Journal of Health Organisation and Management

Critical pedagogy in a health service management development programme: Can “critically thinking” managers change the NHS management culture? : Table of Contents

Sally Sambrook — Sat Nov 07 08:00:18 GMT 2009

Abstract:
Purpose – Management development programmes available to NHS managers focus on a performance orientation and sustain a culture of managerial and medical domination. This paper aims to question whether it is possible to consider NHS management development from a critical (empowerment culture) perspective. Features of the critical management studies approach (CMS) are identified. A new MSc is evaluated against these characteristics, examining the teaching and learning processes and students' perceptions of the programme. The aim is to develop critical thinkers who can return to their organizations and challenge existing power structures and practices to change local cultures and enhance health services. Design/methodology/approach – Empirical research employed anonymous student questionnaires and a focus group. Findings – Student evaluations suggest the MSc can deliver a critical pedagogy and help managers understand issues of power and empowerment, challenge dominant cultures, innovate and effect small, local changes in the NHS culture. Research limitaions/implications – There is a need to continue evaluating the programme and include other stakeholders. Longitudinal research should assess the impact of the managers' changed values, attitudes and behaviours on colleagues, clients and the local cultures. Practical implications – The paper identifies some of the tensions of developing “critical” health service managers, and the problems they encounter back in the “uncritical” NHS context, as well as some of the challenges in “facilitating” a critical curriculum. It questions the ethics of developing (or not) a critical perspective in a local context unfamiliar with CMS. Originality/value – Management development in the NHS largely ignores critical pedagogy. This paper makes a small and unique contribution to understanding how developing “critically thinking” managers can challenge the dominant culture. However, the limitations of such a small-scale study and ethical implications are noted.

Organisational professional conflict and hybrid clinician managers: The effects of dual roles in Australian health care organisations : Table of Contents

Louise Kippist, Anneke Fitzgerald — Sat Nov 07 08:00:18 GMT 2009

Abstract:
Purpose – This article aims to examine tensions between hybrid clinician managers' professional values and health care organisations' management objectives. Design/methodology/approach – Data are from interviews conducted with, and observation of, 14 managerial participants in a Cancer Therapy Unit set in a large teaching hospital in New South Wales, Australia, who participated in a Clinical Leadership Development Program. Findings – The data indicate that there are tensions experienced by members of the health care organisation when a hybrid clinician manager appears to abandon the managerial role for the clinical role. The data also indicate that when a hybrid clinician manager takes on a managerial role other members of the health care organisation are required concomitantly to increase their clinical roles. Research limitations/implications – Although the research was represented by a small sample and was limited to one department of a health care organisation, it is possible that other members of health care organisations experience similar situations when they work with hybrid clinician managers. Other research supports the findings. Also, this paper reports on data that emerged from a research project that was evaluating a Clinical Leadership Development Program. The research was not specifically focused on organisational professional conflict in health care organisations. Practical implications – This paper shows that the role of the hybrid clinician manager may not bring with it the organisational effectiveness that the role was perceived to have. Hybrid clinician managers abandoning their managerial role for their clinical role may mean that some managerial work is not done. Increasing the workload of other clinical members of the health care organisation may not be optimal for the health care organisation. Originality/value – Organisational professional conflict, as a result of hybridity and divergent managerial and clinical objectives, can cause conflict which affects other organisational members and this conflict may have implications for the efficiency of the health care organisation. The extension or duality of organisational professional conflict that causes interpersonal or group conflict in other members of the organisation, to the authors' knowledge, has not yet been researched.

Analysing the “field” of patient safety employing Bourdieusian technologies : Table of Contents

Joanne F. Travaglia, Jeffrey Braithwaite — Sat Nov 07 08:00:18 GMT 2009

Abstract:
Purpose – This paper aims to analyse the development of patient safety as a field within which patients are peripheral stakeholders. Design/methodology/approach – The authors examined the patient safety movement from the perspective of a field in which agents struggle for control over various forms of capital, including economic, social, cultural and symbolic capital. In order to undertake this analysis the authors drew on the literature on errors and patient safety, key inquiries into patient safety, and research conducted with health professionals in New South Wales, Australia. Findings – The patient safety movement has created a heightened sense of awareness of errors and risk across health systems, thereby attracting and creating significant amounts of capital. The authors argue that in the process of struggle to constitute and contain a new field of health, patients and their narratives are rendered vulnerable to appropriation and incorporation. Research limitations/implications – By considering patient safety from a sociological rather than a technical framework, it is possible to gain new insights into why reducing the levels of medical errors have proven so difficult. Practical implications – Improved knowledge of how patient safety operates as a field may contribute to more effective strategies in reducing those types of errors. Originality/value – Despite the growth in the number of publications in patient safety there has been only minimal analysis of the field itself, rather than its technical or organisational components. This paper contributes to a new way of conceptualising and enacting patient safety, one that acknowledges the vulnerability of the parties involved, particularly patients.

Building knowledge integration systems for evidence-informed decisions : Table of Contents

Sat Nov 07 08:00:18 GMT 2009

Abstract:
Purpose – This paper aims to describe methods and models designed to build a comprehensive, integrative framework to guide the research to policy and practice cycle in health care. Design/methodology/approach – Current models of science are summarised, identifying specific challenges they create for knowledge to action (KTA). Alternative models for KTA are outlined to illustrate how researchers and decision makers can work together to fit the KTA model to specific problems and contexts. The Canadian experience with the evolving paradigm shift is described, along with recent initiatives to develop platforms and tools that support the new thinking. Recent projects to develop and refine methods for embedded research are described. The paper concludes with a summary of lessons learned and recommendations that will move the KTA field towards an integrated science. Findings – Conceptual models for KTA are advancing, benefiting from advances in team science, development of logic models that address the realities of complex adaptive systems, and new methods to more rapidly deliver knowledge syntheses more useful to decision and policy makers. Practical implications – KTA is more likely when co-produced by researchers, practitioners, and policy makers. Closer collaboration requires shifts in thinking about the ways we work, capacity development, and greater learning from practice. Originality/value – More powerful ways of thinking about the complexities of knowledge to action are provided, along with examples of tools and priorities drawn from systems thinking.

Understanding and improving patient safety: the psychological, social and cultural dimensions : Table of Contents

John Øvretveit — Sat Nov 07 08:00:18 GMT 2009

Abstract:
Purpose – This paper aims to provide researchers and practitioners with an overview of how organisation behaviour research (OBR) helps to understand and resolve patient safety problems in health care. Design/methodology/approach – The paper describes psychological, sociological and other social science theories and research which help to understand the causes of patient safety problems, how to implement change effectively and how to create an organisational culture of safety. Findings – Social science perspectives and organisational behaviour research are beginning to show why improvements in patient safety are slow, and how to make lasting and effective change. Research limitations/implications – Social sciences and OBR have already helped make healthcare safer, but could make a greater contribution. Progress could be faster with greater awareness of the findings of this research and understanding of social science research paradigms. Practical implications – Better implementation and safer care could result from providing implementers and decision makers with more knowledge and access to social science research. More useful social science research could be developed by research funders and proposal reviewers gaining a greater understanding of social science methods and potential, and by including this research in a field made up largely of traditional experimental medical research methods. Originality/value – This paper provides an overview of the scientific and practical contributions of social sciences to patient safety and shows where future studies could assist understanding of current challenges and speed implementation of change.

Positively deviant networks: what are they and why do we need them? : Table of Contents

Ann Casebeer, Janice Popp, Cathie Scott — Sat Nov 07 08:00:18 GMT 2009

Abstract:
Purpose – This paper aims to report “positively deviant” experiences of three public sector networks seeking to enhance organizational and system level capacities. It is the authors' thesis that the knowledge base concerning the true benefits and pitfalls of networks can be captured and interpreted only through intense, ongoing learning effort embedded in practice on the ground, combined with sustained in-depth observation and collaborative research. Design/methodology/approach – The paper describes through case examples why and how different kinds of networks within different jurisdictional contexts and different organizational cultures are being used to enhance the climate for change towards better health care and improved health. The authors describe the contexts, structures, processes and impacts of three “positively deviant” networks. Findings – The network form can provide opportunity for nurturing changes and innovations within large organizational and complex system environments. This opportunity to create additional and different pathways for improved decision making and service provision comes with challenges that should be recognized. Practical implications – The authors' experiences indicate that, for networks, a key component of success relates to pulling and pushing at the edges of multiple connections and boundaries in “positively deviant” ways. This pushing and pulling is intrinsically evidence of organizational and intraorganizational learning – in the examples presented – for the improvement of health care and health. Originality/value – Other networks can learn from the reported experiences and add their own cases to the empirical understanding of how networks can make a difference; this in turn can help the conceptual and theoretical understanding of them.