Guest editorial

Citation

Hyde, P. (2009), "Guest editorial", Journal of Health Organization and Management, Vol. 23 No. 6. https://doi.org/10.1108/jhom.2009.02523faa.001

Guest editorial

Article Type: Guest editorial From: Journal of Health Organization and Management, Volume 23, Issue 6

About the Guest EditorsPaula Hyde is Senior Lecturer in the Organization Studies Group of Manchester Business School, University of Manchester, UK. She has published widely about organizational dynamics, organizational change and human resource management, especially in health care organizations. Her current research interests include health care management and service delivery and the sociology of work.

Jeffrey Braithwaite is Foundation Professor and Director, Australian Institute of Health Innovation, Director, Centre for Clinical Governance Research, and Professor, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Australia. His research examines the changing nature of health systems, particularly patient safety, leadership and management, the structure and culture of organisations and their network characteristics, attracting funding of more than $32 million, chiefly from National Health and Medical Research Council and Australian Research Council grants. He has published multiple times in the British Medical Journal, The Lancet, Social Science & Medicine, Quality and Safety in Health Care and many other prestigious journals. Jeffrey has received numerous national and international awards including a Vice-Chancellor’s award for teaching from UNSW and six separate awards for research papers in 2007 and 2008.

Anneke Fitzgerald is an Associate Professor of Management and Clinical Leadership employed at the University of Western Sydney, Australia. Prior to joining the university, Anneke worked 20+ years as a clinical nurse specialist, nurse educator and health services manager. With a PhD in Commerce, she has taught predominantly in the areas of management, organisational behaviour, organisational learning, organisational analysis and design, and research skills. Anneke’s current role is in the Dean’s unit in the College of Business as the college research training coordinator. Her research combines organisational behavioural studies and health management service innovation in a pragmatic paradigm. Among several national and international professional memberships, she is an Associate Fellow of the Australian College of Health Services Executives. In addition, she is author or co-author of nine books and/or book chapters, and over 55 refereed journal and conference papers in the above areas.

In its relatively short life history the Journal of Health Organization and Management has rightfully earned a key place amongst multiple research and practice communities. One community that sees it as a flagship publication, and identifies closely with it, is the organisational behaviour in health care crowd and its international institutional form, the Society for the Study of Organising for Healthcare (SHOC). The journal enables the furthering of several of the society’s areas of interest – the way care is organised, how health services are delivered, and the activities of leaders which contribute to the effective functioning of health systems.

One of the major themes that researchers in this tradition keep returning to centres on the behaviours, practices, attitudes and values of the stakeholders making up the health system. Collectively, these are often labelled culture and climate. Health care settings such as hospitals, aged care facilities, trusts, policy bodies, regulatory agencies, general practices are fascinating places in which to examine and appreciate cultures and climates.

This special issue of the journal draws on work in selected papers presented at a biennial conference conducted in Sydney by the Society in March 2008. OBHC2008 had as its theme “culture and climate: cracking the code”. We developed several criteria for choosing work to form the basis of the special issue. We wanted a diversity of contributions, such that the field was illuminated in different ways from varying vantage points. Naturally enough, we also sought to capture scholarly academic writing and thoughtful ideas exemplifying the conference theme. We aimed to include a mix of empirical and theoretical pieces. We did not necessarily seek to publish mainstream studies or literature reviews on culture and climate, but to show the range and depth of offerings that the OBHC community can generate when given a galvanising theme with which to work. In the event we present a patchwork quilt of offerings. It is a rich brocade but nevertheless with a core set of materials, centred on culture and climate, stitched in to the fabric. We hope we have been successful in capturing what the field has to offer, but of course, as is always the case in academic work, you will be the judge.

Turning to the papers, the first, by John Øvretveit, “Understanding and improving patient safety: the psychological, social and cultural dimensions”, goes beyond culture and climate, drawing not only on these literature streams but also international psychological and sociological literatures and studies to examine and enhance approaches to tackling patient safety. Much of the work to date on patient safety has been built on technical and clinical considerations, but we have much to learn from the social sciences. Øvretveit’s paper makes a powerful argument to sustain this claim. Staying with patient safety as a focusing concept, but taking a markedly different tack, Travaglia and Braithwaite (“Analysing the ‘field’ of patient safety employing Bourdieusian technologies”) mobilise the conceptual lexicons and propositions of Pierre Bourdieu as they seek to appreciate the landscape of patient safety. In Bourdieusian-speak, patient safety has its own doxa, or aspects which are taken-for-granted, and is captured by stakeholders with multiple voices who struggle to achieve dominance over the field. Participants use their capital such as resources and power via their habitus, or dispositions, which stem from their histories. Travaglia and Braithwaite show how Australian stakeholders do indeed struggle for dominance over patient safety in a contested field, and they lament how the vulnerable in society are in double jeopardy, from iatrogenic harm and neglect by other stakeholders.

Another way to understand health care cultures and climates is through an appreciation of the system qua system: that is to say, how the components interact and are enabled, and how information spreads through the constituent parts. Ann Casebeer, Janice Popp and Cathie Scott in their contribution “Positively deviant networks: what are they and why do we need them?” analyse aspects of the Canadian health system by presenting three case studies of networks yielding encouraging results in promoting positive change. These networks are notable for the contribution they are making to the improvement of the climate for change, the way decisions are made and services are provided. In short, learning is being enhanced through these networks. More good news from Canada comes in the form of Allan Best, Jennifer Terpstra, Gregg Moor, Barbara Riley, Cameron Norman and Russell Glasgow’s piece “Building knowledge integration systems for evidence-informed decisions”. Best and colleagues skilfully exhibit their interest in models for translating knowledge into action. They argue that the co-production of knowledge is crucial – and many stakeholders need to collaborate in health systems to diffuse information that underpins effective decision making.

Health systems have to be led and managed, of course, and people have to be trained and developed to participate in leadership and management activities. This brings us to the two final papers in the special issue: from Louise Kippist and Anneke Fitzgerald (“Organisational professional conflict and hybrid clinician managers”) and by Sally Sambrook (“Can critical pedagogy be introduced into the NHS managerial culture?”). Kippist and Fitzgerald take us into the fascinating world of the clinician-manager. This chameleon-like character is a hybridised form, with responsibilities as a clinician-professional, providing direct patient care, and as a management-professional, trying to run things, and lead. Striving to pull off both roles simultaneously and successfully is of course a position of conflict because of the natural tensions between the goals and tasks, and values inherent, in enacting these dual responsibilities. Kippist and Fitzgerald conclude that fusing responsibilities for both clinical practice and managerial responsibility may be too fraught for many individuals, and they argue that a separation of these responsibilities, and new models for understanding how people negotiate them, are needed. Related to this problem, Sambrook’s paper considers how a small sample of NHS managers was trained in critical thinking through the course of completing a higher degree. After analysing how this cohort proceeded through their masters program and tried to apply what they learned in practice, Sambrook concluded from her data that they could successfully do so. They employed a new set of technologies and discourses designed to empower them in their work and developed a critical stance. Perhaps the NHS managers in the Sambrook study could be introduced to the conflicted Australian clinician managers examined by Kippist and Fitzgerald. They could support each other in their respective quests to gain expertise in leading and managing in complex health settings.

The 7th Biennial International Conference in Organisational Behaviour in Health Care will take place on 11-14 April 2010 at the University of Birmingham, UK. The theme of the conference is “Mind the gap: policy and practice in the reform of healthcare” and will explore the behaviours of healthcare organisations in shaping, adapting, and resisting developments in healthcare policy and practice. The conference will therefore invite papers that explore theoretical or empirical aspects of the responses of healthcare organisations, managers, clinicians and users to policy and practice initiatives. It is envisaged that these papers may look at a range of both policy – e.g. governance, personalisation, choice – and practice interventions, such as service improvement techniques and medical technology. Papers on these topics will be particularly welcomed from European perspectives, including those from the accession states and development environments. The keynote speaker will be Dr Peter L. Hupe, who is Associate Professor as the Department of Public Administration, Erasmus University. Calls for abstracts will open in March 2009. Further information is available from the Health Services Management Centre web site – www.hsmc.bham.ac.uk/events/SHOC.shtml The early signs are that it is destined to be as successful, intellectually satisfying and as empirically and theoretically rewarding as was OBHC 2008. It should yield a range of equally exciting papers, and no doubt realise another special issue of JHOM. We await that edition with eager anticipation.

Our appreciation goes to the editors of JHOM for entrusting us with the editorial responsibilities for the special issue. We would like especially to thank Ms Deborah Debono of the Centre for Clinical Governance Research, Institute of Health Innovation at University of New South Wales for smoothing the administrative processes via her first-rate editorial support.

Paula HydeManchester Business School, Manchester University, Manchester, UKJeffrey BraithwaiteUniversity of New South Wales, Randwick, Australia Anneke FitzgeraldUniversity of Western Sydney, Penrith South, Australia