Anneke Fitzgerald

Impediments to improvements in service quality in luxury hotels

Purpose – The purpose of this article is to identify the key factors that impede service quality delivery in the context of luxury hotels (four‐ and five‐star properties) in Sydney, Australia.Design/methodology/approach – The empirical dataset for this qualitative study was collected through 22 individual semi‐structured interviews with senior hotel managers of ten luxury hotels in Sydney, Australia. The technique used for analysing the data was progressive comparative analysis, after which constant comparative methodology was applied. The key themes emerging from these techniques have been categorised to form conclusions.Findings – Analysis of the data revealed a number of impediments to developing and maintaining distinguishable, superior service. These impediments fell into four broad areas: Budget constraints, Staff attitude, Lack of mentoring and High customer expectations.Research limitations/implications – The limitations with the current study are primarily related to the scope of the research in ...

Innovative health care delivery teams: learning to be a team player is as important as learning other specialised skills.

PURPOSE The purpose of the paper is to show that free flowing teamwork depends on at least three aspects of team life: functional diversity, social cohesion and superordinate identity. DESIGN/METHODOLOGY/APPROACH The paper takes the approach of a discussion, arguing for a strong need to understand multidisciplinary and cross-functional barriers for achieving team goals in the context of health care. These barriers include a strong medically dominated business model, historically anchored delineations between professional identities and a complex organisational environment where individuals may have conflicting goals. FINDINGS The paper finds that the complexity is exacerbated by the differences between and within health care teams. It illustrates the differences by presenting the case of an operating theatre team. RESEARCH LIMITATIONS/IMPLICATIONS Whilst the paper recommends some ideas for acquiring these skills, further research is needed to assess effectiveness and influence of team skills training on optimising multidisciplinary interdependence in the health care environment. ORIGINALITY/VALUE The paper shows that becoming a team member requires team membership skills.

Lean in healthcare – history and recent developments

Purpose – This editorial briefly outlines present applications of lean systems applications in healthcare and then summarises the contributions to this special edition. Design/methodology/approach – A brief background to lean is introduced to provide the context for the subsequent papers in this special issue Findings – The requirements for successful introduction of Lean Systems Thinking (LST) to healthcare organizations share much in common with the requirements for the initial introduction of lean to manufacturing organizations. However, introducing LST in healthcare is further complicated by the necessity of navigating complex social and organisational structures associated with the professional identities of healthcare practitioners. Originality/value – Though there has been a recent increase in the reported research on LST in healthcare, these reports have focused on the gains achieved through the application of lean tools and techniques. This work explores the under-reported socio-technical aspects that greatly affect the success of lean interventions.

Elaborated Integration of Qualitative and Quantitative Perspectives in Mixed Methods Research: A Profound Enquiry into the Nursing Practice Environment

Abstract Integration of quantitative and qualitative components in mixed methods research deserves more discussion in the literature, as it is critical for quality research outcomes. This paper describes an elaborated integration of these two components in the context of an empirical research study about nursing practice environments (NPE). Different types of integration such as combining notions at research conceptualisation stage, mixing data collection methods and synthesising findings, are described to show how qualitative and quantitative components can work interdependently to reveal ‘what’ and ‘how’ components of the research phenomenon. For example, through application of elaborated integration, it was revealed that ‘concern for cost’ is a defining organisational characteristic of the current NPE. Additionally, we learnt about the ‘how’ component with the revelation of nurses’ belief that nurse administrators are acting with the intention of saving costs rather than enhancing quality of care. Therefore, this paper provides an empirical case of how to conduct integration of different components of mixed methods research with a great deal of depth, rationality and inquisitiveness.

Finding brilliance using positive organizational scholarship in healthcare.

PURPOSE Positive organizational scholarship in healthcare (POSH) suggests that, to promote widespread improvement within health services, focusing on the good, the excellent, and the brilliant is as important as conventional approaches that focus on the negative, the problems, and the failures. POSH offers different opportunities to learn from and build resilient cultures of safety, innovation, and change. It is not separate from tried and tested approaches to health service improvement--but rather, it approaches this improvement differently. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH POSH, appreciative inquiry (AI) and reflective practice were used to inform an exploratory investigation of what is good, excellent, or brilliant health service management. FINDINGS The researchers identified new characteristics of good healthcare and what it might take to have brilliant health service management, elucidated and refined POSH, and identified research opportunities that hold potential value for consumers, practitioners, and policymakers. RESEARCH LIMITATIONS/IMPLICATIONS The secondary data used in this study offered limited contextual information. PRACTICAL IMPLICATIONS This approach is a platform from which to: identify, investigate, and learn about brilliant health service management; and inform theory and practice. SOCIAL IMPLICATIONS POSH can help to reveal what consumers and practitioners value about health services and how they prefer to engage with these services. ORIGINALITY/VALUE Using POSH, this paper examines what consumers and practitioners value about health services; it also illustrates how brilliance can be theorized into health service management research and practice.

Health LEADS Australia and implications for medical leadership

Purpose – The purpose of this paper is to call for strong medical co-leadership in transforming the Australian health system. The paper discusses how Health LEADS Australia, the Australian health leadership framework, offers an opportunity to engage medical clinicians and doctors in the leadership of health services. Design/methodology/approach – The paper first discusses the nature of medical leadership and its associated challenges. The paper argues that medical leaders have a key role in the design, implementation and evaluation of healthcare reforms, and in translating these reforms for their colleagues. Second, this paper describes the origins and nature of Health LEADS Australia. Third, this paper discusses the importance of the goal of Health LEADS Australia and suggests the evidence-base underpinning the five foci in shaping medical leadership education and professional development. This paper concludes with suggestions on how Health LEADS Australia might be evaluated. Findings – For the well-bein...

Making Intergenerational Care a Possibility in Australia: A Review of the Australian Legislation

ABSTRACT In the Australian context, the out-of-home care of children and respite service for older adults are segregated. Yet internationally there has been a shift toward intergenerational programs that purposefully bring together younger and older people for mutual benefits. This paper examines the enablers of, supports for, and constraints of introducing intergenerational care programs (IGC) within the Australian legislation and regulations of child-care and aged-care programs. In doing so, program design features, workforce strategies, and built environment are considered. The literature indicates that the meshing of standards into IGC programs provides an opportunity to make intergenerational care an attractive model for respite to caregivers and recipients of care, while providing intergenerational contact for younger families. Such a program is likely to be cost effective with economies-of-scale workforce efficiencies. Future research will involve a needs assessment of potential consumers to explore the possible demand for intergenerational care programs within Australia before conducting a trial of different intergenerational care programs.

Business and Scientific Forms of Argumentation in Commercialization: Dictators and Chinwaggers

Commercialisation activities combining the discoveries of one occupational group, such as scientists, with the commercial skills of engineers and managers involve interactions across occupational cultures. This paper considers how dissent can be interpreted as a sign of dysfunction or cause for concern. The context of the study is Australian hybrid research organisations comprised of academic, government and industry personnel. Semi-structured interviews of a total of twenty scientists, engineers and managers focussed on their experiences and perceptions of occupational norms, including styles of debate, and the potential of these norms to facilitate or obstruct commercialization. Distinctive patterns of argumentation were identified as typical of commercial and research occupations. In addition, the interviewees confirmed that occupational forms of argumentation could influence the outcomes of commercialization

Developing an evaluation framework for clinical redesign programs : lessons learnt

Purpose The purpose of this paper is to present lessons learnt through the development of an evaluation framework for a clinical redesign programme - the aim of which was to improve the patient journey through improved discharge practices within an Australian public hospital. Design/methodology/approach The development of the evaluation framework involved three stages - namely, the analysis of secondary data relating to the discharge planning pathway; the analysis of primary data including field-notes and interview transcripts on hospital processes; and the triangulation of these data sets to devise the framework. The evaluation framework ensured that resource use, process management, patient satisfaction, and staff well-being and productivity were each connected with measures, targets, and the aim of clinical redesign programme. Findings The application of business process management and a balanced scorecard enabled a different way of framing the evaluation, ensuring measurable outcomes were connected to inputs and outputs. Lessons learnt include: first, the importance of mixed-methods research to devise the framework and evaluate the redesigned processes; second, the need for appropriate tools and resources to adequately capture change across the different domains of the redesign programme; and third, the value of developing and applying an evaluative framework progressively. Research limitations/implications The evaluation framework is limited by its retrospective application to a clinical process redesign programme. Originality/value This research supports benchmarking with national and international practices in relation to best practice healthcare redesign processes. Additionally, it provides a theoretical contribution on evaluating health services improvement and redesign initiatives.

Hospital employees’ perceptions of fairness and job satisfaction at a time of transformational change

Objective This study examines the relationships between job satisfaction and organisational justice during a time of transformational change. Methods Data collection occurred immediately before a major regional hospitals move to a greenfield site. Existing measures of job satisfaction and organisational justice were used. Data were analysed (n=316) using descriptive, correlation and regression methods together with interactions between predictor variables. Results Correlation coefficients for satisfaction and organisational justice variables were high and significant at the P<0.001 level. Results of a robust regression model (adjusted R(2)=0.568) showed all three components of organisational justice contributed significantly to employee job satisfaction. Interactions between the predictor variables showed that job satisfaction increased as the interactions between the predictor variables increased. Conclusions The finding that even at a time of transformational change staff perceptions of fair treatment will in the main result in high job satisfaction extends the literature in this area. In addition, it was found that increasing rewards for staff who perceive low levels of organisational justice does not increase satisfaction as much as for staff who perceive high levels of fairness. If people feel negative about their role, but feel they are well paid, they probably still have negative feelings overall. What is known about the topic? Despite much research highlighting the importance of job satisfaction and organisational justice in healthcare, no research has examined the influence of transformational change, such as a healthcare organisational relocation, on these factors. What does this paper add? The research adds to academic literature relating to job satisfaction and organisational justice. It highlights the importance of organisational justice in influencing the job satisfaction of staff. What are the implications for practitioners? Financial rewards do not necessarily motivate staff but low rewards do demotivate. Shortages of health professionals are often linked to a lack of job satisfaction, and recruitment and retention strategies are often based on salary.