Emerald | Journal of Health Organization and Management | Table of Contents http://www.emeraldinsight.com/1477-7266.htm Table of contents from the most recently published issue of Journal of Health Organization and Management Journal en-gb Tue, 12 Aug 2014 00:00:00 +0100 2014 Emerald Group Publishing Limited editorial@emeraldinsight.com support@emeraldinsight.com 60 Emerald | Journal of Health Organization and Management | Table of Contents http://www.emeraldinsight.com/common_assets/img/covers_journal/jhomcover.gif http://www.emeraldinsight.com/1477-7266.htm 120 157 The association between subcultures and resistance to change – in a Swedish hospital clinic http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=4&articleid=17114677&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - The purpose of this paper was to explore the different subcultures and the employees’ preparedness for change at an orthopaedic clinic in a university hospital in Sweden. <B>Design/methodology/approach</B> - Surveys were sent out to 179 nurses and physicians. The survey included the two instruments Organisational Values Questionnaire (OVQ) and Resistance to Change Scale (RTC).<B>Findings</B> - The results suggest a dominance of a human relations culture i.e. flexibility, cohesion and trust, in the orthopaedic clinic. These characteristics seemed to decrease resistance to change. Opposite to this, planning, routines and goal setting appeared to increase change-resistant behaviour. <B>Practical implications</B> - By predicting potential obstacles in a certain context prior to a change process, resources can be used in a more optimal way. An instrument that pinpoints the culture of a particular healthcare setting may be a useful tool in order to anticipate the possible outcome of change. <B>Originality/value</B> - The rational goal/internal processes dimension exerted a stronger association with resistance to change than in earlier studies. Deeply rooted standards and routinised care models, governed by work schedules, could be an obstacle to introducing a care model based on the individual needs of the patient. There was, however, a surprisingly low resistance to change. The results are contrary to the accepted understanding of public organisations known to be slow to change. Article literatinetwork@emeraldinsight.com (Eric Carlstrom, Lars-Eric Olsson) Tue, 12 Aug 2014 00:00:00 +0100 Introducing a multimedia course to enhance health professionals’ skills to facilitate communities of practice: experiences of the first cohort of course participants http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=4&articleid=17114684&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - Scholarship about Communities of Practice (COP) is uncovering evidence that interactivity between community members contributes to improvement in practice. Leadership and facilitation are crucial elements of successful COP implementation. This paper describes an innovative COP facilitator’s course and reports on the experiences of participants in the first course. <B>Design/methodology/approach</B> - In response to this need and emerging evidence, an on-line COP Facilitator’s Course was developed and implemented in Alberta, Canada, in 2011. This course included a home-based COP practicum, introductory face-to-face session, an on-line discussion board moderated by faculty, and on-line learning modules. Evaluation of the course was formalized in a qualitative study incorporating content analysis of postings, semi-structured interviews of successful participants and narrative responses to questions in a post course survey.<B>Findings</B> - Fifteen of 22 participants perceived they acquired basic knowledge about community facilitation by completing the self-learning modules and assignments. Many did not establish home-based COP and only partially participated in the interactive components of the course. Six participants successfully completed the course by establishing home-based COP and actively participating in the social and interactive components of the course. They perceived they met course objectives and greatly benefited from participation in the course, in particular when they pushed themselves to facilitate in new and different ways, and when they were actively engaged with their home-based COP where they could practice and receive feedback.<B>Research limitations/implications</B> - While the main reasons why participants dropped out or failed to complete all course components were reported, the experiences and perceptions of six participants who successfully completed all course components form the major part of the evaluation of the course and hence introduce bias. A more in depth analysis of why learners are reluctant to engage in participatory learning could be the focus of further studies.<B>Practical implications</B> - The following key recommendations emerged in the study alongside recommendations for further study of best practices in supporting COP facilitation: 1. A formal interview before enrolment into the COP facilitator’s course is recommended to reinforce the comprehensiveness, time commitment and the practical applications intended within the course. 2. Methods of "aggressive facilitation" with skilled COP facilitators can best model facilitation to those involved in the course. 3. Supporting course participants to trial out a diversity of community facilitation skills in the safety of the course is crucial to success. <B>Originality/value</B> - The collaboration, networking and interactivity of interdisciplinary healthcare workers is of tremendous consequence to health outcomes and a vital concern to practitioners and administrators. Little is currently understood of the leadership and facilitation of the COP models and these discoveries lend a timely contribution to the field. Article literatinetwork@emeraldinsight.com (Sonya L. Jakubec, John Parboosingh, Barbara Colvin) Tue, 12 Aug 2014 00:00:00 +0100 The impact of an integrated care service on service users: the service users’ perspective http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=4&articleid=17114646&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - The purpose of this paper is to examine the effects of an integration programme on service users from users’ own perspective.<B>Design/methodology/approach</B> - Multi-method approach was used. Both quantitative and qualitative data collection and analysis were employed to uncover and examine service users’ views of the impact of the integration programme.<B>Findings</B> - An improvement in the physical functioning of one in three occupational equipment users; a rise in the level of satisfaction of 85% of occupational health and 82% of physiotherapy users; older people with complex problems and high-level needs were able to be helped to live at home; and waiting times for both assessment and for services within two weeks and four weeks were below the national achievement and ministerial targets. The impact of the integration programme on users was complex. Positive outcomes were achieved for some user groups and individuals but not for others. A lack of change outcomes in social care, and service users’ low level of satisfaction with social care services appears to be associated with the impact of agency work and the predominant aim in social work of achieving maintenance and prevention outcomes. <B>Originality/value</B> - This paper contributes to knowledge on what and how the total integration in Cambridgeshire has benefited users. Article literatinetwork@emeraldinsight.com (Mei Hu) Tue, 12 Aug 2014 00:00:00 +0100 Self-employed nurses as change agents in healthcare: strategies, consequences, and possibilities http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=4&articleid=17114678&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - This article reports on ethnographic research that investigated how self-employed nurses perceive the contemporary healthcare field, what attributes they possess that facilitate their roles as change agents, what strategies they use to influence change, and what consequences they face for their actions, thus contributing to what is known about organizational change in institutionalized settings such as healthcare.<B>Design/methodology/approach</B> - Focused ethnography was used to explore self-employed nurses’ work experiences and elucidate the cultural elements of their social contexts, including customs, ideologies, beliefs, and knowledge and the ways that these impact upon the possibilities for change in the system.<B>Findings</B> - These self-employed nurses reflected on the shortcomings in the healthcare system and took entrepreneurial risks that would allow them to practice nursing according to their professional values. They used a number of strategies to influence change such as capitalizing on opportunities, preparing themselves for innovative work, managing and expanding the scope of nursing practice, and building new ideas on foundational nursing knowledge and experience. They had high job satisfaction and a strong sense of contribution but they faced significant resistance because of their non-traditional approach to nursing practice.<B>Originality/value</B> - Despite dramatic restructuring in the Canadian healthcare system, the system remains physician-centered and hospital-based. Nursing’s professional potential has been largely untapped in any change efforts. Self-employed nurses have positioned themselves to deliver care based on nursing values and to promote alternative conceptions of health and healthcare. This study offers a rare exploration of this unique form of nursing practice and its potential to influence health system reform. Article literatinetwork@emeraldinsight.com (Sarah Wall) Tue, 12 Aug 2014 00:00:00 +0100 Patient satisfaction and gp trustworthiness, practice orientation and performance: implications for selection, training, revalidation http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=4&articleid=17114637&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - The research examines the doctor-patient relationship from the patients’ perspective. It tests a number of hypothesised relationships with respect to the interaction inside the doctor-patient relationship including the continuity of care, doctors’ practice orientation and performance, which help enhance the understanding of patient trust and satisfaction. <B>Design/methodology/approach</B> - A quantitative survey using a closed-ended questionnaire provided a useable sample of 372 respondents. <B>Findings</B> - There was an overall high level of patient trust in and satisfaction with GPs as well as good patient rapport with their GPs. Patients who were most satisfied with their doctor perceived them to be more trustworthy, were more satisfied with their performance and perceived them to have greater preference for a sharing orientation than those patients who were least satisfied. <B>Practical implications</B> - The research findings suggest ways of maintaining and enhancing trust through training, continuing professional development, appraisals and assessments and revalidation of doctors. The skill sets and competencies related to trust and practice are presented in light of current practice trends and changing health care agendas, including the recent Department of Health White Paper, ‘Liberating the NHS’ (2010). Since the questionnaire was able to discriminate between those patients who were most and least satisfied with their doctors, it identified what patients appreciate and are concerned about with respect to GPs and their practice. <B>Originality/value</B> - The research provides new insights and understanding of how patient satisfaction in the GP-patient relationship is influenced by GPs’ trustworthiness, practice orientation and performance, for academic and practitioner communities. Article literatinetwork@emeraldinsight.com (Barend Van Den Assem, Victor Dulewicz) Tue, 12 Aug 2014 00:00:00 +0100 Emotion, power and identity. emotional display of envy when taking on management roles in a professional hierarchy http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=4&articleid=17114683&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - Drawing on a previous study of organising processes and the construction of identity in a Swedish geriatric clinic, the impact of emotions is brought to the fore in the interpretation of power relations among professional groups. The purpose of this article is to find a way to interpret emotions as discursively constructed in organising processes. <B>Design/methodology/approach</B> - A sequence of critical events is described where leading positions were negotiated at the clinic. Senior physicians and head nurses are highlighted as opposing forces in a struggle where envious emotions seemed to be a driving force in the political interplay. The empirical material in this article comes from the previous study. It is a set of participant observations and parts of interviews that took place before and after the implementation of a new organisational plan for the clinic.<B>Findings</B> - The envious and regressive undertone in the relationships between the actors made them act for egocentric reasons instead of creating new ways of collaborating and learning new leading roles. The power relations of the medical hierarchy were reproduced, which made new ways of relating threatening and difficult to achieve.<B>Originality/value</B> - The results of the study confirm that people involved and perhaps in conflict with each other have to be able to, or get help to, make sense of their emotional experiences to employ them constructively. Otherwise they fall back into well-known patterns in order to feel secure. A vital part of learning in change processes is the support to individuals and groups in gaining emotional understanding of themselves and others. Leaders and managers who often are initiators of change ought to be aware of the importance of emotional support in change processes. If they are not, they are destined to be a part of the confusion. Article literatinetwork@emeraldinsight.com (Ulla Sebrant) Tue, 12 Aug 2014 00:00:00 +0100 Running a hospital patient safety campaign: a qualitative study http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=4&articleid=17114651&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - Research on patient safety campaigns has mostly concentrated on large-scale multi-organisation efforts, yet locally-led improvement is increasingly promoted. We aimed to characterise the design and implementation of an internal patient safety campaign at a large acute NHS hospital trust with a view to understanding how to optimise such campaigns. <B>Design/methodology/approach</B> - We conducted a qualitative study of a campaign that sought to achieve 12 patient safety goals. We interviewed 19 managers and 45 frontline staff, supplemented by 56 hours of non-participant observation. Data analysis was based on the constant comparative method. <B>Findings</B> - The campaign was motivated by senior managers’ commitment to patient safety improvement, a series of serious untoward incidents, and a history of campaign-style initiatives at the trust. While the campaign succeeded in generating enthusiasm and focus among managers and some frontline staff, it encountered three challenges. First, though many staff at the sharp end were aware of the campaign, their knowledge and acceptance of its content, rationale and relevance for distinct clinical areas were variable. Second, the mechanisms of change, albeit effective in creating focus, may have been too limited. Third, many saw the tempo of the campaign as too rapid. Overall, the campaign enjoyed some success in raising the profile of patient safety. However, its ability to promote change was mixed, and progress was difficult to evidence because of lack of reliable measurement.<B>Originality/value</B> - Our study shows that single-organisation campaigns may help in raising the profile of patient safety. We offer important lessons for the successful running of such campaigns. Article literatinetwork@emeraldinsight.com (Piotr Ozieranski, Victoria Robins, Joel Minion, Janet Willars, John Wright, Simon Weaver, Graham P Martin, Mary Dixon Woods) Tue, 12 Aug 2014 00:00:00 +0100 A simple structure for managing quality improvement http://www.emeraldinsight.com/journals.htm?issn=1477-7266&volume=28&issue=4&articleid=17114671&show=abstract <strong>Abstract</strong><br /><br /><B>Purpose</B> - To describe how a fractal-based quality management infrastructure could benefit quality improvement and patient safety efforts in health care. <B>Design/methodology/approach</B> - Our premise for an this infrastructure comes from our quality improvement work with health care professionals and organizations. We used the a fractal structure system in a health system initiative, a statewide collaborative, and several countrywide efforts to improve quality of care. It is responsive to coordination theory andThis infrastructure is responsive to coordination theory and repeats specific characteristics at every level of an organization, with vertical and horizontal connections among these levels to establish system-wide interdependence. <B>Findings</B> - The fractal system infrastructure helped a health system achieve = 96% compliance on national core measures, and helped intensive care units across the United States, Spain, and England to reduce central line-associated bloodstream infections.<B>Practical implications</B> - The fractal system approach organizes workers around common goals, links all hospital levels and , supports peer learning and accountability, grounds solutions in local wisdom, and effectively uses available resources. <B>Originality/value</B> - The concept of deliberately creating an infrastructure to manage quality improvement and patient safety work and support organizational learning is new to health care. This paper clearly describes how to create a fractal infrastructure that can scale up or down to a department, hospital, health system, state, or country. Article literatinetwork@emeraldinsight.com (Peter J Pronovost, Jill A Marsteller) Tue, 12 Aug 2014 00:00:00 +0100