Andreas Hellström

Process management in healthcare: investigating why it's easier said than done

The purpose of this paper is to investigate what happens when a new management idea with manufacturing origin is implemented in a healthcare organization. In this paper, it is focussed on process m ...

Among Fumblers, Talkers, Mappers, and Organizers: Four applications of process orientation

The study describes different applications of process orientation and associates the applications with organisational performance and inhibiting factors. The objective of the study is to analyse potential differences between the various applications of process orientation and thus to empirically validate what organisations actually do when managing their processes. The article uses survey data from 183 employees of various healthcare facilities in one region in Sweden. Four significantly different user groups of process orientation existed in the studied population. These were Fumblers, Talkers, Mappers and Organisers. The Organisers perceived the greatest effect on organisational performance, slightly greater than the Talkers. The Mappers perceived a significantly lower effect. The results also show that the perceived resistance from inhibiting aspects decreases the more visible and structural the application of the process orientation is, i.e. Mappers and Organisers. The linguistic and cognitive approach that the Talkers have taken has been perceived as fruitful in terms of organisational performance. We argue that the suggested classification of process orientation contributes to a better understanding among practitioners by showing that different applications of process orientation exist and by showing what effects can be expected from these applications. By not seeing process orientation as one single idea or application, it is our intention that this study contribute to a broader view of process orientation.

The role of quality managers in contemporary organisations

A key question for firms nowadays is how to organise work with quality management. This naturally includes the role of the quality managers and it appears as if the profession of quality managers is at a crossroads. Alternatives are that the role of a quality manager broadens to include quality at a strategic level in the firm and that Six Sigma specialists and Lean Production managers drive the development of quality management in the future. In this paper, we present the results from a survey of 212 quality managers in Swedish organisations. The purpose is to contribute to an understanding of how the management of quality is designed and practised in contemporary organisations. This study shows that a quality managers operational responsibility is quite narrowly defined. The agenda of the quality manager is mainly related to quality standards, such as ISO 9000 and environmental management systems. These programmes frame the work of the quality manager, which in many cases leaves other programmes, such as Six Sigma and Lean Production, to other departments or parallel improvement structures.

An Emerging Science of Improvement in Health Care

ABSTRACT The purpose of this article is to describe the emerging science of improvement in health care and to add a perspective from the industrial quality improvement movement, the use of data from quality registers, and to give some personal reflections and suggestions. Furthermore, we want to introduce to the broader quality management community what is happening in health care with respect to quality improvement. We will discuss some of the challenges of the health care system and the current status of a science of improvement and give some suggestions for further improvements to the area. We discuss a possible extension of improvement knowledge and the theoretical and practical arsenal of a science of improvement, in particular, understanding variation and implications for the use of, for, example control charts. In addition, the normative side of a science of improvement is discussed. The article ends with some brief reflections of use for future research agendas.

Adopting a management innovation in a professional organization: The case of improvement knowledge in healthcare

The purpose of this paper is to study critical practices when adopting improvement knowledge as a management innovation in a professional organization. Design/methodology/approach This article is based on an action research approach, in which practitioners and researchers are seen as a part of a participative community generating actionable knowledge. Research involved gathering data over a five-year period through more than 250 interviews and 25 focus groups. Findings This paper identifies five critical practices for adopting a management innovation in a professional context: (1) focusing on labeling and theorizing to create an organization’s own vocabulary; (2) focusing on the role of internal change agents; (3) allowing for an evolutionary adoption process; (4) building new professional competence through the change agents; (5) and adopting a research-driven approach to the adoption of a management innovation. Practical implications For healthcare practitioners, this paper points to practices to consider when adopting improvement knowledge – for example, identifying the patient as the guiding principle and encouraging involvement and local change initiatives. For practitioners in other professionally driven organizations, this paper identifies critical practices for adopting a management innovation – for example, focusing on theorizing and labeling in order to create an organization’s own vocabulary related to the professional context. Originality/value On a generic level, this paper contributes to the understanding of critical aspects when adopting management innovations in a professional organization. In a healthcare context, this paper points to the value of improvement knowledge for improving quality of care. Improvement knowledge is relatively new in healthcare, and this study provides an example of a hospital in which this management innovation helped transform the organization.

Adopting Process Management – the Importance of Recognizing the Organizational Transformation

The purpose of this study is to investigate what happens within an organization when a process view of the business is adopted. With the example of an empirical case, we aim to illustrate: how members of the organization make sense of process management; what contributions members of the organization consider to be the result of adopting a process view; and the relationship between the functional and the process structure. The empirical base in this study is one of Sweden’s largest purchasing organizations within the public sector. The results are drawn from interviews with the process owners and a survey to all members involved in process teams. The case findings reveal an ambiguous image of process management. At the same time as process management solved specific organizational problems, it generated new dilemmas. It is argued that it is more rewarding to consider the adoption of the process view a “social negotiation” rather than the result of planned implementation. The study also highlights that the meaning of process management is not anything given but something being created, and its negotiation and translation into organizational practice is open‐ended. Furthermore, the study givs an illustration of the conflict between the adopted process view and the existing functional organization.

Process Management as a Contagious Idea: A Contribution to Røvik's Virus-Inspired Theory

‘Travelling ideas’ denotes the fact that virtually identical management ideas crop up more or less simultaneously in similar organizations. Røvik, who recently launched his ‘virus-inspired theory’ approach, seeks to pinpoint the possibility that the encounter between idea and practice may be lasting, ideas may affect practice, and leaders in organisations may play a more active role than the one often depicted in management fashion theory. This article is a contribution to his virus-inspired theory. It focuses on processes in their pragmatic form, as value-creating flows in organisations. We have studied Process Management (PM) as an idea, and how it has penetrated and flourished in the Swedish Customs Service. We argue that the empirical test in this article supports Røviks belief that a virus-inspired theory gives a richer picture than the fashion theory. Through our analysis we show that four of our six hypotheses, derived from the virus-inspired theory, are strengthened by the empirical story from the Customs Service.

A physician lead, and learning driven approach to regional development of 23 cancer pathways in Sweden

Abstract Purpose This chapter presents a framework for an action research based intervention to develop and transform sustainable healthcare in a regional context. The framework is illustrated by the case of the Regional Cancer Centre (RCC) West in western Sweden. Design/methodology/approach The framework draws upon and develops Pettigrew’s context–content–process model of strategic change and applies it to the unfolding narrative of the change effort. The empirical focus is the activities of a learning platform consisting of the RCC leadership, senior cancer physicians designated as process owners and an action research team. Data were collected from documents, observations of the learning platform, notes from meetings and interviews. Outcome data were obtained via the self-reporting of the physicians. Findings The learning platform established the capability for wide ranging development and quality improvement on the 23 cancer pathways as well as some support activities around principles of patient-centred care. A clear result is greater inter-organisational collaboration between care professionals as well as the introduction of new medicines, clinical methods, joint learning activities and new forms of measurement and monitoring of care practices. All of the improved measures are sustained. Originality/value Whilst there is no shortage of rhetoric on patient-centred care, the reality is that in complex healthcare systems solutions such as process-oriented approaches often fail. This case presents a model and an approach that eschews clear visions for change and instead places an emphasis on dialogue, participation, professional autonomy and collaborative communities as means for achieving the patient-centred ideal. The case also shows the value of seeing sustainable health systems as being grounded on practitioner–scholar collaboration that combines practical knowing with scientific knowledge.

Editorial: Why a special issue on healthcare action research?

Healthcare systems across the globe are facing environments characterized by major challenges (Dent, 2003; Mohrman, Shani, & McCracken, 2012). Although national and institutional contexts are complex and varied, a number of common challenges can nevertheless be discerned. Rising expectations of care by patients and politicians are prevalent in many countries (Mohrman & Shani, 2011; WHO, 2008). Moreover, tight budget constraints get ever tighter, particularly in national contexts where austerity measures are seen as necessary in the aftermath of the financial crisis of 2008. In many cases, increasing staff shortages in the health profession are impacting negatively on the quality of service delivery. At the same time, political and regulatory environments are becoming more challenging and higher treatment costs and longer life expectancies are increasing the burdens on care systems (WHO, 2013). Increasingly, healthcare providers are required to deliver ‘more with less’ – and this invariably means embarking on new developmental trajectories and grappling with organizational change. This is all the more so in developing countries (WHO, 2013). It is also argued that the development and transformation of healthcare systems must be sustainable entailing sub-systems that balance or equitably trade off social/ human, economic and ecological dimensions (Mohrman, Shani, & McCracken, 2012). In many cases, however, some of these sub-systems and the logics that underpin them dominate over the others. Yet even such a view on sustainability, based on the so-called triple bottom line, does not per se give a central prioritization to those at the heart of all health systems, namely patients. Thus, the imbalances inherent in many parts of the systems in various parts of the world need more attention if desired clinical outcomes are to be achieved in a way that delivers

System-Wide Change in Cancer Care: Exploring Sensemaking, Sensegiving and Consent

This article explores the symbolic aspects of change agency on a learning platform designed to facilitate system-wide transformation in cancer care. A sensemaking–sensegiving perspective is adopted to analyze the construction of meaning in interaction between the leader of a regional cancer center, senior physicians, and an action research team in relation to patient-centered care. The analysis suggests that the physicians, as change agents, made sense of the vision from three quite distinct discourses in relation to the development effort. We argue that although meanings reconstructed in development initiatives may well be far from shared, this by no means implies that they are dysfunctional.