Public Healthcare Organizations Research Articles

Implications of Preparedness and Response Core Competencies for Public Health

Public health care practitioners and organizations are a part of community readiness for, response to, and recovery from emergencies and disasters of all kinds. Although response to health threats, particularly communicable disease outbreaks, have long been a part of public health practice, 2 advancements in preparedness, including the integration of public health into the broader community emergency response system and the clarification of exactly what knowledge, skills, and attitudes a public health professional brings to the response, have been made since 2001. This article presents the newly affirmed core competencies to be attained and maintained by the majority of the public health workforce and discusses some of the many ways in which these competencies influence practice, research, and education.

Service Quality and Perceived Value of Technology-Based Service Encounters: Evaluation of Clinical Staff Satisfaction in Taiwan

Previous research has evaluated technology-based service encounters (TBSEs) in the delivery of health care by assessing patient satisfaction. This study examined service quality and perceived value of TBSEs used in health organisations from the perspective of clinical staff, with staff technology readiness as a moderator. A quantitative survey was conducted in Taiwan, across private and public healthcare organisations. Results showed that TBSEs had a direct effect on service quality and perceived value, which in turn had a direct effect on staff satisfaction in using TBSEs. However, service quality had no effect on perceived value when moderated by technology readiness. Theoretical and managerial implications of these findings are discussed.

Job satisfaction among public health professionals working in public sector: a cross sectional study from Pakistan

BackgroundJob satisfaction largely determines the productivity and efficiency of human resource for health. It literally depicts the extent to which professionals like or dislike their jobs. Job satisfaction is said to be linked with the employee’s work environment, job responsibilities and powers and time pressure; the determinants which affect employee’s organizational commitment and consequently the quality of services. The objective of the study was to determine the level of and factors influencing job satisfaction among public health professionals in the public sector.MethodsThis was a cross sectional study conducted in Islamabad, Pakistan. Sample size was universal including 73 public health professionals, with postgraduate qualifications and working in government departments of Islamabad. A validated structured questionnaire was used to collect data from April to October 2011.ResultsOverall satisfaction rate was 41% only, while 45% were somewhat satisfied and 14% of professionals highly dissatisfied with their jobs. For those who were not satisfied, working environment, job description and time pressure were the major causes. Other factors influencing the level of satisfaction were low salaries, lack of training opportunities, improper supervision and inadequate financial rewards.ConclusionOur study documented a relatively low level of overall satisfaction among workers in public sector health care organizations. Considering the factors responsible for this state of affairs, urgent and concrete strategies must be developed to address the concerns of public health professionals as they represent a highly sensitive domain of health system of Pakistan. Improving the overall work environment, review of job descriptions and better remuneration might bring about a positive change.

Decoupling the use and meaning of strategic plans in public healthcare

BackgroundThe culture of New Public Management has promoted the diffusion of strategic management tools throughout Public Healthcare Organisations (PHOs). There is consensus that better strategic planning tools are required to achieve higher levels of organisational performance. This paper provides evidence and understanding of the emergent uses and scope of strategic planning in PHOs, in order to answer three research questions: (i) has the New Public Management approach changed the organisational culture of PHOs in terms of how they adopt, diffuse, and use strategic planning documents? (ii) how coherent are strategic planning documents in PHOs? and (iii) what are the main purposes of strategic documents in PHOs?MethodsAn analysis was carried out in three Italian Local Health Authorities. We analysed the number and types of formal strategic documents adopted between 2004 and 2012, evaluating their degree of coherence and coordination, their hierarchy, their degree of disclosure, and the consistency of their strategic goals. A content analysis was performed to investigate overlap in terms of content and focus, and a qualitative analysis was carried out to study and represent the relationships between documents.ResultsThe analysis showed that a rich set of strategic documents were adopted by each PHO. However, these are often uncoordinated and overlap in terms of content. They adopt different language and formats for various stakeholders. The presence of diverse external drivers may explain the divergent focus, priorities and inconsistent goals in the strategic documents. This planning complexity makes it difficult to determine how the overall goals and mission of an organisation are defined and made visible.ConclusionsThe evidence suggests that PHOs use a considerable number of strategic documents. However, they employ no clear or explicit overarching strategy currently, and strategic planning appears to be externally oriented. All the documents communicate similar topics to different stakeholders, although they use different language to answer to the different expectations of each stakeholder. Therefore, strategic planning and plans seem to be driven by neo-institutional approaches, as they are means to build consensus and negotiate ground for strategic actions, rather than means to identify strategic choices and priorities.

Idea Selection in Idea Development Conversations: the Co-Evolution of Ideas and Networks

This study adds to the existing literature linking networks and innovations by investigating how interorganizational networks select which particular creative ideas will be implemented. Drawing on theories of dialogue and research on the cognitive and affective foundations of interpersonal relations, I develop a model of how individual reactions in innovation conversations constitute interpersonal relationships between conversing actors, aggregating into sets of directed networks. The empirical analysis of this paper is based on innovation conversations in a collaboration project between nine public health care organizations. First, the analysis shows how actors’ (positive support, negative influence, neutral persuasion, and neutral floor-giving) reactions towards each other’s ideas aggregate into idea-specific networks evolving over time. Then, I elaborate how network density, idea advocate centrality, and the evolution of the network over time conditioned idea selection. In the empirical context studied, ideas were selected for implementation when the idea-specific network was homogeneous, dense, and had the idea advocate as a most influential hub. This study provides a theoretical understanding how idea advocates can influence group affective states in social interaction, leading to the formation of a network supporting idea selection.

Is the public healthcare sector a more strenuous working environment than the private sector for a physician?

The present study examined the differences between physicians working in public and private health care in strenuous working environments (presence of occupational hazards, physical violence, and presenteeism) and health behaviours (alcohol consumption, body mass index, and physical activity). In addition, we examined whether gender or age moderated these potential differences. Cross-sectional survey data were compiled on 1422 female and 948 male randomly selected physicians aged 25-65 years from The Finnish Health Care Professionals Study. Logistic regression and linear regression analyses were used with adjustment for gender, age, specialisation status, working time, managerial position, and on-call duty. Occupational hazards, physical violence, and presenteeism were more commonly reported by physicians working in the public sector than by their counterparts in the private sector. Among physicians aged 50 years or younger, those who worked in the public sector consumed more alcohol than those who worked in the private sector, whereas in those aged 50 or more the reverse was true. In addition, working in the private sector was most strongly associated with lower levels of physical violence in those who were older than 50 years, and with lower levels of presenteeism among those aged 40-50 years. The present study found evidence for the public sector being a more strenuous work environment for physicians than the private sector. Our results suggest that public healthcare organisations should pay more attention to the working conditions of their employees.

La "clinical governance" č una prospettiva innovativa per le aziende ospedaliere?

In public health care organizations, the doctor is not only important as a provider of medical services but also as the individual that determines the demand of medical services; the doctor is both a participant in the definition of demand for services and the actual person representing the offer of them. Therefore health care organizations must guarantee the possibility for the doctor to act independently. On the other hand this autonomy is limited by the fact that doctors must act within the boundaries of structures that impose rules, hierarchies and adherence to organizational levels. This is the reason why in a hospital structure the doctor does not have the possibility to act in total autonomy. Within the hospital organization conflicts arise that must be either prevented and/or managed trough both coordination and integration of processes. The 2004 reform proposed by minister Sirchia constitutes an answer to the above conflict. It was inspired by the British experience with "clinical governance". Mr. Sirchia's law proposal creates the so called "clinical coordinator" and provides it with a position in the clinical organization's top management with the responsibility of definition of policies as well as coordination and controls. He will act as a medical director too. But the creation of the "clinical coordinator" position rather than solve the integration problems, would have generated permanent conflicts at top management level. Luckily the law proposal did not become an act of Parliament; but the problem of finding real solutions to the conflicts arising from the diversity of medical and economic cultures remains.

Attracting public service motivated employees: how to design compensation packages

Public sector managers want to attract employees with high public service motivation as they are expected to perform better. The public service motivation literature rarely gives practical advice on how this can be done. Recognizing that compensation packages act as a sorting device that can be used to attract specific types of workers, we combine empirical measures of public service motivation with a newly developed approach to employees’ monetary valuation of compensation packages. This tool can be used to improve recruitment and retention of employees with high public service motivation. We find that public service motivated employees have a lower preference for bonus payments and stronger preferences for health care packages, but the associations depend on the specific context in which the employees work. This implies that the employees’ perceptions of the compatibility between the compensation package elements and societal interest should be taken into account, when the employees are motivated by doing good for society. Points for practitioners The findings of the article have implications for public managers who want to improve performance in their organizations by attracting employees with a high level of public service motivation. Our results indicate that bonuses should then be avoided, especially in administrative positions and when an emotion-based orientation towards doing good for others and society is important. Health care packages are generally a good idea, when it is important to attract employees who want to do good for the specific users of the service. Private health packages should, however, be avoided in public health care organizations.

Nursing power as viewed by nursing professionals

The concept of nursing power has not been extensively reported in the nursing literature. Power is an extremely abstract concept, making it difficult to define and study. However, when defined as the capacity to achieve goals, power becomes a significant resource in nursing. The aim of this study was to describe how nursing professionals perceive the level of nursing group power in public healthcare organizations. Additionally, the connections between the background variables and nursing group power were analysed. The participants in the study consisted of 289 Finnish nurses working in the specialist healthcare sector in Finland. The Sieloff-King Assessment of Group Outcome Attainment within Organizations© (SKAGOAO) instrument was utilized to assess the level of nursing group power within the selected organizations. According to the present study, nursing professionals rated the outcome attainment (mean, 1.93), as well as goals/outcome competency (mean, 2.24), as very good. The position of nursing (mean, 2.55) as part of the healthcare service system was considered fairly respected. The role of nursing (mean, 2.54) was also considered to be at a good level. As regards to the actualization of power or outcome attainment capacity, respondents gave the lowest ratings to controlling the effects of environmental forces (mean, 2.75), resources (mean, 3.48), communication competency (mean, 3.00) and group supervisor's outcome attainment competency (mean, 2.87). Age, education, type of employment and work experience had an impact on how nursing group power was perceived. The results of the present study indicated that the nurses perceived the lowest levels of group power in relation to the subscales of controlling the effects of environmental forces, resources, communication competency and group supervisor's outcome attainment competency.

Use of After Action Reports (AARs) to Promote Organizational and Systems Learning in Emergency Preparedness

Many public health and healthcare organizations use formal knowledge management practices to identify and disseminate the experiences gained over time. The “lessons-learned” approach is one such example of knowledge management practice applied to the wider concept of organizational learning. In the field of emergency preparedness, the lessons-learned approach stands on the assumption that learning from experience improves practice and minimizes avoidable deaths and negative economic and social consequences of disasters. In this project, we performed a structured review of AARs to analyze how lessons learned from the response to real-incidents may be used to maximize knowledge management and quality improvement practices such as the design of public health emergency preparedness (PHEP) exercises. We chose as a source of data the “Lessons Learned Information Sharing (LLIS.gov)” system, a joined program of the U.S. Department of Homeland Security DHS and FEMA that serves as the national, online repository of lessons learned, best practices, and innovative ideas. We identified recurring challenges reported by various states and local public health agencies in the response to different types of incidents. We also strived to identify the limitations of systematic learning that can be achieved due to existing weaknesses in the way AARs are developed.

Exploring the relationship between organizational culture and clinical governance in the Italian NHS

The present study aims to explore the relationship between senior management team culture and clinical governance by investigating public healthcare organizations in three Italian Regions: Emilia-R...

Towards a balanced performance measurement system in a public health care organization

This article attempts to devise an integrated performance measurement framework to assess the Hong Kong Hospital Authority (HA) management system by harnessing previous performance measurement systems. An integrated evaluative framework based on the balanced score card (BSC) was developed and applied using the case study method and longitudinal data to evaluate the HA's performance management system. The authors unveil evolving HA performance indicators (P1). Despite the HA staffs explicit quality emphasis, cost control remains the primary focus in their performance measurements. RESEARCH LHNITATIONS/IMPLICATIONS: Data used in this study are from secondary sources, disclosed mostly by HA staff. This study shows public sector staff often attach too much importance to cost control and easily measurable activities at the expense of quality and other less easily measurable attributes'. A balanced performance measurement system, linked to health targets, with a complementary budgeting process that supports pertinent resource allocation is yet to be implemented in Hong Kong's public hospitals.

A new concept of a multidisciplinary lymphoedema centre: established in connection to a department of dermatology and the Copenhagen Wound Healing Center

Lymphoedema is increasingly recognized as a significant problem in healthcare. The number of patients is growing, posing a future challenge to healthcare systems and economics. Over the past decade, specialized lymphoedema management has been established around the world to accommodate the growing demands. However, information on organization, experiences and outcome are scarce. To conduct a clinical perspective analysis describing the establishment, organization, function and results of a new, multidisciplinary lymphoedema centre functioning as a university hospital unit in connection to a department of dermatology and the Copenhagen Wound Healing Center and integrated as a national expert function in the public healthcare organization of Denmark. Data were collected following the establishment of a lymphoedema centre based on the structured, multidisciplinary organization of lymphoedema management. During the first 4·5 years a total of 8058 patient consultations were performed. The mean duration of symptoms at the first visit was 19 years (range 1-67) and 31% of patients had never received any diagnosis or treatment prior to referral. Complications were found in 48% of referred patients. All patients received appropriate diagnostic investigations and treatment according to best practice. Multidisciplinary assessment involving four or more different healthcare professions was needed in 86% of cases. Research opportunities and expert education of staff were enhanced. A multidisciplinary lymphoedema centre improves management, knowledge and awareness of lymphoedema. This model, with minor adjustments, may be applicable for other regions and countries.

Middle managers on the slide

PurposeThis article aims to examine middle managers in health care and how their role has changed in times of fiscal constraints. It seeks to focus particularly on how cost savings influence the position of middle managers in the organisation between governance and advocacy pressure.Design/methodology/approachA total of 25 Swedish middle managers from public health care organisations during fiscal constraints were interviewed about what contributes to their positioning in the organisation.FindingsThe loyalty of middle managers is tested in the “in between” role. Excessive loyalty, in any direction, can distance a middle manager from their expected position. In times of a weakening economy, middle managers are expected to be a tool that is used by the management to communicate savings, personnel reductions, redundancies and closures. This contributes to middle managers sliding out of their role in between.Practical implicationsMiddle managers’ skills are within care itself. In times of cost savings, demands are placed on their ability to handle advanced management tasks. They need to gain a clearer insight into management control, understanding conflict management and leadership.Originality/valueThe article explains not only why middle managers slide up (take on governance roles) and down (take on advocacy roles) in the organisation, which has been described previously. It also explains why middle managers slide out (abdicate responsibility) of the role between governance and advocacy during times of fiscal limitations.

Administrative stressors and nursing job outcomes in Australian public and non‐profit health care organisations

The main aim of this study is to develop a path model to examine the effect of administrative stressors on nursing work outcomes in a sample of Australian public and non-profit nurses. The implementation of managerial reform initiatives has negative consequences on work outcomes. However, less is known about the effects of these stressors in public and non-profit health care organisations. An online, self-completion questionnaire was sent to a random sample of nurses, employed in nursing-related occupations. Useable surveys were received from 251 nurses. The path model was analysed using SmartPLS software (SmartPLS, Hamburg, Germany). Public and non-profit nurses experienced time and resource administrative-related stressors (such as resource shortage and pay not as good as other people doing similar work). They relied on work-related social support to reduce the negative consequences. Resource stressors led to job dissatisfaction while time stressors led to psychological strain. Nursing staff who reported better psychological health reported higher job satisfaction and higher level of commitment towards their organisations. Context-specific administrative stressors have a negative impact on the work outcomes of public and non-profit nurses. Work-related social support mechanisms were found to mediate the negative consequences of administrative resourcing stressors on nursing job satisfaction. Nursing managers have to be sympathetic and care for the negative experiences of nursing staff, especially when there is an increasing level of administrative expectations during organisational change. Senior management should take note of the stressors caused by the lack of resources such as information, staffing and resources, as these were found to lead to an increase in nurses seeking work-related social support from their peers and supervisors. Effective implementation of these strategies would lead to a nursing workforce, which has higher level of psychological health, job satisfaction and organisational commitment.

An evaluation framework for measuring supply chain performance in the public healthcare sector: evidence from the Italian NHS

Innovations in supply chain (SC) management are rapidly spreading in public healthcare sectors across developed countries. In particular, healthcare managers and policymakers view SC innovation as a way to lower costs and improve quality. However, although the related rhetoric is strong, the literature provides little evidence of the benefits and performance of such SC initiatives. Above all, the literature lacks a sound conceptual framework for appraising SC management in public healthcare organisations. We argue that the public nature of healthcare and the specificities of the healthcare context require a specific theoretical approach to identifying the appropriate dimensions of SC initiatives to evaluate. Drawing from an extensive literature review and a longitudinal analysis of an inductive case study – a public hospital network developed in Tuscany (ESTAV), Italy – this work proposes a framework for assessing supply chain performance in the public healthcare sector. In addition, an empirical analysis was conducted to test the soundness and robustness of the framework, and this article presents conclusions regarding its applicability and managerial implications.

Lazy Monopoly vs Competing Organization: A Case of St. Petersburg Health Insurance System

The paper analyzes the activity of medical organizations in Russian health insurance system. A conception of “exit”, “voice” and “loyalty” by A. Hirschman is used to reveal the position of health care consumers . On the basis of researches that have been conducted in 2003, 2005 and 2007 the paper proves the idea that the majority of public health care organizations presents “lazy monopoly”. In a market without competition, consumers who do not express their dissatisfaction by exercising their right of “exit” (in this case by changing doctor or provider of health services within compulsory medical insurance system) or of “voice” are encouraged to go to another market – either to pay for services at public institutions or to turn to private organizations. As a result, public clinics do not lose money and are not motivated to improve performance and quality. The paper includes analysis of some tools which could make health organizations to become less “lazy”, such as introduction of competition between health insurance organizations, increase of physicians salary, etc.

Managing clinical integration: a comparative case study in a merged university hospital

This paper seeks to explore critical factors that may obstruct or advance integration efforts initiated by the clinical management following a hospital merger. The aim is to increase the understanding of why clinical integration succeeds or fails. The authors compare two cases of clinical integration efforts following the Karolinska University Hospital merger in Sweden. Each case represents two merged clinical departments of the same specialty from each hospital site. In total, 53 interviews were conducted with individuals representing various staff categories and documents were collected to check data consistency. The study identifies three critical factors that seem to be instrumental for the process and outcome of integration efforts and these are clinical management's interpretation of the mandate; design of the management constellation; and approach to integration. Obstructive factors are: a sole focus on the formal assignment from the top; individual leadership; and the use of a classic, planned, top-down management approach. Supportive factors are: paying attention to multiple stakeholders; shared leadership; and the use of an emergent, bottom-up management approach within planned boundaries. These findings are basically consistent with the literature's prescriptions for managing professional organisations. Managers need to understand that public healthcare organisations are based on competing institutional logics that need to be handled in a balanced way if clinical integration is to be achieved--especially the tension between managerialism and professionalism. By focusing on the merger consequences for clinical units, this paper addresses an important gap in the healthcare merger literature.

Metastructuration actions of management: critical for stakeholder intervention in IS/IT implementations

Metastructuration actions (overarching activities from management that shape and align users’ activities of IS/IT use) are often advocated to improve the success of IS/IT implementation. But how can management support enhance the success of IS/IT by metastructuration actions, when they are dealing with multiple stakeholders? This key question is addressed in this paper. Building on Orlikowski et al. (1995), we explore the contextual conditions of metastructuration actions of management concerning three other key stakeholders: users, the IT department, and external service providers or consultants. The empirical case context is a Dutch public healthcare organisation that deployed three (different) departmental information systems. Based on 26 interviews with all stakeholders that were involved in the deployment of the three departmental information systems, we find that three types of metastructuration actions were critical in a particular relationship with two types of stakeholders. We conclude that this demonstrates that stakeholder context is indeed conditional to metastructuration actions, and hence the success of an IS/IT implementation in terms of perceived system quality and acceptance.

Italian Public Health Care Organizations: Specialization, Institutional Deintegration, and Public Networks Relationships

The Italian National Health Service (INHS) has undergone profound changes over the past three decades. With establishment of the INHS in 1978--a tax-based public health care system with universal coverage--one of the underlying principles was integration. The recognition of health and health care as requiring integrated answers led to the creation of a single public organization, the Local Health Unit, responsible for the health status of the population of its catchment area. At the beginning of the 1990s, the scenario radically changed. The creation of hospital trusts, the development of quasi-market mechanisms and management control tools, the adoption of a prospective payment system for reimbursing health care providers--all were signs of deintegration and institutional unbundling. Two structural changes have deeply sustained this deintegration: patients' empowerment and the increased possibilities for outsourcing practices. In more recent years, a new reintegration effort has occurred, often led by regional governments and based on institutional cooperation and network relationships. However, the earlier structural changes require innovative approaches and solutions if public health care organizations want to retain their leading role.