Public Healthcare Organizations Research Articles

Connecting HRM and change management: the importance of proactivity and vitality

Purpose – Organizations are continuously under pressure to adapt to changing circumstances. Job proactivity and vitality are important in changing environments. For instance, vital employees can better deal with change because they possess more energy. However, it is still unclear how organizations can stimulate proactivity and vitality. The purpose of this paper is to connect HRM and change management by analyzing how HRM practices can stimulate job proactivity and vitality. Design/methodology/approach – The authors used survey data collected in three large public healthcare organizations in the Netherlands (n=1,507) to investigate the effects of five important HRM practices on proactivity and vitality. Analyses were performed using structural equation modeling. Findings – Results suggest that three HRM practices are particularly effective for improving proactivity and vitality: high autonomy, high participation in decision making and high quality teamwork. Based on these results, the authors discuss the...

Effects of injury level and severity on direct costs of care for acute spinal cord injury.

New treatments are being investigated for spinal cord injury (SCI), and any improvement may result in incremental cost savings. The objective of this study was to determine the direct costs of care 2 years after an SCI, stratifying for completeness and level of injury. A retrospective database analysis was carried out using data from the Quebec Trauma Registry, the Quebec Medical Insurance Board, and the Quebec Automobile Insurance Corporation between 1997 and 2007. Excluding individuals sustaining moderate or severe traumatic brain injuries, 481 individuals who sustained an SCI from motor vehicle accidents were identified. Individuals were classified as complete and incomplete in the following categories: C1-C7, C8-T6, T7-L1, L2-S5. Using data from governmental public healthcare organizations makes this study comprehensive. For C1-C7 complete and incomplete spinal cord injuries, the first-year cost was $157 718 and $56 505, respectively (2009 Canadian dollars calculated per patient). Similar differences between complete and incomplete spinal cord injuries were seen for the other groups. Furthermore, for complete injuries, costs were higher for higher levels of injury during both the first and the second year after injury. For incomplete lesions, costs did not differ significantly between groups during the first or the second year. Incomplete spinal cord injuries result in lower healthcare costs compared with complete injuries across all groups during the first 2 years after injury. As less severe levels of injury result in measurably lower costs, the funds spent to reduce the severity or level of SCI could at least partially be recouped through healthcare savings.

Dificultades éticas en las organizaciones sanitarias asistenciales públicas

Today you can ask if you can apply ethics to organizations because much of the greater overall impact decisions are not made by private individuals, are decided by organizations. Any organization is legitimate because it satisfies a need of society and this legitimacy depends if the organization does with quality. To offer a good service, quality service, organizations know they need to do well, but seem to forget that should do well not only instrumental level, must also make good on the ethical level. Public health care organizations claim to promote attitudes and actions based on ethics, level of their internal functioning and level of achievement of its goals, but increased awareness and analysis of its inner workings can question it. Such entities, for its structure and procedures, may make it difficult for ethical standards actually govern its operation, also can have negative ethical consequences at the population level. A healthcare organization must not be organized, either structurally or functionally, like any other organization that offers services. In addition, members of the organization can not simply be passive actors. It is necessary that operators and users have more pro-ethical behaviors. Operators from the professionalism and users from liability.

Circuits of power and accountability during institutionalisation of competitive tendering in public sector organisations

Purpose – This study aims to analyse the role of circuits of power in institutionalising competitive tendering in public sector organisations and effects on accountability among public decision makers. Design/methodology/approach – The study used intensive field research data based on interviews, meeting observations and document analysis in a city, referred to as Sunset City, in Finland from 2008 to 2013. Findings – The relationship between institutionalisation of competitive tendering and accountability for total costs of public services depends on how public officials use management accounting and control systems to limit procurement risks and how political decision makers hold public officials to account. This study uses the concept of organisational outflanking within the circuits of power to analyse and explain the finding of ceremonial accountability. Research limitations/implications – Empirical findings cannot be generalised to other situations, but the theoretical framework used in this study can be applied elsewhere. Practical implications – It is advisable to avoid institutionalising macro-institutional market-based mechanisms, such as open competitive tendering in public health care organisations and municipalities in the EU, the consequences of which in terms of total costs, quality of services and accountability among organisational actors at local levels cannot be foreseen, minimised or controlled. Originality/value – This study uses the framework of circuits of power to extend the Burns and Scapens institutional framework to accountability for using public funds in outsourcing services during the ongoing financial crisis.

Effect of Organizational Process and Demographic Variables on Psychological Contract Fulfillment and Turnover Intentions of Doctors in Private and Public Healthcare Organizations

Purpose: The study examined differences in the psychological contract fulfillment and turnover intentions of doctors in private and public hospitals as a function of perceived levels of workplace process factors and demographic characteristics of doctors. It was expected that the relationship between both these factors were more likely to be positive with psychological contract fulfillment and more likely to be negative with turnover intentions of doctors in the private hospitals as compared to the public hospital. Sample and Method : The study was conducted on a sample of 131 doctors from a large public hospital (N=67) and a large private hospital (N=64) in north India using questionnaire method. Finding: Correlation and stepwise regression analysis of the data revealed that amongst the workplace factors, 'role efficacy' of doctors expectedly emerged as a positive predictor of psychological contract fulfillment in private hospitals while unexpectedly, role efficacy, perceived organizational support, participation, positively predicted turnover intentions in both the hospital. Among the demographic variables, duration of participants, promotion, age, positively predicted turnover intentions in both the hospitals. Implication and Value: The study has important implications for Indian hospitals in the private and public.sector which are currently facing problems of workforce retention due to staff perceptions of inadequacy of their workplace environments and job conditions. Data also showed that retention strategies of west are not always applicable and suitable in Indian context.

Eduard Lent (1831-1911): founder and supporter of public health care, social institutions, and physician self-management

Modern urology owes much to our predecessors. Researchers in the 20th century were able to develop their specialist techniques and their professional independence on the basis of the fundamental studies and measures carried out by their predecessors in the 19th century. As a medical practitioner, Eduard Lent provided pioneering solutions to the three major sociomedical problems of his time, namely wide-spread epidemics like cholera, social inequalities, and lack of organization of the medical profession. His answer are to be found in the organization of public healthcare, establishment of suitable social institutions, and the promotion of self-government of the medical profession. These achievements have left their imprint on many fields, including urology.

Impact of a logistic improvement in an hospital pharmacy: effects on the economics of a healthcare organization

Health logistics are traditionally overlooked in Italy as scarcely strategic. More recently, Italian Central Government and Region have reviewed costs only in the direction of a curtailing of the pro-patient cost. Today we know that a more costeffective organization can be obtained also increasing the productivity of administration and services. More and more literature is produced about Supply Chain and Logistics for healthcare services, emphasizing the growing attention on the subject. This paper analyzes a real case study from an Italian public healthcare organization, to verify the impact, in terms of efficiency and cost-effectiveness, of a logistic improvement, particularly in pharmaceutics area. Keywords : Supply chains, logistics, productivity improvement, healthcare services

Strengthening the Service Delivery of Public Health System

This paper presents an operational research conducted to strengthen the service delivery of public health system in East Godavari District in Andhra Pradesh. This research was motivated by a situation where the poor were found opting for private hospitals despite prodding from government staff during a Dengue outbreak in July 2013 in a coastal village. Broadly, the research found that the underlying causes were the distorted incentive structure of doctors, organizational issues and gaps in supply chain of medicines. This paper presents a quantitative as well as qualitative analysis on the various factors which render the public hospitals unattractive for poor patients who are not rich enough to afford public hospitals. Further, it presents operational suggestions to make public hospitals more competitive and policy level changes for compensation system to doctors and organization of public health care to reorient the incentive structure of health personnel towards better service delivery at government hospitals.

Management accounting use and financial performance in public health-care organisations: Evidence from the Italian National Health Service

Reforms of the public health-care sector have emphasised the role of management accounting (MA). However, there is little systematic evidence on its use and benefits.To fill this gap, we propose a contingency-based model which addresses three related issues, that is, whether: (i) MA use is influenced by contextual variables and MA design; (ii) top-management satisfaction with MA mediates the relationship between MA design and MA use; and (iii) financial performance is influenced by MA use.A questionnaire was mailed out to all Italian public health-care organisations. Structural equation modelling was performed to validate the research hypotheses.The response rate was 49%. Our findings suggest that: (i) cost-containment strategies encourage more sophisticated MA designs; (ii) MA use is directly and indirectly influenced by contingency, organisational, and behavioural variables; (iii) a weakly significant positive relationship exists between MA use and financial performance.These findings are relevant from the viewpoint of both top managers and policymakers. The former must make sure that MA is not only technically advanced, but also properly understood and appreciated by users. The latter need to be aware that MA may improve performance in ways and along dimensions that may not fully translate into better financial results.

Coping with the financiers: attracting venture capital investors and end-users in the biomaterials industry

A substantial amount of research has been committed to exploring how university-based research can be transferred to industry and be commercialised. This literature emphasises the substantial institutional, cultural and financial barriers to what has been referred to as academic entrepreneurship. At the same time, and most noteworthy in the USA, university patenting has grown remarkably since the mid-1960s; today (2014), much of the basic life science research conducted by universities is being transformed into health care innovations. This paper reports on a case study of the biomaterials and medical device industry in Sweden and emphasises that, while capital funding is a key challenge for university spin-outs, an additional and less widely recognised concern facing these companies is how to make the public sector health care organisations, primarily, actually buy the products developed. The study suggests that perhaps too much emphasis is being put on ‘upstream activities’, including the early stage support provided by incubators and state agencies that provide seed-money funding, while more mature biomaterials and medical device companies are suffering from both a lack of unified regulatory frameworks and policies governing the procurement of new health care innovations.

Interns' perceptions of performance feedback

Internship, the first year after medical school, is an important time for identity formation and role development. Effective performance feedback is essential for identifying strengths and weaknesses, guiding self-regulation to improve clinical performance and developing accurate self-assessment. However, developing feedback systems is notoriously difficult. A better understanding of interns' perspectives is important to increase engagement with feedback systems and to improve their effectiveness. This study explores the interns' role clarity and confidence in evaluating their own performance; their views of the existing health care organisation's formal performance appraisal system based on national intern assessment tools and guidelines and whether the self-directed audit of clinical tasks is a feasible feedback tool. Qualitative data were collected through a cross-sectional survey using semi-structured interviews with interns in their last week of employment from a single large regional public health care organisation in Australia. Interviewee-verified data were analysed thematically using a 'framework' approach. Twenty-one of 28 interns were included in the final analyses. We found that interns conceptualise good performance in terms of efficient completion of daily tasks and are unable to confidently judge their own performance. The current health care organisation performance appraisal system based on national intern assessment tools and guidelines does not meet their expectations and could be improved through greater involvement of the medical staff who work alongside interns on a daily basis, particularly registrars and regular, scheduled opportunities for formative and informal feedback with a focus on personalised, constructive feedback. The introduction of specific task assessments or audit, such as a formal appraisal of patient discharge documentation, is also valued. Performance appraisal formats need improving to better align with interns' expectations, to meet interns' learning goals and to improve practices in the health care organisation.

Interview: A 20-year ‘search for evidence‘ leads to the Center for Medical Technology Policy

Sean R Tunis is the founder, President and Chief Executive Officer of the Center for Medical Technology Policy in Baltimore (MD, USA). The Center for Medical Technology Policy‘s main objective is to improve the quality, relevance and efficiency of clinical research by providing a neutral forum for collaboration among experts, stakeholders and decision-makers. Tunis was a member of the Institute of Medicine Committee on Initial National Priorities for Comparative Effectiveness Research. He advises a wide range of domestic and international public and private healthcare organizations on issues of comparative effectiveness, evidence-based medicine, clinical research, reimbursement and health technology policy. In September of 2005, Tunis was the Chief Medical Officer at the Centers for Medicare and Medicaid Services, where he had lead responsibility for clinical policy for the Medicare and Medicaid programs. Previously, he served as the Director of the Health Program at the Congressional Office of Technology Assessment and as a health policy advisor to the US Senate, where he worked on pharmaceutical and device policy issues. Tunis trained at the University of California in Los Angeles (CA, USA) and the University of Maryland in Internal Medicine and Emergency Medicine (MD, USA) and holds adjunct faculty positions at the Tufts University School of Medicine (MA, USA), the Department of Internal Medicine at the Johns Hopkins School of Medicine (MD, USA), and the Department of Surgery at the University of California at San Francisco (CA, USA).

Implementing person-centered care in a general medical clinic: cultural barriers and driving forces

Public healthcare organisations in Sweden have been described as strongly hierarchical and coherent organisations [1]. To bring about control, generalized care models have been developed to handle hospital clinics and primary care sites [2]. This paper examines the preparedness to change in hospital settings. The purpose of the present study was to reveal barriers to the introduction of person-centred care (PCC). Organisational culture and resistance to change on hospital ward and clinical level and was based on the 2 concepts of “organisational culture” and “resistance to change”. These 2 concepts were measured by questionnaires based on theories of organisational culture and resistance to change.

PRACTITIONER APPLICATION: Do Senior Management Cultures Affect Performance? Evidence From Italian Public Healthcare Organizations

PRACTITIONER APPLICATION: Do Senior Management Cultures Affect Performance? Evidence From Italian Public Healthcare Organizations

Do Senior Management Cultures Affect Performance? Evidence From Italian Public Healthcare Organizations

Healthcare organizations are often characterized by diffuse power, ambiguous goals, and a plurality of actors. In this complex and pluralistic context, senior healthcare managers are expected to provide strategic direction and lead their organizations toward their goals and performance targets. The present work explores the relationship between senior management team culture and performance by investigating Italian public healthcare organizations in the Tuscany region. Our assessment of senior management culture was accomplished through the use of an established framework and a corresponding tool, the competing values framework, which supports the idea that specific aspects of performance are related to a dominant management culture. Organizational performance was assessed using a wide range of measures collected by a multidimensional performance evaluation system, which was developed in Tuscany to measure the performance of its 12 local health authorities (LHAs) and four teaching hospitals (THs). Usable responses were received from 80 senior managers of 11 different healthcare organizations (two THs and nine LHAs). Our findings show that Tuscan healthcare organizations are characterized by various dominant cultures: developmental, clan, rational, and hierarchical. These variations in dominant culture were associated with performance measures. The implications for management theory, professional practice, and public policy are discussed.

The Blurring of Attractive Work Practices Across Health Care Sectors

Magnet-style characteristics are considered important to the recruitment and retention of nurses. Little is known about nurses’ perceptions of these characteristics across public, private, and third sector health care organizations. The primary aim of this paper is to examine these characteristics across sectors to determine whether differences in key Magnet-style characteristics exist. Given the employee-level focus, demographic factors were also considered. Australian nurses ( n = 459) were recruited using an online panel. No differences between sectors on work environment dimensions were found. Gender, age, employment type, and tenure revealed significant relationships with various work characteristics. Similarities in the work perceptions across sectors implies no specific sector will be differentially impacted by the increasing nurse shortages. An increasing emphasis on contemporary work environments will increase the presence of Magnet-like characteristics irrespective of sector. These results highlight the potential of practice permeability occurring, particularly in a system with common policy and operational drivers.

Pap, Mammography, and Clinical Breast Examination Screening Among Women with Disabilities: A Systematic Review

BackgroundResearch has found some disparities between U.S. women with and without disabilities in receiving clinical preventive services. Substantial differences may also exist within the population of women with disabilities. The current study examined published research on Pap smears, mammography, and clinical breast examinations across disability severity levels among women with disabilities. MethodsInformed by an expert panel, we followed guidelines for systematic literature reviews and searched MEDLINE, PsycINFO, and Cinahl databases. We also reviewed in-depth four disability- or preventive service-relevant journals. Two reviewers independently extracted data from all selected articles. FindingsFive of 74 reviewed publications of met all our inclusion criteria and all five reported data on Pap smears, mammography, and clinical breast examination. Articles classified disability severity groups by functional and/or activity levels. Associations between disability severity and Pap smear use were inconsistent across the publications. Mammography screening fell as disability level increased according to three of the five studies. Results demonstrated modestly lower screening, but also were inconsistent for clinical breast examinations across studies. ConclusionEvidence is inconsistent concerning disparities in these important cancer screening services with increasing disability levels. Published studies used differing methods and definitions, adding to concerns about the evidence for screening disparities rising along with increasing disability. More focused research is required to determine whether significant disparities exist in cancer screening among women with differing disability levels. This information is essential for national and local public health and health care organizations to target interventions to improve care for women with disabilities.

Collective voicing as a reflexive practice

This article focuses on the co-construction of a reflexive practice in a public health-care organisation. We study how the reflexive methods of applied drama and theatre facilitate ‘collective voicing’, specifically in the context of dental health-care professionals’ reflections on their own practices in perplexed situations. Our emphasis is on research-based theatre as a way by which the employees of an organisation can become more reflexive in their relationship with customers. This study makes use of the research-based theatre approach, illustrating how various voices – even those of young customers – are expressed, heard and discussed in order to interpret the status quo of perplexed situations and relationships and to imagine possible choices for disentangling the perplexity. Our study demonstrates the value of post-Boalian applied drama and theatre practices and presents a path for collective voicing as a learning process enabling reflexive practice in organisations.

The Interaction of Public Health and Primary Care: Functional Roles and Organizational Models that Bridge Individual and Population Perspectives

Introduction: Public health and primary care are often conceived as two entities providing complementary services within the health system. This scoping review aims to better understand how the two sectors interact by identifying their shared functions, and by identifying organizational models that could facilitate the interaction between the two domains. Methodology: We conducted a review of published literature using PubMed and CINAHL journal indices. Our search yielded 179 articles. We reviewed abstracts and retained 55 relevant articles. We developed an extraction grid, based on a conceptual framework of functions of public health and primary care, in order to evaluate the relevance of selected articles, classify the information according to their functional connection, and identify interactions between them. Results: Our search identified various activities through which public health can contribute to more effective primary care, and functions usually performed by primary care that seemed to support a population health approach. Most authors identified screening and immunization as actions that are carried out in primary care, but that can benefit from the support of public health. Health promotion and lifestyle modification are also shared responsibilities that can take the form of collective or individual intervention. The surveillance and protection function of public health, which actually takes place in primary care, consists of case identification for prevention or early treatment. Primary care is the setting where patients present, whereas public health has the role of investigation and of providing advice to clinical settings. Planning and evaluation are also emerging activities that concern both public health and primary care. Many authors recognized that public health provides tools that enhance the planning of primary care activities and are more aligned with the actual needs of populations. Others noted that public health is able to assess primary care in light of the changing health of populations, which may lead to better results for groups of patients. Conclusion: One of the routes to a better understanding of how public health and primary care organizations can better interact is to identify the different contexts in which they collaborate successfully. Our scoping review of the scientific and gray literature identified various ways by which public health and primary care either reinforce each other through their respective functions, or increasingly act in a collaborative manner to increase population health and improve health systems performance.

Adopting the Municipal Enterprise Form in Finland: Core Dilemmas in the Transformation of Public Healthcare Organizations

Using a combination of institutional and dilemma theory, this article maps the core dilemmas underlying the transformation of three public healthcare organizations into municipal enterprises. The results concerning the expectations and outcomes of the processes of change show that identified dilemmas affect the isomorphic institutional process by either diminishing or enhancing isomorphic forces. Further analysis reveals the unconscious use of the dilemma reconciliation method among the senior managers and other decision-makers in the organizations. The discussion illustrates how dilemmas, together with isomorphic forces, are connected to decision-making. It highlights the need to investigate strategic dilemma management as a tool for resolving contradictory aims in the public healthcare sector.