Emerald | Journal of Health Organization and Management | Table of Contents

Managing people to manage care: From patient to people-centredness at OBHC 2012

literatinetwork@emeraldinsight.com (Aoife McDermott, Mary A Keating) — Fri, 14 Jun 2013 00:00:00 +0100

Abstract

Not available.

High performance HRM: NHS employee perspectives

Fri, 14 Jun 2013 00:00:00 +0100

Abstract

Purpose - This article examines NHS employee perspectives of how high performance HR practices contribute to their performance.Design/methodology/approach - It draws on an extensive qualitative study of the NHS. A novel two-part method was used; the first used focus group data from managers to identify high performance HR practices specific to the NHS. Employees then conducted a card-sort exercise where they were asked how or whether the practices related to each other and how each practice affected their work.Findings - Eleven high performance HR practices relevant to the NHS were identified. We identified four reactions to a range of HR practices which we develop into a typology according to anticipated beneficiaries (personal gain, organization gain, both gain and no-one gains). Employees were able to form their own patterns (mental models) of performance contribution for a range of HR practices (60 interviewees produced 91 groupings). These groupings indicated three bundles particular to the NHS (professional development, employee contribution and NHS deal).Practical implications - These mental models indicate employee perceptions about how health services are organized and delivered in the NHS and illustrate the extant mental models of health care workers. As health services are rearranged and financial pressures begin to bite these mental models will affect employee reactions to changes both positively and negatively.Originality/value - The novel method allows for identification of mental models that explain how NHS workers understand service delivery. It also delineates the complex and varied relationships between HR practices and individual performance.

Achieving organisational competence for clinical leadership: the role of high performance work systems

literatinetwork@emeraldinsight.com (Sandra Leggat, Cathy Balding) — Fri, 14 Jun 2013 00:00:00 +0100

Abstract

Purpose - While there has been substantial discussion about the potential for clinical leadership in improving quality and safety in healthcare, there has been little robust study. This paper presents the results of a qualitative study with clinicians and clinician managers to gather opinions on the appropriate content of an educational initiative being planned to improve clinical leadership in quality and safety among medical, nursing and allied health professionals working in primary, community and secondary care.Design/methodology/approach - Twenty-eight clinicians and clinician managers throughout the state of Victoria, Australia participated in focus groups to provide advice on the development of a clinical leadership program in quality and safety. An inductive, thematic analysis was completed to enable the themes to emerge from the data. Findings - Overwhelmingly the participants conceptualised clinical leadership in relation to organisational factors. Only four individual factors, comprising emotional intelligence, resilience, self-awareness and understanding of other clinical disciplines, were identified as being important for clinical leaders. Conversely seven organisational factors, comprising role clarity and accountability, security and sustainability for clinical leaders, selective recruitment into clinical leadership positions, teamwork and decentralised decision making, training, information sharing, and transformational leadership, were seen as essential, but the participants indicated they were rarely addressed. The human resource management literature includes these seven components, with contingent reward, reduced status distinctions and measurement of management practices, as the essential organisational underpinnings of high performance work systems. Practical implications - The results of this study propose that clinical leadership is an organisational property, suggesting that capability frameworks and educational programs for clinical leadership need a broader organisation focus. Originality/value - This is the first study to qualitatively explore the link between HPWS and clinical leadership.

Work engagement as a key driver of quality of care: A study with midwives

literatinetwork@emeraldinsight.com (Yseult Freeney, Martin R Fellenz) — Fri, 14 Jun 2013 00:00:00 +0100

Abstract

Purpose - Against a backdrop of increased work intensification within maternity hospitals, the present study sought to examine the role of work engagement in the quality of care delivered to patients and in general health of the midwives delivering care as reported by midwives and nurses.Design/methodology/approach - Quantitative questionnaires consisting of standardised measures were distributed to midwives in two large maternity hospitals. These questionnaires assessed levels of work engagement, supervisor and colleague support, general health and quality of care.Findings - Structural Equation Modelling analysis revealed a best-fit model that demonstrated work engagement to be a significant partial mediator between organisational and supervisor support and quality of care, and as a significant predictor of self-reported general health. Together, supervisor support, social support and organisational resources, mediated by work engagement, explained 38% of the variance in quality of care at the unit level and 23% of variance in general health among midwives (?2 (67) = 113; p <.01, CFI=.961, RMSEA = .06).Research limitations/implications - The study is limited in that it uses self-report measures of quality of care and lacks objective indicators of patient outcomes. The cross-sectional design also does not allow for causal inferences to be drawn from the data.Practical implications - This study provides evidence for the links between of individual levels of work engagement and both health and self-reports of unit level quality of care . The results support the importance of health services organisations and managers deploying organisational resources to foster employee work engagement. The results also highlight the significant role of the immediate nurse manager and suggest training and development for such roles is a valuable investment.Originality/value - These results are the first to link work engagement and performance in health care contexts and point to the value of work engagement for both unit performance and for individual employee well-being in health organisations.

The role of organizational justice, burnout and commitment in the understanding of absenteeism in Canadian healthcare sector

Fri, 14 Jun 2013 00:00:00 +0100

Abstract

Purpose - The purpose of this study is to integrate Greenberg’s perspective on the connection between injustice and stress in order to clarify the role of organizational justice, burnout and organizational commitment in the understanding of absenteeism. Design/methodology/approach - The study was carried out among 457 workers of a large health care establishment in the Canadian public health care sector. The model was tested using structural equation methods.Findings - The results reveal that procedural and interactional justices have an indirect effect on exhaustion through distributive injustice. Moreover, we found that distributive injustice is indirectly linked to short-term absences through exhaustion. By contrast, the relationship between distributive injustice and long-term absence can be explained by two mediating variables, namely, exhaustion and psychosomatic complaints.Research limitations/implications - In spite of the non-longitudinal nature of this study, the results suggest that the stress model and the medical model best explain the relationship between organizational injustice and absenteeism, while the withdrawal model via organizational commitment is not associated in our study with absenteeism.Practical implications - Health care managers should consider the possibility of better involving employees in the decision making process in order to increase their perception of procedural and interactional justice, and indirectly reduce exhaustion and absenteeism through a greater perception of distributive justice.Originality/value - This is one of the first studies to provide a complete model that analyzes the stress process in terms of how organizational justice affects short- and long-term absences, in a bid to understand the specific process and factors that lead to shorter and longer episodes of absence.

Industrial Relations Conflict in Irish Hospitals: A Review of Labour Court Cases

literatinetwork@emeraldinsight.com (Jennifer Cowman, Mary A Keating) — Fri, 14 Jun 2013 00:00:00 +0100

Abstract

Purpose - The purpose of this paper is to explore the nature of industrial relations (IR), and IR conflict in the Irish healthcare sector. Design/methodology/approach - The paper is based on a thematic analysis of Labour Court cases concerning hospitals over a ten year period. Findings - The findings of the paper indicate that the nature of IR conflict is changing in healthcare. The paper suggests that alternative manifestations of IR conflict evident in the Irish healthcare sector include (i) absenteeism as a form of temporary exit, and (ii) resistance. The key groups in the sector are discussed in the context of their contrasting disputes. The themes which characterise negotiations are identified as precedent, procedure and partnership. Research limitations/implications - The research was conducted in the healthcare sector, thus transferability is limited. Caution is also required as the research pertains to one national setting which, despite sharing some structural similarities with other health and IR systems, is a unique context. Practical implications - The paper highlights the importance of recognising IR conflict in its various forms. It is further suggested that managing the process of IR conflict may be significant in furthering change agendas. Originality/value - The value of the paper centres on the investigation of alternative manifestations of IR conflict in the healthcare sector.

Challenges in transferring individual learning to organizational learning in the residential care of older people

Fri, 14 Jun 2013 00:00:00 +0100

Abstract

Purpose - The aim was to evaluate the outcomes of a workplace learning intervention on organizational learning and to identify factors influencing the creation of organizational learning in residential care of older people.Design/methodology/approach - The study consisted of a quasi-experimental intervention for outcome evaluation. In addition, a case study design was used to identify factors influencing organizational learning. Outcomes were evaluated using the validated Dimensions of the Learning Organization Questionnaire at three time points, and interviews were conducted with nursing staff and managers.Findings - The intervention had some effects on the individual level, but no improvements to organizational learning were found. Hindering factors for creating organizational learning were poor initial learning climate, managers’ uncertainty about their role, lack of ownership and responsibility among staff and managers, managers’ views of personality being a more important component than staff development in older people´s care, and a lack of systems for capturing acquired knowledge.Research limitations/implications - Future research should focus on managers’ attitudes concerning staff learning in older people´s care and issues related to outcome measurements of workplace learning. Practical implications - The content and design of future workplace learning initiatives should, in addition to the activities of the current intervention, pay more attention to creating common goals for the learning as well as situate the learning more in the practical work context.Originality/value - The study offers suggestions for the transfer of individual-level learning to organizational learning in older people´s care.