Change In Healthcare Organizations Research Articles

Functioning of Health Care During the COVID-19 Pandemic – Review of Literature

Purpose: A review of the literature on reorganization of the health care system in selected medical specializations during the COVID-19 pandemic. Design/methodology/approach: A review and analysis of available scientific literature from ScienceDirect, Google Scholar, PubMed and other scientific sources, and data analysis using Microsoft Excel. Articles were found using specific keywords, then they were assessed in detail against the criteria set by the authors Findings: The COVID-19 pandemic caused many organizational changes in health care. As a result of activities limiting the spread of COVID-19 in medical facilities, the following were observed: increased use of telemedicine to contact medical staff, limited access to physicians of various specialties, delayed diagnosis and treatment in many fields of medicine and also increased financial investment in the health care. Additionally, the pandemic reduced social contacts. It is forecast that after the pandemic, there will be an increase in demand for medical consultations due to undiagnosed and untreated patients during the pandemic. Research limitations/implications: A lack of scientific study with long-term data, a survey on a small group of respondents, studies from countries with different degrees of development (a more difficult comparative analysis), discrepancy of data in some studies due to insufficient research on the new virus – SARS-CoV-2. Originality/value: The work collects data from various medical disciplines and presents the possible impact of reorganization on the post-pandemic situation. The article is original because of the combination of medical and management aspects of the health care organization during the pandemic.

Faktor Organisasi yang Mempengaruhi Pelaksanaan Audit Maternal

Maternal audits are part of a change in health care organizations. However, complicated and rigid bureaucracy resulting in difficulties for the organization to accept change without clear and convincing scientific evidence. The maternal mortality remains high, indicating that the maternal audit is not optimal. Often audit recommendations are not implemented so that the expected changes do not occur. This study aims to find suboptimal organizational aspects in the implementation of audits to encourage all parties to collaborate in sustainable, targeted and planned changes. This is a qualitative research with a narrative review approach using secondary data from the previous seven articles. Articles were analyzed to find various obstacles and constraints on maternal audit, and then categorized based on the context of organizational behavior, namely individual, group and structure. This study identified complexities in maternal auditing, interrelated between individual, group and structural aspects, including problems of persecution, low cooperative behavior, and political policies. Those have a major impact on efforts to reduce maternal mortality. Therefore, it requires clinical and non-clinical interventions, as well as political, in accelerating the reduction of maternal mortality. The arrangement of policies, analysis processes, and follow-up on maternal audits must involve every element of the organization, both individuals and groups, in the organizational structure.

Facilitating cultural change in healthcare organisations

The need for cultural change in healthcare organisations is well documented. There is a plethora of evidence to demonstrate the devastating impact of poor workplace culture on staff and patient outcomes. However, balanced against the significant financial pressures and a staffing crisis, cultural change is unlikely to be made a priority, despite the fact that many of the problems faced by organisations are compounded by poor workplace culture. The evidence demonstrates the positive difference cultural change can make, building staff confidence and encouraging innovation which, in turn, will result in greater efficiency and best use of limited funding. This article presents a simple model that may, when combined with other cultural tools, offer organisations a cost-effective and practical way to develop a positive workplace culture.

The impact of COVID-19 on chronic care according to providers: a qualitative study among primary care practices in Belgium

BackgroundThe COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for next waves of the pandemic.MethodsA qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. Twenty-one people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM).ResultsThree themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care, and reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated.ConclusionOur findings show a disruption of the delivery of chronic care in the Belgium prim care context. In such contexts, the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during next waves of the epidemic.

Managing Complex Healthcare Change: A Qualitative Exploration of Current Practice in New South Wales, Australia.

PurposeAs the cost of healthcare continues to rise, healthcare organizations internationally are seeking long-term solutions to eradicate inefficiency, achieve value-based healthcare, and minimize hospital inpatient services. This requires transformational change in healthcare organizations, and associated change management and leadership capability at multiple levels. Despite the critical need for effective change leadership and management in healthcare, limited evidence exists that this currently occurs in addition to the capability and capacity for managing change in health systems.MethodsSemi-structured interviews were undertaken with 16 healthcare managers and leaders at a range of levels in nine healthcare organizations across the public health system of one Australian state (New South Wales), including metropolitan, regional and rural geographical areas. Thematic content analysis was undertaken with the emergent data.ResultsFour key themes emerged from the data: 1) lack of adoption of frameworks and methods for change management for any scope or scale of change, 2) inadequate resources for delivering, managing and leading change, 3) insufficient leadership, capacity and capability in managing change, and 4) the need for support and culture that supports change at all levels of the system.ConclusionEnsuring dedicated resources for change and sufficient capacity and capability amongst health professionals and managers at every level in a health system are required for effective management of change. An enabling culture for change, supported by adequate education and training in change leadership and management are critical in order for the benefits of health service and system changes to be realised.

Ideological tensions amidst rapid and continuous organizational change in healthcare

PurposeThe aim of this study was to explore the nature of frontline nurses' experiences of living with rapid and continuous organizational change.Design/methodology/approachA critical hermeneutic approach was utilized. This was a qualitative inquiry theoretically guided by critical management studies.FindingsParticipants recognized that many change initiatives reflected an ideological shift in healthcare that supported a culture of service, whilst sacrificing a culture of care. A culture of service prioritized cost-savings and efficiency, which saw nurses lose the time and resources required to provide quality, safe care.Practical implicationsNurses felt morally responsible to uphold a culture of care, which proved challenging and at times unobtainable. The inability to provide quality, safe care in light of organizational changes resulted in a multitude of negative emotional repercussions, which fostered moral distress.Originality/valueThe findings from this study bring to light ideological tensions that negatively impact nurses. This study supports the conclusion that the planning, implementation and evaluation of organizational change initiatives must reflect a culture of care in order to alleviate the many negative experiences of organizational change noted in this study.

The Perspective of Nurses Concerning the Characteristics and Competencies of a Change Manager in Healthcare System

Introduction: Nowadays “change” in all aspects of human's life and organizations is rapidly increasing. By knowing the characteristics of change managers as the main pillars of change in healthcare organizations we can implement effective changes in healthcare systems. Therefore, the aim of this study was to determine the characteristics and competencies of change managers in healthcare system. Methods: This descriptive cross-sectional study was conducted on nurses in educational hospitals of Kerman University of Medical Sciences in 2016. In this study 280 nurses entered the study based on stratified random sampling. To collect data, a valid and reliable questionnaire was used. Data were analyzed using cluster analysis by SPSS software version 16. Result: The highest mean score regarding the characteristics of a change manager was related to "evaluation system and feedback" (9.22 ± 1.17), and "counselor and guider" in the process of change (9.31 ± 1.10). Conversely, "creating an amicable atmosphere in the workplace" (7.35 ± 2.45) and "thinking to reduce resistance" (8.04 ± 1.07) achieved the lowest scores. Totally, 4 roles as futurist and planner; coordinator and information provider; facilitator; and strategist were identified for a change manager in healthcare system. Conclusion: Characteristics such as futurist, information provider, facilitator and strategist are the main traits of a change manager. Emphasizing these characteristics and making managers ready in this regard can enhance their performance in the process of change and makes the change easier.

Educação permanente em saúde: estratégia vital para práticas seguras

O objetivo deste estudo é refletir sobre a Política Nacional de Educação Permanente em Saúde e sua relação com Política Nacional de Segurança do Paciente a partir do constructo do referencial teórico filosófico. Trata-se de um estudo qualitativo de cunho reflexivo e filosófico sobre a política de educação permanente e práticas seguras em saúde, sob a perspectiva de Emerson Merhy. O objeto de estudo foi construído a partir do processo de trabalho alinhado a Política de Educação Permanente em Saúde que permite produzir um terreno fértil de possibilidades. Sendo esta, uma forma de trazer para discussão de um coletivo de trabalho as diversas formas de garantir práticas seguras nos serviços de saúde. É importante que o trabalhador possa questionar sua prática promovendo aprendizado significativo, ampliando sua autonomia e protagonizando processos de cuidado mais seguros para si ou para outrem. A Política de Segurança do Paciente instiga uma mudança de cultura nas organizações de saúde. Uma abordagem educacional a fim de discutir processos seguros a partir da Política de Educação Permanente em Saúde mobiliza os cenários de produção de cuidado.

Sustainability endeavors and sustainable development in Spanish public hospitals

Purpose The research aims to describe the foundation of healthcare organizations’ past and present sustainability endeavors; describe the direction of a health-care organizations’ sustainable development; reveal and characterize what determines the foundation and direction in a public health-care sector; and provide some insights into social marketing for sustainability endeavors. Design/methodology/approach Based on a semi-inductive approach, judgmental sampling was applied to select relevant health-care organizations. Informants were identified according to their knowledge of their organizations’ sustainability initiatives. Findings Offer insights into the foundation of sustainability endeavors and the direction of sustainable development for upstream social marketing in the studied public sector. The social marketing perspective is a common factor of relevance for the studied public hospitals. Research limitations/implications The foundations of sustainability endeavors undertaken across the studied health-care organizations have not so far been homogenous. The direction of sustainable development has also varied across the studied public healthcare organizations and there is a need to move beyond individuals and shift from a micro to a macro/structural environment of sustainable development, so as to observe the effectiveness of any social marketing intervention. Practical implications This study highlights the importance of applying an upstream social marketing approach and programs, as part of a social marketing strategy, to promote and stimulate sustainable change in health-care organizations. Social implications Contrary to the common sense predominating in many societies nowadays regarding sustainability endeavors and sustainable development, we conclude that neither the foundation of such endeavors nor the direction of sustainable development has progressed adequately in the studied public healthcare sector. As social marketing is intended to benefit society and foster social change, the macro level of intervention of the upstream approach clearly reveals its usefulness in the public health area. Originality/value Reveals two axes based on a social marketing approach. One is of micro and macro determinants characterizing the direction of sustainable development in a public sector. Another is of homogeneous and heterogeneous foundations of sustainability endeavors.

Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses

BackgroundHealth care organizations are constantly changing as a result of technological advancements, ageing populations, changing disease patterns, new discoveries for the treatment of diseases and political reforms and policy initiatives. Changes can be challenging because they contradict humans’ basic need for a stable environment. The present study poses the question: what characterizes successful organizational changes in health care? The aim was to investigate the characteristics of changes of relevance for the work of health care professionals that they deemed successful.MethodsThe study was based on semi-structured interviews with 30 health care professionals: 11 physicians, 12 registered nurses and seven assistant nurses employed in the Swedish health care system. An inductive approach was applied using questions based on the existing literature on organizational change and change responses. The questions concerned the interviewees’ experiences and perceptions of any changes that they considered to have affected their work, regardless of whether these changes were “objectively” large or small changes. The interviewees’ responses were analysed using directed content analysis.ResultsThe analysis yielded three categories concerning characteristics of successful changes: having the opportunity to influence the change; being prepared for the change; valuing the change. The interviewees emphasized the importance of having the opportunity to influence the organizational changes that are implemented. Changes that were initiated by the professionals themselves were considered the easiest and were rarely resisted. Changes that were clearly communicated to allow for preparation increased the chances for success. The interviewees did not support organizational changes that were perceived to be implemented unexpectedly and/or without prior communication. They conveyed that it was important for them to understand the need for and benefits of organizational changes. They particularly valued and perceived as successful organizational changes with a patient focus, with clear benefits to patients.ConclusionsOrganizational changes in health care are more likely to succeed when health care professionals have the opportunity to influence the change, feel prepared for the change and recognize the value of the change, including perceiving the benefit of the change for patients.

Beyond Resilience and Burnout: The Need for Organizational Change to Promote Humanistic Practice and Teaching in Healthcare

Rapid changes in healthcare organization and practice environments, increasingly driven by business models and commercial interests, are associated with widespread burnout and dissatisfaction among healthcare professionals and pose barriers to humanistic relationship-centered quality care. Studies show burnout and significant stress currently affect over half of US physicians and nurses. Clinicians’ ability to provide compassionate care is significantly challenged. Most solutions to date have included individual interventions designed to enhance well-being and promote resilience. We examined organizational factors that inhibit or promote humanistic practice by faculty physicians in today’s healthcare environment. In this qualitative study, physician faculty who completed a one-year faculty development program in humanism at eight US academic medical centers provided written answers to two open-ended questions: a) What institutional or specific organizational unit-related factors promote humanism for you and others? b) What institutional or specific organizational unit-related factors inhibit or pose barriers, to humanism for you and others? 74% (68/92) of the physicians participated. The constant comparative method was used to analyze responses. We found that organizational culture was the central theme. Motivators of humanism included leadership supportive of humanistic practice, responsibility to role model humanism, organized activities promoting humanism, and practice structures that facilitate humanism. Factors that inhibited humanism included “top down” organizational culture, non-supportive leadership, time and bureaucratic pressures, and non-facilitative practice structures. Our findings suggest that organizational culture is, at a minimum, equally important as individual interventions. We describe features of organizational culture that reinforce humanistic practice and care in healthcare institutions and offer recommendations for organizational change that support the primacy of humanistic, compassionate, high quality patient care.

Resource Orientation in Managing Changes in Healthcare Organizations - Research Results

Resource Orientation in Managing Changes in Healthcare Organizations - Research Results

An ethically mindful approach to AI for health care

Health-care systems worldwide face increasing demand, a rise in chronic disease, and resource constraints. 1 Martin GP Sutton E Willars J Dixon-Woods M Frameworks for change in healthcare organisations: a formative evaluation of the NHS Change Model. Health Serv Manage Res. 2013; 26: 65-75 Crossref PubMed Scopus (14) Google Scholar At the same time, the use of digital health technologies in all care settings has led to an expansion of data. These data, if harnessed appropriately, could enable health-care providers to target the causes of ill-health and monitor the effectiveness of preventions and interventions. For this reason, policy makers, politicians, clinical entrepreneurs, and computer and data scientists argue that a key part of health-care solutions will be artificial Intelligence (AI), particularly machine learning. 2 Chin-Yee B Upshur R Three problems with big data and artificial intelligence in medicine. Perspect Biol Med. 2019; 62: 237-256 Crossref PubMed Scopus (27) Google Scholar , 3 Harerimana G Jang B Kim JW Park HK Health big data analytics: a technology survey. IEEE Access. 2018; 6: 65661-65678 Crossref Scopus (47) Google Scholar AI forms a key part of the National Health Service (NHS) Long-Term Plan (2019) in England, the US National Institutes of Health Strategic Plan for Data Science (2018), and China's Healthy China 2030 strategy (2016).

Оценка и развитие лидерских качеств медсестер в здравоохранении Казахстана

zakhstan. Methods. In this study the leadership competency dimensions were summarized into six leadership competency domains: Setting direction, Managing services and driving results, Leading people and teams, Enhancing nursing professionalism and ethics, Communication and team collaboration skills, and Self-leadership. The questionnaire based on these competency domains was sent to respondents electronically and in paper version for the respondents to assess their own leadership competencies. Results. According to the results, all competency domains and different competency statements in the questionnaire were relevant. In all competency domains, the managers have some or good competency level. However, in enhancing nursing professionalism and ethics, the ability to apply the nursing reform in service development was seen challenging as only half of the respondents had good or excellent competency. The nursing reform described in the Comprehensive Plan of Nursing Care Development in the Republic of Kazakhstan until 2020 was not familiar to almost half of the respondents. According to the results, the educational degree in nursing required should be a higher education degree (bachelor level). Conclusions. Medical universities have an important role in enhancing nursing research, nursing profession and nursing leadership education. It is recommended that the medical universities promote and support the structural changes in healthcare organizations by competence development of chief and senior nurses

Nurses' views of organizational readiness for change.

"Organizational readiness for change" is critical to successfully managing change in healthcare organizations. Yet healthcare and nursing studies about this relatively new concept are few and lack clear criteria on what comprises "organizational readiness for change." This study assessed organizational (hospital) readiness for change, as perceived by registered nurses in two types of hospital in Jordan. Using a quantitative research design, the researcher collected data from a convenience sample of 153 nurses from one major government hospital and one major private hospital. The response rate was 64%. The lowest means, indicating unreadiness for change, were reported for the following items: having developed plans for expanding ambulatory care or enhancing continuity of care, including nurses on all committees, and involving them in policy development and strategic planning efforts. The only difference between the types of hospitals in terms of readiness for change was the use of "collaboration and multidisciplinary work": the governmental hospital was more ready than the private hospital in this regard. To prepare for change, nurse leaders should initiate interventions to enhance organizational readiness and facilitate the integration of change, such as continuing education courses for staff and focus on teamwork, open communication, total quality management, strategic planning, advanced nursing practice and participatory management, especially shared decision-making and policy development. Successful leaders support employees' creative ideas, focus on the timing of the change, and provide training on change management.

Advancing in Integrated Care:Results of 4 years of evaluation

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Network analysis of the structure of inter-professional knowledge exchange related to Electronic Health Record Medication Reconciliation within a Social Knowledge Networking system.

BackgroundIn fall 2016, a 2-year grant was secured to pilot a Social Knowledge Networking (SKN) system pertaining to Electronic Health Record (EHR) Medication Reconciliation (MedRec), to enable Augusta University Health System to progress from “limited use” of EHR MedRec technology, to “meaningful use” (MU). A total of 50 “SKN users” (practitioners), participated in discussing practice issues related to EHR MedRec, over a 1-year period. These discussions were moderated by five “SKN moderators” (senior administrators). The pilot study, completed in fall 2018, found that inter-professional knowledge exchanges on the SKN, enabled several collective learning (“aha”) moments to emerge. These learning dynamics in turn, were associated with distinct improvement trends in two measures of MU of EHR MedRec technology, identified for the study. A key takeaway was that an SKN could be a valuable tool in enabling MU of EHR MedRec technology.PurposeThe study’s key findings related to the content and dynamics of inter-professional knowledge exchange on the SKN system, and their association with trends in measures of MU of EHR MedRec technology, have been described in a separate publication. This paper seeks to describe the structure of inter-professional knowledge exchange (or the pattern of connections) related to EHR MedRec, over the 1-year SKN period.MethodsSocial network analysis (SNA) techniques were used to describe the structure of inter-professional knowledge exchange on the SKN system.ResultsResults revealed that three of the five SKN moderators played a strong “collective brokerage” role in facilitating inter-professional knowledge exchange related to EHR MedRec, to enable learning and practice change. Together, they played complementary roles in reinforcing best-practice assertions, providing IT system education, and synthesizing collective learning moments, to enable “champions for change” to emerge from among SKN users.ConclusionResults provide insight into the structure of effective knowledge-sharing networks for enabling inter-professional learning and practice change in health care organizations.

From events to personal histories: narrating change in health-care organizations

ABSTRACTTo cope with large-scale change managers must understand complex events, but representations of change are never objective and factual, they reflect choices. They are not simply chronicles but personal histories. We apply this perspective to analyze change in public sector health-care organizations. Health-care is an illuminating context because it is affected by large-scale policy-driven reform. There is a clear macro-context against which to map personal histories, which although diverse in terms of content, have common narrative templates which give them with structure. This helps managers understand a chaotic and complex flow of events; enabling them to cope with change.

Measuring change attitudes in health care organizations

PurposeMeasuring attitudes of healthcare providers and managers toward change in health care organizations (HCOs) has been of widespread interest. The purpose of this paper is to evaluate the psychometric characteristics and usability of an abbreviated German version of the Change Attitude Scale.Design/methodology/approachThe Change Attitude Scale was used in a survey of healthcare providers and managers in German hospitals after the implementation of a breast cancer center concept. Reliability analysis, confirmatory factor analysis, structural equation modeling and bivariate analysis were conducted.FindingsData from 191 key persons in 82 hospitals were analyzed. The item-scale structure produced an acceptable model fit. Convergent validity was shown by significant correlations with measures of individuals’ general opinions of the breast center concept. A non-significant correlation with a scale measuring the hospital’s hierarchical structure of leadership verified discriminant validity. The interaction of key persons’ change attitude and hospitals’ change performance through change culture as a mediator supported the predictive validity.Research limitations/implicationsThe study found general support for the validity and usability of a short version of the German Change Attitude Scale.Practical implicationsSince attitudes toward change influence successful implementation, the survey may be used to tailor the design of implementation programs and to create a sustainable culture of high readiness for change.Originality/valueThis is the first study finding that a short instrument can be used to measure attitudes toward change among healthcare providers and managers in HCOs.

A study on the influence of factors associated with organizational readiness for change in healthcare organizations using TISM

PurposeThe purpose of this paper is to identify, analyze and develop a model to measure the interactions among different factors of organizational readiness for change in service sector specific to healthcare organization. The total interpretive structural modeling (TISM)-based readiness for change is to build a theoretical framework to understand the mutual interactions among the factors and to identify the driving and dependence power of these factors.Design/methodology/approachTISM is used to identify factors that contribute to analyze the readiness state before starting a change implementation process in healthcare. Matrice d’Impacts croises-multiplication applique´ a classement analysis is used to find the driving and dependent factors of change in healthcare.FindingsThis paper identified 12 factors of readiness for change from literature review followed by expert interview to understand the inner connection of factors and study inner relationships. The result says that state of affairs, recent trends in healthcare sector, technology advancement and interdependence among departments are key factors for readiness of change.Research limitations/implicationsThis research mainly focused on readiness factors for change in the healthcare sector.Practical implicationsThis study will be useful for researcher and practitioners to understand the readiness factors for change.Originality/valueIn this research work, TISM-based readiness for the change framework structural model has been proposed for healthcare organizations which is a new effort in the area of organizational change management in this sector.