Change In Healthcare Organizations Research Articles

Organ Donation Breakthrough Collaborative

Organ Donation Breakthrough Collaborative

The Process of Change in Healthcare Organizations

The Process of Change in Healthcare Organizations

Anestesias en Cataluña en las edades extremas: pediatría y geriatría

The objective of this arm of the ANESCAT 2003 study was to analyze the characteristics of the youngest and oldest patients receiving anesthesia in Catalonia, Spain, and the procedures for which they require it. We analyzed data from questionnaires pertaining to pediatric (under age 14 years) and geriatric patients (older than age 65 years). Pediatric patients underwent 6.3% of all anesthetic procedures and patients over 65 years old accounted for 32.9% of the sample population. Two of every 3 pediatric patients were males, whereas 55% of patients over age 65 years were females. The most frequently performed interventions requiring anesthesia in patients under 14 years of age were tonsillectomy and/or adenoidectomy (19.3%), nonsurgical procedures (11.5%), circumcision (10.6%), inguinal herniorrhaphy (8.3%), and appendectomy (4.2%). The most common procedures in elderly patients were cataract extraction (31.9%), nonsurgical procedures (9.5%), inguinal herniorrhaphy (4.4%), total knee replacement (3.6%), transurethral bladder surgery (3.2%), and repair of femoral neck fractures (2.6%). Because of the high incidence of appendectomy in patients between 8 and 14 years old and of femoral neck fractures in patients over 85 years old, the rate of emergency anesthesias in patients in those age brackets was around 30%. Pediatric and geriatric patients and the interventions for which they are administered anesthesia have particular features. Taking them into consideration in the short term would facilitate the development of new therapeutic strategies and the introduction of changes in health care organization.

Reluctant but resourceful middle managers: the case of nurses in the NHS

This study counters the widely held view that middle managers have little to contribute to strategic change in health care organizations. In particular, it argues that middle managers with a nursing background that manage clinical activity should be involved in strategic change beyond mere implementation of decisions made by executive management. Constraints upon this are noted - the power of doctors and central government intervention - that means middle managers enact a semiautonomous strategic role. Antecedents for the semiautonomous role are investment in organization and management development, developing lateral organizational structures that allow middle managers to make a contribution to the development, as well as the implementation of strategy and allowing middle managers to interact with other stakeholders outside the confines of the organization.

Risk, safety and organizational change in health care?

The increased emphasis on risk assessment and management in health care systems has major implications for the overall management and delivery of health care. Concerns with ensuring safety and minimizing harm are driving ‘modernization’ of health care systems. In this editorial I use recent articles published in Health, Risk and Society to consider the impact of such changes on professional decision-making, especially the pressure to move from decisions grounded in tacit knowledge to those based on knowledge encoded in clinical guidelines or computer-based decision support systems. These articles indicate that the current changes are unlikely to have the desired impact as they tend to disregard the reality of professional decision-making, especially the ways in which professionals need to use tacit knowledge when using decision-support systems and they also fail to recognize that professionals can exploit and use risk and uncertainty to override formal decision-making systems.

Let's be PALS: User‐Driven Organizational Change in Healthcare*

This paper explores user‐driven organizational change in the National Health Service (NHS). The NHS Plan (Department of Health, 2000) created Patient Advice and Liaison Services (PALS) to provide information, solve problems and drive user‐led change. Evidence is drawn from a study of PALS in London acute, primary care, mental health and specialist trusts, drawing on discussion forums, interviews with PALS officers and documentation. From context and role profiles, two conclusions are evident. First, organizational instability, boundary disputes, variable management support, resource limitations, financial insecurity and multi‐site working characterize the context in which PALS operate, and the officer role is characterized by problem diversity, overlap with complaints systems, monitoring problems, relationship building and ‘serial users’. Second, these context and role attributes restrict PALS to ‘repair and maintenance’, ensuring that established systems work correctly. While PALS sit on the bottom rung of a ‘participation ladder’, their contribution is more than tokenistic. However, a processual perspective demonstrates how a fluid, networked, and diversified context isolates PALS structures from management decision‐making, constraining their power base, and inhibiting the promotion of substantive change agendas.

Use of complex adaptive systems metaphor to achieve professional and organizational change

This paper uses the experiences of a programme designed to bring about change in performance of public health nurses (health visitors and school nurses) in an inner city primary care trust, to explore the issues of professional and organizational change in health care organizations. The United Kingdom government has given increasing emphasis to programmes of modernization within the National Health Service. A central facet of this policy shift has been an expectation of behaviour and practice change by health care professionals. Change was brought about through use of a Complex Adaptive Systems approach. This enabled change to be seen as an inclusive, evolving and unpredictable process rather one which is linear and mechanistic. The paper examines in detail how the use of concepts and metaphors associated with Complex Adaptive Systems influenced the development of the programme, its implementation and outcomes. The programme resulted in extensive change in professional behaviour, service delivery and transformational change in the organizational structures and processes of the employing organization. This gave greater opportunities for experimentation and innovation, leading to new developments in service delivery, but also meant higher levels of uncertainty, responsibility, decision-making and risk management for practitioners. Using a Complex Adaptive Systems approach was helpful for developing alternative views of change and for understanding why and how some aspects of change were more successful than others. Its use encouraged the confrontation of some long-standing assumptions about change and service delivery patterns in the National Health Service, and the process exposed challenging tensions within the Service. The consequent destabilising of organizational and professional norms resulted in considerable emotional impacts for practitioners, an area which was found to be underplayed within the Complex Adaptive Systems literature. A Complex Adaptive Systems approach can support change, in particular a recognition and understanding of the emergence of unexpected structures, patterns and processes. The approach can support nurses to change their behaviour and innovate, but requires high levels of accountability, individual and professional creativity.

10 Years Beyond the Health Security Act Failure

Ten years after the failure of President Clinton's Health Security Act (HSA), the United States continues to face multiple stresses in health care, including large numbers of uninsured individuals, increasing costs, questions about quality, and dissatisfaction with managed care. Using the framework of the HSA-particularly universal coverage, spending and managed competition, insurance for low-income persons, and patients' rights-the post-HSA evolution and current status of the US health care system is traced and lessons to guide future actions are outlined. Neither incremental legislation nor private sector changes in health care organization and financing during the past decade have ameliorated the problems addressed by the HSA, and new troubles have emerged. These problems affect every group in the country and continue to deteriorate health care, yet there has been no political support for large-scale reform. The core components of a vision for future action-universal coverage, quality improvement, cost containment, and subsidies for the economically vulnerable-are essential. There is a pressing need to construct a clear vision that would tie together incremental steps into a rational approach to comprehensive reform and to actually move toward the realization of that vision.

Two decades of organizational change in health care: what have we learned?

The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals and physicians, as health providers rethought their organizational roles given perceived market imperatives. Mergers, acquisitions, internal restructuring, and new interorganizational relationships occurred at a record pace. Matching this was a large wave of study and discourse among health services researchers, industry experts, and consultants to understand the causes and consequences of organizational change. In many cases, this literature provides mixed signals about what was accomplished through these organizational efforts. The purpose of this review is to synthesize this diverse literature. This review examines studies of horizontal consolidation and integration of hospitals, horizontal consolidation and integration of physician organizations, and integration and relationship development between physicians and hospitals. In all, around 100 studies were examined to assess what was learned through two decades of research on organizational change in health care.

A training course for psychiatric nurses in Russia.

This article describes the impact on mental health services in Russia of a training course for psychiatric nurses in the management of aggression. This project, which is part of a seven-year international partnership between mental health professionals in the UK and Russia, demonstrates the importance of nurse training to effect change in healthcare organisations.

Organizational readiness for telemedicine: implications for success and failure.

The use of telemedicine brings about change in health-care organizations and opens up new possibilities for service delivery. The organizational environment is often crucial in determining whether or not telemedicine applications will be successful. To examine the concept of 'organizational readiness for telemedicine' as a factor to explain why telemedicine initiatives succeed or fail, the results were used of interviews with key informants, conducted in two studies: the Alliance for Building Capacity project and the National Initiative for Telehealth guidelines project. The data indicate that organizational readiness for telemedicine is a multifaceted concept that is related to planning and the workplace environment. A greater understanding of the factors within organizational readiness could help to avoid costly implementation errors. 'Readiness' needs to be systematically assessed and is important for long-term success.

Leaders and Health Care Organizational Change: Art, Politics and Progress

Leaders and Health Care Organizational Change: Art, Politics and Progress

Organizational Restructuring in European Health Systems: The Role of Primary Care

Abstract The main goal of this paper is to review the strategies developed across European health care systems during the 1990s to improve coordination among health care providers. A second goal is to provide some analytical insights in two fields. On the one hand, we attempt to clarify the relationships between pro‐coordination strategies and organizational change in health care. Our main conclusion is that the specific features of health care impede the operation of either market or hierarchical coordination mechanisms. These can, however, be selectively successful if applied as levers to promote the role and impact of the pro‐cooperative coordination strategies which are ultimately required to foster adequate inter‐professional and inter‐organizational coordination. On the other hand, we try to cast some light on the ongoing debate on convergence versus path dependency within the broader field of welfare state reform. Evidence on pro‐coordination reforms in health care apparently supports some insights from previous work on the centrality of the socio‐political structure to account for varying patterns of selective path dependency across countries. In particular, the informal power resources of specialist physicians vis‐à‐vis primary care professionals and the state are critical to explain the different rhythm and fate of pro‐coordination reforms across Europe. Against received wisdom, the evidence examined suggests that selective path dependency might apparently be compatible with a general trend towards convergence understood as hybridization.

Toward a communicative perspective of collaborating in research: the case of the researcher-decision-maker partnership.

In the shift to a post-industrial order, the production and use of knowledge is gaining greater importance in a world beyond science. Particularly in the health sciences, research foundations are emphasising the importance of translating research results into practice and are experimenting with various strategies to achieve this outcome, including requiring practitioners to become part of funded research teams. In this paper, we present a case of a partnership between researchers and decision-makers in Canada who collaborated on an investigation of implementing change in health care organisations. Grounded in this case and recent empirical work, we propose that such research collaborations can be best understood from a communicative perspective and as involving four key elements: relational stance that researchers and decision-makers assume toward each other; purpose at hand that situates occasions for developing and using knowledge; knowledge-sharing practices for translating knowledge; and forums in which researchers and practitioners access knowledge. Our analyses suggest that partnerships are most effective when researchers see the value of contextualising their work and decision-makers see how this work can help them accomplish their purpose at hand.

Gaining and maintaining commitment to large-scale change in healthcare organizations.

Healthcare administrators have sought to improve the quality of healthcare services by using organizational change as a lever. Unfortunately, evaluations of organizational change efforts in areas such as total quality management (TQM), continuous quality improvement (CQI), and organizational restructuring have indicated that these change programmes have not fulfilled their promise in improving service delivery. Furthermore, there are no easy answers as to why so many large-scale change programmes are unsuccessful. The aim of this analysis is to provide insights into practices that may be utilized to improve the chances of successful change management. It is proposed that in order to effect change, implementers must first gain commitment to the change. This is done by ensuring organizational readiness for change, surfacing dissatisfaction with the present state, communicating a clear vision of the proposed change, promoting participation in the change effort, and developing a clear and consistent communication plan. However gaining commitment is not enough. Many change programmes have been initially perceived as being successful but long-term success has been elusive. Therefore, maintaining commitment during the uncertainty associated with the transition period is imperative. This can be done by successfully managing the transition using action steps such as consolidating change using feedback mechanisms and making the change a permanent part of the organization's culture.

Fostering Ethical Competence in Nursing Education

The nursing shortage, continuous substantive changes in health care organizations, and technological advances in the health care system highlight the importance of ethical competence in nursing, and healthcare. The shortage of nurses is compounded when today's practicing nurse experiences the moral distress associated with being unable to practice in congruence with the nursing code of ethics and standards of practice. Education of today's healthcare professionals must be responsive to a workplace dominated by the brisk pace of change, developing technology, the demand for efficiency and cost effectiveness, and the growth of information. This healthcare environment mandates examination of how nursing curricula foster sound ethical decision-making.

Revisión sistemática de los estudios de satisfacción realizados en España en el período 1986-2001

ObjectivesTo study the aims, methodology and applicability of patient satisfaction studies carried out in the Spanish National Health System (SNHS). Material and methodsSystematic review of patient satisfaction studies performed in the SNHS from between 1986 and 2001 included in Medline and the Spanish Medical Index (Índice Médico Español). ResultsOne hundred twenty-four articles on patient satisfaction were reviewed. The articles were almost equally divided between primary and specialized care. The most frequent topic was a specific healthcare process (33.9%), a healthcare resource (27.4%), or an organizational model (21%). Ninety percent of the studies used quantitative methodology. Seventy-one percent of the studies used a specifically designed instrument to measure satisfaction but only 46.8% of these instruments underwent a validation process. Fortytwo percent of the studies showed serious flaws in methodological validity and 24% proposed changes that could be applied to other places. ConclusionsThere are few published data to indicate that the SNSH is changing due to the results of patient satisfaction studies. Moreover, significant changes in healthcare organization and clinical practice on the basis of the research performed to date cannot be proposed.

Readiness for organizational change: A longitudinal study of workplace, psychological and behavioural correlates

To examine factors influencing readiness for healthcare organizational change, 654 randomly selected hospital staff completed questionnaires measuring the logistical and occupational risks of change, ability to cope with change and to solve jobrelated problems, social support, measures of Karasek's (1979) active vs. passive job construct (job demand× decision latitude) and readiness for organizational change. Workers in active jobs (Karasek, 1979) which afforded higher decision latitude and control over challenging tasks reported a higher readiness for organizational change scores. Workers with an active approach to job problem‐solving with higher job change self‐efficacy scores reported a higher readiness for change. In hierarchical regression analyses, active jobs, an active job problem‐solving style and job‐change self‐efficacy contributed independently to the prediction of readiness for organizational change. Time 1 readiness for organizational change scores and an active approach to job problem‐solving were the best predictors of participation in redesign activities during a year‐long re‐engineering programme.

Intrathecal anesthesia

Development of new drugs and special techniques, as well as changes in health care organization have markedly influenced the use of spinal block and its indications. The present review overviews recent developments in local anesthetic drugs, side effects and special techniques for intrathecal anesthesia. Severe complications after spinal anesthesia are acceptably rare. The cardiovascular effects associated with sympathetic block are more frequent but may successfully be treated with volume expansion and administration of vasoactive drugs while the multimodal approach to prevention of such side effects can also reduce the incidence. Based on recent magnetic resonance imaging studies the volume of cerebrospinal fluid at the lumbosacral level is the main determinant of the effects produced by intrathecal injection of local anesthetic solutions. Unfortunately, it is not possible to estimate the volume of cerebrospinal fluid at the lumbosacral region in clinical practice, but it is clear that the total dose of local anesthetic injected into the subarachnoid space is the primary determinant of both therapeutic and unwanted effects of spinal anesthesia. There is overwhelming evidence of the potential risk for neurological dysfunction associated with spinal lidocaine. This evidence is even more relevant in outpatients, in whom lidocaine is primarily indicated. On the other hand, several studies have demonstrated the efficacy and safety of using small doses of long-acting agents, such as bupivacaine or ropivacaine, to produce a short spinal block. The addition of small doses of opioids further helps to minimize the dose of local anesthetic solution required, without affecting the recovery profile from spinal block. The extensive use of pencil-point designs for spinal needles, and the availability of needles of very small size have allowed a significant reduction in the incidence of postdural puncture headache. The changes in health care organization observed during the past few years have forced us to change the indications for and clinical uses of intrathecal anesthesia techniques in accordance with the changing needs of surgery. The development of new drugs and special techniques for spinal anesthesia will further improve the clinical use of this old but trusted technique.

Leaders and Health Care Organizational Change: Art, Politics, and Process

Back to table of contents Previous article Next article Book ReviewsFull AccessLeaders and Health Care Organizational Change: Art, Politics, and ProcessEric Lister, M.D.Eric ListerSearch for more papers by this author, M.D.Published Online:8 Oct 2014https://doi.org/10.1176/appi.ps.53.10.1337AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Stewart Gabel, M.D., has a lot to teach us about organizational change. He understands the psychology of health care providers and the pressures affecting us. He clearly has firsthand experience with change processes—both successful and unsuccessful—in health care organizations. He understands the inevitable turbulence of the transitional phase between idea and successful implementation in which successful leadership spells the difference between success and failure. He also knows about individual and organizational resistances, even the unconscious resistance often experienced by the leaders of change, and he points out the tactics that can mitigate these resistances.Leaders and Health Care Organizational Change begins with an introduction to the challenges of leadership and the leader's many responsibilities during change processes. Gabel then takes us through each phase of the process, from the initial conceptualization of a major initiative for change through enlisting cooperation, planning, dealing with the disruption of change, deciding to stay the course versus revising the road map for change, and, finally, the solidification of gains. At each phase, the focus is on the challenges facing the leader and on the work of leadership.Gabel also understands how important it is to teach through cases rather than using a purely didactic approach. Each chapter contains a number of case examples that all have the ring of believability. The cases are by far the best feature of this book. Gabel seems to want to give us both a theoretical approach to change and a series of techniques that we can use in our own organizations.The problem with this book is not in the content but, for this reader, in the delivery. Despite the case examples, the writing style is that of an unexciting discursive essay—factual and uninflected. The case studies run, without any editorial demarcation, into case analyses, thus losing some of the punch that they might otherwise have had. Each chapter reads like a sequence of commentaries on points important to the topic at hand, ending in a summary that straightforwardly recapitulates the points just elaborated.It is in this dryness and in the author's failure to offer synthetic insights rather than simple chapter summaries that the book disappoints. Despite the richness of Gabel's case examples, he chose not to capture, communicate, or leverage the energy and intensity that surrounds change. Nor does he offer synthetic commentary, drawn from case analyses, that would constitute a truly unique contribution to the literature of change. Again, from my perspective, a book that might have been truly brilliant emerges as useful, but hardly captivating.Despite the book's shortcomings, I would recommend it to leaders who are engaged in significant change processes. The points Gabel makes are solid, the cases are realistic, and the guidance offered is educated, accessible, and quite useful.Dr. Lister is managing partner of Ki Associates, an organizational consulting firm in Portsmouth, New Hampshire, specializing in work with governing bodies and executive teams of health care organizations.by Stewart Gabel; New York, Kluwer Academic/Plenum Publishers, 2001, 206 pages, $42.50 FiguresReferencesCited byDetailsCited byNone Volume 53Issue 10 October 2002Pages 1337-1337 Metrics PDF download History Published online 8 October 2014 Published in print 1 October 2002