Journal of Health Organization and Management最新文献

Purpose: The aim of the study was to compare the explanatory power of the dissatisfaction-based account of aged care employee turnover against that of Lee and Mitchell's (1994) unfolding theory of turnover.

Design/methodology/approach: Mixed method prospective cohort study with three waves of employee survey data and an exit interview drawn from employees of a large Australian not-for-profit aged care provider. Independent t tests and mediated logistic regression analyses were conducted. Final sample: nStayers at Wave 3 = 138; nLeavers by Wave 3 = 42).

Findings: The classic dissatisfaction-based theory accounts for 19% of actual leavers. The five unfolding theory exit pathways accounted for 73.8% of all leavers. Stayers had the same dissatisfaction as leavers. Shock-based turnover (40.5% of all leavers) was more common than dissatisfaction-based turnover (33.5%). An additional 11.9% of leavers resigned to retire from paid work.

Research limitations/implications: Dissatisfaction-based theory provided a relatively weak explanation of aged care turnover in this organisation. The unfolding theory provided a better and more nuanced account of employee leaving.

Practical implications: Unfolding theory exit interviews will assist aged care employers to better identify organizationally specific exit patterns and assist in finding appropriate organizational solutions to employee turnover.

Originality/value: This paper provides the first direct comparison of two explanations of aged care employee turnover and provides guidance to better retention at a time of labour shortage.

Purpose: The importance of employment in recovery from mental health illness has led to broad recognition of the integration of employment-oriented support into mental health treatment. However, there is variation in the extent to which an employment orientation permeates healthcare services. This article explores how managers and advisors in health and welfare services in Norway function as "change agents", who work to increase an employment orientation in mental health services.

Design/methodology/approach: The empirical material consists of 20 interviews with change agents in health and welfare organisations. They work to implement a model - individual placement and support - to integrate an employment orientation in healthcare services. The findings are analysed using the framework of "institutional work" to elucidate the strategies used by change agents.

Findings: The findings underscore a consensus on the health advantages of employment and that employment-oriented support belongs in mental health treatment. However, this concept requires further cultivation within healthcare services, with individual actors playing a key role as change agents. Depending on the stage of the various organisations in the change process and the actors' positions within the institutional context, the actors engaged in both creative and maintenance institutional work.

Practical implications: The article´s findings are significant for how health organisations can work to achieve desired changes.

Originality/value: This article contributes to the literature on collaboration and implementation of employment-oriented practices in healthcare by directing attention to the dynamics of organisational change processes and the efforts of individual actors to promote change.

Purpose: This study aims to identify and assess the factors challenging the integration of artificial intelligence (AI) technologies in healthcare workplaces.

Design/methodology/approach: The study utilized a mixed approach, that starts with a literature review, then developing and testing a questionnaire survey of the factors challenging the integration of AI technologies in healthcare workplaces. In total, 46 factors were identified and classified under 6 groups. These factors were assessed by four different stakeholder categories: facilities managers, medical staff, operational staff and patients/visitors. The evaluations gathered were examined to determine the relative importance index (RII), importance rating (IR) and ranking of each factor.

Findings: All 46 factors were assessed as "Very Important" through the overall assessment by the four stakeholder categories. The results indicated that the most important factors, across all groups, are "AI ability to learn from patient data", "insufficient data privacy measures for patients", "availability of technical support and maintenance services", "physicians' acceptance of AI in healthcare", "reliability and uptime of AI systems" and "ability to reduce medical errors".

Practical implications: Determining the importance ratings of the factors can lead to better resource allocation and the development of strategies to facilitate the adoption and implementation of these technologies, thus promoting the development of innovative solutions to improve healthcare practices.

Originality/value: This study contributes to the body of knowledge in the domain of technology adoption and implementation in the medical workplace, through improving stakeholders' comprehension of the factors challenging the integration of AI technologies.

Purpose: The purpose of this paper is to improve the understanding of the social contexts of sustainable Lean culture in healthcare by examining self-efficacy (SE) as a fundamental construct related to the value of perceived readiness, prior education of Lean and the importance of leadership's system-level support.

Design/methodology/approach: A descriptive correlational study was conducted to identify the relationships between SE and Lean readiness factors, SE and prior Lean training, SE and clinical vs administrative roles and SE and perceived system-level support in a large health system.

Findings: There was a statistically significant difference in self-reported readiness to use Lean tools between individuals who had received Lean training during their academic education and those who had not; however, their level of education did not impact SE. Lastly, and perhaps most important, the learner who embodies SE also has system-level support.

Research limitations/implications: Future directions of this research, in addition to assessing team readiness as other studies suggest, would be to evaluate individual team member readiness by gauging SE and addressing deficits prior to the deployment of process improvement (PI) projects to promote success and sustainability.

Practical implications: This contributes to the ongoing scholarship of Lean management systems, providing clinical and non-clinical leaders with a contextual understanding of their supportive role in the SE of teams.

Originality/value: This study demonstrates the value of understanding SE of individual team members and how it can contribute to overall improved team outcomes, directly impacting the sustainability of Lean change culture and its promotion of improved patient safety, cost efficiencies and access to care.

Purpose: Tactical capacity planning is crucial when hospitals must cope with substantial changes in patient requirements, as recently experienced during the Covid-19 pandemic. However, there is only little understanding of the nature of capacity limitations in a hospital, which is essential for effective tactical capacity planning.

Design/methodology/approach: We report a detailed analysis of capacity limitations at a Norwegian tertiary public hospital and conducted 22 in-depth interviews. The informants participated in capacity planning and decision-making during the Covid-19 pandemic. Data are clustered into categories of capacity limitations and a correspondence analysis provides additional insights.

Findings: Personnel and information were the most mentioned types of capacity limitations, and middle management and organizational functions providing specialized treatment felt most exposed to capacity limitations. Further analysis reveals that capacity limitations are dynamic and vary across hierarchical levels and organizational functions.

Research limitations/implications: Future research on tactical capacity planning should take interdisciplinary patient pathways better into account as capacity limitations are dynamic and systematically different for organizational functions and hierarchical levels.

Practical implications: We argue that our study possesses common characteristics of tertiary public hospitals, including professional silos and fragmentation of responsibilities along patient pathways. Therefore, we recommend operations managers in hospitals to focus more on intra-organizational information flows to increase the agility of their organization.

Originality/value: Our detailed capacity limitation analysis at a tertiary public hospital in Norway during the Covid-19 pandemic provides novel insights into the nature of capacity limitations, which may enhance tactical capacity planning.

Purpose: Staff shortages in the healthcare sector increase the competition for qualified staff. A magnet hospital is intended to attract, and retain healthcare professionals. This article aims to investigate the challenges related to implementation of a magnet hospital model, and given these challenges, to analyse the interplay between different organisational levels in a Swedish hospital.

Design/methodology/approach: The data collection followed the implementation of a magnet hospital model and consisted of 14 meeting observations, 31 interviews and 13 document analyses.

Findings: The model implementation was driven by a top-down approach, with accompanying bottom-up activities, involving healthcare professionals, to ensure adaption to the hospital's conditions at different organisational levels. The findings revealed that the model was more appealing to top management, seeking a standardised solution to attract and retain nurses. Clinic managers preferred tailor-made solutions for managing their employee resourcing challenges. Difficulties in translating and contextualising the model to the hospital's conditions created challenges at every organisational level. Some were contained within a level while others spread to the organisational level below and turned into something else.

Originality/value: Apart from unique empirical material depicting the implementation of a magnet hospital model as an effort to attract and retain healthcare professionals, the value of this study lies in the attention given to the challenges that arise when responsibility for implementing a management model is shifted from top management to change agents tasked with facilitating and executing the organisational change.

Purpose: An "open communication culture" in the workplace is considered a key contributor to high-quality interaction and providing means to address problems at work. We study how the ideals of "open communication" operate in healthcare.

Design/methodology/approach: We use discourse analysis to investigate the audio-recorded data from 14 workshop team discussions in older people services.

Findings: We found four imperatives concerning the interactional conduct of their colleagues in problematic situations that nursing professionals prefer: (1) Engage in direct communication and avoid making assumptions, (2) Address problems immediately, (3) Deal directly with the person involved in the matter and (4) Summon the courage to speak up. Through these imperatives, the nursing professionals invoke and draw upon the "open communication" discourse. Although these ideals were acknowledged as difficult to realize in practice and as leading to experiences of frustration, the need to comply with them was constructed as beyond doubt.

Practical implications: Workplace communication should be enhanced at a communal level, allowing those with less power to express their perspectives on shaping shared ideals of workplace interaction.

Originality/value: The expectation that an individual will simply "speak up" when they experience mistreatment by a colleague might be too much if the individual is already in a precarious position.

Purpose: The purpose of this research is to examine the relationship between high- performance work systems (HPWS) and organisational innovation in hospital settings, examining the role of employee engagement as a mediator in this relationship. Additionally, the study aims to investigate the moderating role of perspective-taking between HPWS and employee engagement as well as the moderating effect of trust in leader on the connection between employee engagement and organisational innovation.

Design/methodology/approach: A quantitative-deductive causal method, along with a cross-sectional approach, was utilized. Structural equation modelling was applied to analyse data from a sample of 530 doctors employed in hospitals, practicing human resources management in the public and private sectors of Sindh province, Pakistan.

Findings: The findings show positive effects of HPWS on employee engagement and organisational innovation. Additionally, employee's engagement partially mediates the relationship between HPWS and organisational innovation, while the moderating role of perspective-taking significantly influences the link between HPWS and employee engagement.

Originality/value: While HPWS are recognized for enhancing organisational innovation, this study confirms their positive effects on individual and organisational outcomes, particularly within the healthcare sector in Pakistan. This study suggests that when HPWS are effectively perceived and implemented, these integrated practices can be beneficial for both employees and organizations, even in challenging situations.