Journal of Health Organization and Management最新文献

Purpose: This narrative literature review examines intersectional employee voice inequalities in a non-Western, high power distance context to develop a multilevel conceptual framework.

Design/methodology/approach: The authors use Leininger's (1997, 2002) culture care model to explore multilevel influences on intersectional voice inequalities. The article applies insights from a review of 31 studies to the specific challenges of migrant palliative care (PC) nurses in Saudi Arabia.

Findings: The themes identified in the review indicate how better transcultural communications might mitigate voice inequalities that influence migrant employee wellbeing and intentions to quit which result from cultural incongruities.

Originality/value: The impact of national culture differences and intersectional inequalities on employee voice has largely been ignored in academic research. This paper offers unique insights drawing on culture care theory into intersectional voice challenges from a non-Western perspective in the underresearched setting of Saudi Arabia which is mid-way through a national transformation program. It starkly contrasts policy ambitions for advancing healthcare with discriminatory practices based on conservative attitudes which stifle migrant worker voices.

Purpose: This study is undertaken to explain how servant leadership affects employees' service performance through their felt obligation toward their leaders. Furthermore, the study explores how the relationship between felt obligation and service performance is moderated by performance pressure.

Design/methodology/approach: The data were collected from 312 manager-subordinate dyads working in private sector hospitals of Karachi. The data were analyzed through covariance-based structural equation modeling.

Findings: The study found that employees' performance is affected by servant leadership and felt obligation toward managers. Furthermore, the study found that felt obligation toward leader mediates the relationship between servant leadership and employees' performance. Finally, the study found that the relationship between felt obligation toward leader and employees' performance was not contingent upon perceived performance pressure.

Originality/value: The study confirms the mediating role of felt obligation toward leaders linking servant leadership to employees' service performance. The study also tests the moderating role of performance pressure influencing the relationship between relationship between felt obligation toward leaders and employees' service performance.

Purpose: Innovation is widely desired within healthcare organizations, yet the efficacy of programs aimed at fostering it remain largely unassessed, with little consideration given to their effects on employee experience. The Veterans Health Administration (VA) innovators network (iNET) was established to provide organizational support to improve and reimagine patient care and processes across the VA. We evaluated participant perspectives on how iNET impacted workplace experience and fostered innovation.

Design/methodology/approach: Semi-structured interviews were conducted using purposive sampling to maximize diversity for program roles and site characteristics, reviewed using a rapid matrixed approach, then analyzed using a hybrid inductive/deductive approach that applied a theoretical framework of innovation supportive domains.

Findings: 21 project investees, 16 innovation specialists and 13 leadership champions participated from 15 sites nationally. Most participants reported strongly positive impacts including feeling re-energized, appreciating new experiences and expanded opportunities for connecting with others, sense of renewed purpose, better relationships with leadership and personal recognition. Negative experiences included time constraints and logistical challenges. Participants' experiences mapped frequently onto theorized domains of supporting a curious culture, creating idea pathways and porous boundaries, fostering/supporting catalytic leadership and supporting (role) diverse teams. The program's delivery of ready resources was critically supportive though at times frustrating.

Originality/value: Participants' experiences support the conclusion that iNET fosters innovation and positively impacts participating employees. In the post-pandemic context of unprecedented challenges of healthcare worker burnout and stress, effective innovation training programs should be considered as a tool to improve worker experience and retention as well as patient care.

Purpose: Access to medical care extends to not only the timely and appropriate receipt of services but also addresses inclusivity and underlying determinants of health. Given that patients from disadvantaged backgrounds have been shown to be more likely to experience delays in care, a same day access scheduling initiative was proposed to address this equity issue. Therefore, this study aims to evaluate our experience, focusing on identifying socioeconomic and demographic patterns of same day access utilization.

Design/methodology/approach: From March 2021 to January 2023, all patients referred for new consultation to a tertiary care-based radiation oncology department were offered same day appointments as part of a prospective pilot initiative. Descriptive statistics were used to identify factors predictive of utilization.

Findings: On multivariate analysis, patient characteristics independently associated with higher odds of same day access utilization included low-income status ([OR] = 3.70, 95% CI (1.47-6.14)) and Black or Latino race ([OR] = 4.05, 95% CI: 1.72-9.11).

Research limitations/implications: While we were unable to acquire data on actual clinical outcomes for patients opting for same day appointments, the enthusiasm for this program was obvious.

Practical implications: Patients from disadvantaged backgrounds and vulnerable segments of the population were more likely to elect for same day appointments. Implications on health equity are discussed.

Social implications: Patient-centered approaches to overcome barriers of access can potentially help ensure that care is equitable.

Originality/value: Our findings, representing the first published data analyzing a longitudinal experience with same day appointments in oncology, strongly suggest that certain disadvantaged populations may benefit more from access initiatives.

Purpose: This study investigates the impact of perceived inclusion among healthcare employees on intrinsic motivation and its subsequent effects on work engagement and stress levels. Drawing from multiple theoretical frameworks, the study hypothesizes the following: (a) perceived inclusion positively influences employees' intrinsic motivation, and (b) perceived inclusion and intrinsic motivation serve as resources that enhance employee well-being by promoting work engagement and reducing stress.

Design/methodology/approach: Data were collected from 407 healthcare workers across the European Union. The research objectives were achieved through statistical analysis of the gathered responses.

Findings: The results indicate a positive relationship between perceived inclusion and intrinsic motivation. Importantly, both perceived inclusion and intrinsic motivation emerged as significant predictors of work engagement. Additionally, perceived inclusion was found to have a negative association with stress levels, underscoring its importance in healthcare management.

Research limitations/implications: The study is subject to certain limitations, including the cross-sectional design and reliance on self-reported data, which may affect the generalizability of the findings.

Practical implications: The findings highlight the importance of fostering perceived inclusion and intrinsic motivation among healthcare employees to enhance work engagement and reduce stress, thus offering valuable insights for healthcare management practices.

Originality/value: This study contributes to the existing literature by examining the complex interplay between perceived inclusion, intrinsic motivation, work engagement and stress within the healthcare sector. It also identifies avenues for future research in this area.

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.