revenue streams if they are to become financially self-sustaining. This financial structure and distribution mechanism will be vital in safeguarding the future of some of England’s and Australia’s most important cricket organisations.
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Russell Mannion, Huw Davies, Martin Powell, John Blenkinsopp, Ross Millar, Jean McHale and Nick Snowden
The purpose of this paper is to explore whether official inquiries are an effective method for holding the medical profession to account for failings in the quality and safety of…
Abstract
Purpose
The purpose of this paper is to explore whether official inquiries are an effective method for holding the medical profession to account for failings in the quality and safety of care.
Design/methodology/approach
Through a review of the theoretical literature on professions and documentary analysis of key public inquiry documents and reports in the UK National Health Service (NHS) the authors examine how the misconduct of doctors can be understood using the metaphor of professional wrongdoing as a product of bad apples, bad barrels or bad cellars.
Findings
The wrongdoing literature tends to present an uncritical assumption of increasing sophistication in analysis, as the focus moves from bad apples (individuals) to bad barrels (organisations) and more latterly to bad cellars (the wider system). This evolution in thinking about wrongdoing is also visible in public inquiries, as analysis and recommendations increasingly tend to emphasise cultural and systematic issues. Yet, while organisational and systemic factors are undoubtedly important, there is a need to keep in sight the role of individuals, for two key reasons. First, there is growing evidence that a small number of doctors may be disproportionately responsible for large numbers of complaints and concerns. Second, there is a risk that the role of individual professionals in drawing attention to wrongdoing is being neglected.
Originality/value
To the best of the authors’ knowledge this is the first theoretical and empirical study specifically exploring the role of NHS inquiries in holding the medical profession to account for failings in professional practice.
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John Blenkinsopp, Nick Snowden, Russell Mannion, Martin Powell, Huw Davies, Ross Millar and Jean McHale
The purpose of this paper is to review existing research on whistleblowing in healthcare in order to develop an evidence base for policy and research.
Abstract
Purpose
The purpose of this paper is to review existing research on whistleblowing in healthcare in order to develop an evidence base for policy and research.
Design/methodology/approach
A narrative review, based on systematic literature protocols developed within the management field.
Findings
The authors identify valuable insights on the factors that influence healthcare whistleblowing, and how organizations respond, but also substantial gaps in the coverage of the literature, which is overly focused on nursing, has been largely carried out in the UK and Australia, and concentrates on the earlier stages of the whistleblowing process.
Research limitations/implications
The review identifies gaps in the literature on whistleblowing in healthcare, but also draws attention to an unhelpful lack of connection with the much larger mainstream literature on whistleblowing.
Practical implications
Despite the limitations to the existing literature important implications for practice can be identified, including enhancing employees’ sense of security and providing ethics training.
Originality/value
This paper provides a platform for future research on whistleblowing in healthcare, at a time when policymakers are increasingly aware of its role in ensuring patient safety and care quality.
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Nikolaos Apostolopoulos, Vanessa Ratten, Stavros Stavroyiannis, Ilias Makris, Sotiris Apostolopoulos and Panagiotis Liargovas
The COVID-19 crisis has brought to the forefront the importance of rural health enterprises (RHEs), the peculiarity, in these terms, of rural areas, and the impact of rurality on…
Abstract
Purpose
The COVID-19 crisis has brought to the forefront the importance of rural health enterprises (RHEs), the peculiarity, in these terms, of rural areas, and the impact of rurality on health entrepreneurial activities. This paper aims to undertake a literature review regarding RHEs in the EU, identify research gaps and set future research directions.
Design/methodology/approach
A systematic literature review was conducted and the key aspects coded across four thematic areas – after examining 68 papers.
Findings
The findings reveal that more intense research should be conducted across four area which emerged; rural health providers vs urban health providers; RHEs and rural development; RHEs and quality of life; and social RHEs.
Research limitations/implications
Future research avenues were identified and suggestions for further research on RHEs were provided.
Practical implications
The paper provides insights into how rural areas can attract health enterprises and how health enterprises can operate in rural areas.
Originality/value
This research expands on the limited existing knowledge of RHEs and sets the foundations for further research.
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Ralph A. Gigliotti, Brighid Dwyer and Kristina Ruiz-Mesa
Ross Millar and Helen Dickinson
– The purpose of the paper is to examine the metaphors used by senior managers and clinicians in the delivery of healthcare reform.
Abstract
Purpose
The purpose of the paper is to examine the metaphors used by senior managers and clinicians in the delivery of healthcare reform.
Design/methodology/approach
A study of healthcare reform in England carried out a series of semi structured interviews with senior managers and clinicians leading primary and secondary care organisations. Qualitative data analysis examines instances where metaphorical language is used to communicate how particular policy reforms are experienced and the implications these reforms have for organisational contexts.
Findings
The findings show how metaphorical language is used to explain the interactions between policy reform and organisational contexts. Metaphors are used to illustrate both the challenges and opportunities associated with the reform proposals for organisational change.
Originality/value
The authors provide the first systematic study of patterns and meanings of metaphors within English healthcare contexts and beyond. The authors argue that these metaphors provide important examples of “generative” dialogue in their illustration of the opportunities associated with reform. Conversely, these metaphors also provide examples of “degenerative” dialogue in their illustration of a demarcation between the reform policy proposals and existing organisational contexts.
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The importance of hospital board engagement in the work of governing healthcare quality has been demonstrated in the literature. Research into influences on effective corporate…
Abstract
Purpose
The importance of hospital board engagement in the work of governing healthcare quality has been demonstrated in the literature. Research into influences on effective corporate governance has traditionally focused on board architecture. Emerging research is bringing to light the importance of governance dynamics. This paper contributes to emerging research through highlighting how communication and leadership underpin effective engagement in governing healthcare quality.
Design/methodology/approach
A comparative case study of eight Australian public hospitals was undertaken involving document review, interviews and observations. Case studies were allocated into high- or low-engagement categories based on evidence of governance processes being undertaken, in order to compare and contrast influencing factors. Thematic analysis was undertaken to explore how communication and leadership influence healthcare governance.
Findings
Several key components of communication and leadership are shown to influence healthcare quality governance. Clear logical narratives in reporting, open communication, effective questioning and challenge from board members are important elements of communication found to influence engagement. Leadership that has a focus on healthcare excellence and quality improvement are aligned and promote effective meeting processes is also found to foster governance engagement. Effective engagement in these communication and leadership processes facilitate valuable reflexivity at the governance level.
Practical implications
The findings highlight the way in which boards and senior managers can strengthen governance effectiveness through attention to key aspects of communication and leadership.
Originality/value
The case study approach allows the exploration of communication and leadership in greater depth than previously undertaken at the corporate governance level in the healthcare setting.
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Chris Mason, Michael J. Roy and Gemma Carey
This paper aims to explore how social enterprises are treated in scholarly research on quasi-markets. In so doing, the paper aims to show that a number of critical knowledge gaps…
Abstract
Purpose
This paper aims to explore how social enterprises are treated in scholarly research on quasi-markets. In so doing, the paper aims to show that a number of critical knowledge gaps persist which require deeper engagement from researchers, practitioners and policymakers alike.
Design/methodology/approach
This study adopts a conceptual analysis of the existing literature concerning social enterprises and quasi-markets.
Findings
The paper finds that there are four main knowledge gaps in this area. First, there are moral dilemmas created by boundary shifts, arising from the development of quasi-markets. Second, the phenomenon of “tactical mimicry” (Day and Teasdale 2016) represents a key theoretical platform not yet fully explored. Third, the lack of clear, comparative assessments of social enterprises across quasi-markets, and other types of service providers is also apparent despite offering a significant methodological opportunity for scholars. Fourth, there is the issue of how social enterprises engage in, and resource the operational functions that will support their management of conflicting logics, especially rigorous impact measurement.
Originality/value
This paper uses a synthesis of key social enterprise and quasi-market studies to extend current debate in this area, which tends to be diffused and complex. By focussing on critical knowledge gaps, the paper contributes a meta-level appraisal of the key areas for future research, providing a focussed agenda for scholars to target their efforts in growing this important body of knowledge.