Emerald | Journal of Health Organization and Management

Reforms and clinical managers' responses A study in Norwegian hospitals

Inger Johanne Pettersen — 2012-03-16 00:00:00.0

Abstract

Purpose - This paper seeks to explore the legitimacy of budgets as management control processes in hospitals after comprehensive reforms have been implemented in the Norwegian hospital sector in 2002.Design/methodology/approach - The paper employs qualitative interviews with top level clinical managers in three large hospitals. Findings - Our empirical study shows a variety of practices among the clinical managers as to management control adjustments. The managers use different strategies in order to cope with the budget frames. Research limitations/implications - This paper contributes to the current debate and research relating to the budgeting and performance management practises in hospital settings. Practical implications - These findings contribute to contextual knowledge that is relevant in understanding the diverse practices of clinical managers in hospitals as complex service producing organizations. Originality/value - It challenges the idea that the strategies used by managers can be understood by the concepts of the means-end rationality prescribed in most of the reforms introduced into the hospital sector.

Organizational culture, intersectoral collaboration and mental health care

Penelope Fay Mitchell, Philippa Eleanor Pattison — 2012-03-16 00:00:00.0

Abstract

Purpose - This study investigates whether and how organizational culture moderates the influence of other organizational capacities upon the uptake of new mental health care roles by non-medical primary health and social care services.Design/methodology/approach - Using a cross-sectional survey design, data were collected in 2004 from providers in 41 services in Victoria, Australia, recruited using purposeful sampling. Respondents within each service worked as a group to complete a structured interview that collected quantitative and qualitative data simultaneously. Five domains of organizational capacity were analyzed: leadership, moral support and participation; organizational culture; shared concepts, policies, processes and structures; access to resource support; and social model of health. A principal components analysis explored the structure of data about roles and capacities, and multiple regression analysis examined relationships between them. The unit of analysis was the service (n=41).Findings - Organizational culture was directly associated with involvement in two types of mental health care roles and moderated the influence of factors in the inter-organizational environment upon role involvement. Research limitations/implications - Congruence between the values embodied in organizational culture, communicated in messages from the environment, and underlying particular mental health care activities may play a critical role in shaping the emergence of intersectoral working and the uptake of new roles.Originality/value - This study is the first to demonstrate the importance of organizational culture to intersectoral collaboration in health care, and one of very few to examine organizational culture as a predictor of performance, compared with other organizational-level factors, in a multivariate analysis. Theory is developed to explain the findings.

Health tourism – definition focused on the Swiss market and conceptualisation of health(i)ness

Susanne Hofer, Franziska Honegger, Jonas Hubeli — 2012-03-16 00:00:00.0

Abstract

Purpose - To give an overview of current research regarding the concept of "health tourism" with a focus on Switzerland, and to see if a consensus on this concept and its embedding in existing/future markets can be found. Design/methodology/approach - Explorative study combining literature review, questionnaires and qualitative interviews. Grounded theory was employed. Findings - A service from the field of health care must have been provided prior to health tourism, allowing it to be classified under the health care system. Thus, health tourism is classified under the market for the sick and not under tourism which targets the healthy. Furthermore a new market for the healthy is emerging, which needs to be defined. As an example Health(i)ness could help to clarify the terminology, to be seen as a gatekeeper of health and as a cultural paradigm change from cure to prevention. Research limitations/implications - Further research is needed, regarding the positioning and development of health tourism and its synergies, as the cost pressures in health care increase and will continue to have a sustainable impact on health tourism. Practical implications - Better knowledge of the term health tourism, its general classification, and particular reference to Switzerland, and information about upcoming changes in health care.Originality/value - The findings add to the knowledge of how health tourism is embedded into health care and tourism, and show potential within the market for the healthy. To members of the tourism and health care market.

Primary care in the United States: Practice-based innovations and factors that influence adoption

Debora Goetz Goldberg — 2012-03-16 00:00:00.0

Abstract

Purpose - Purpose - This study explored the use of specific innovations in primary care practices. The research examined whether a relationship exists between environmental factors and organizational characteristics and the level of innovation in primary care practices in Virginia. Design/methodology/approach - Design/methodology/approach - The study utilized multiple secondary data sets and an organizational survey of primary care practices to define the external environment and the level of innovation. Institutional theory was used to explain the connection between innovations in primary care practices and institutional forces within the environment. Resource dependency theory was used to explain motivators for change based on a dependence on scarce financial, human, and information resources. Findings - Findings - Results show a positive association between organizational size, organizational relationships, and stakeholder expectations on the level of innovation. A negative association was found between competition and the level of innovation. No relationship was found between degree of Medicare and managed care penetration and innovation, nor between knowledge of and difficulty complying with payer organization requirements and innovation.Research limitations/implications - Originality/value - Originality/value – Primary care physician practices exist in a market-driven environment characterized by high pressure from regulatory sources, decreasing reimbursement levels, increasing rate of change in technologies, and increasing patient and community expectations. This study contributes new information on the relationship between organizational characteristics, the external environment and specific innovations in primary care practices. Information on the contributing factors to innovation in primary care is important for improving delivery of health care services and the ability of these practices to survive.

Age-related attitudes: The influence on relationships and performance at work

Franz Josef Gellert, Rene Schalk — 2012-03-16 00:00:00.0

Abstract

Purpose - This paper aims to examine the influence of age and age-related attitudes on relationship factors. In addition, it assesses how both factors affect care service work performance. Design/methodology/approach - The paper explores the influence of age and age-related attitudes on the relationship quality among employees, affecting performance in mentally and physically demanding work settings. We conducted our research in six residential homes for the elderly in Germany (152 respondents) and collected the data with questionnaires. Data are analyzed by multi-hierarchical regression analyses.Findings - Results show that age-related attitudes (intergenerational cooperation and the perception of older employees’ capabilities) are important factors influencing the perceived quality level of in-group cooperation, LMX and MMX. Both age-related attitudes and relationship factors influence perceived employee performance, and job satisfaction.Research limitations/implications - The findings contribute to understanding how age-related attitudes influence relationships among employees, the relationship between employees and supervisor, and the effect on service performance. The mono-cultural sample might be a limitation, as well as the composition of the sample: The majority of respondents is female.Practical implications - For leaders, supervisors and managers the results contribute to understanding how employees’ age-related attitudes, in mentally and physically demanding work settings, influence the quality level of relationships and outcomes. This is relevant in the context of leaders/supervisors promoting followers’ individual development and group/team development.Originality/value - The paper shows that in care service work with an increasing number of older employees, the positive perception of age-related attitudes influences relationship quality and performance positively.

Discursive construction of polyphony in healthcare management

Anneli Hujala, Sari Rissanen — 2012-03-16 00:00:00.0

Abstract

Purpose - The aim of the article is to understand and define how the polyphony of management is constructed in interaction and to describe this through concrete management meeting cases. Polyphony refers to the diverse voices of various organization members, and how these voices are present, disclosed and utilized in management.Design/methodology/approach - The study is based on the social constructionist and discursive perspectives of management, which question the traditional, individualistic approaches of management. The issue was examined through a qualitative case study by analysing the micro-level management discourse in three healthcare organizations.Findings - Discursive practices that enhance or inhibit polyphony are often unnoticed and unconscious. ‘Key moments of management discourse’ are an example of unconscious mundane practices through which members of organizations construct the reality of management.Research limitations/implications - Empirical results are locally contextual. In the future, research will be able to apply the approach to diverse contexts as well as link micro-level discourses to the construction of broader health and social management discourses. Practical implications - The paper increases our understanding about how to enhance participation and staff contribution, and how to utilize the knowledge of all members of the organization. Originality/value - The study increases the understanding about micro-level issues of management and challenges the conventional, taken-for-granted assumptions behind organization and management theories.