Kathryn J Hayes

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.

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.

Managing occupational boundaries to improve innovation outcomes in industry-research organisations

Commercialisation activities combining the discoveries of one occupational group, such as scientists, with the commercial skills of managers involve interactions across occupational and organisational cultures. This article explores the challenges posed by working across occupational and organisational boundaries, and describes management techniques developed informally in four Australian organisations to address barriers to knowledge transfer. It identifies the existence of Knowledge-stewarding Communities of Practice (CoP) that span organisational boundaries and impact commercialisation outcomes. It also presents recommendations for management practice based upon diversity management and innovation theories. The context of the study is Australian hybrid industry-research organisations composed of academic, government and industry personnel. Semi-structured interviews with a total of twenty scientists, engineers and managers focused on their experiences of knowledge sharing across organisational and occupational cultures, and methods used to manage these boundaries. The existence and efficacy of boundary-crossing individuals and boundary object strategies are explored. A generic process management model of innovation is extended to acknowledge and accommodate occupational and organisational cultural proclivities towards exploration or exploitation, and to stimulate future research.

Trialability, observability and risk reduction accelerating individual innovation adoption decisions

PURPOSE The purpose of this paper is to provide a retrospective analysis of computer simulations role in accelerating individual innovation adoption decisions. The process innovation examined is Lean Systems Thinking, and the organizational context is the imaging department of an Australian public hospital. DESIGN/METHODOLOGY/APPROACH Intrinsic case study methods including observation, interviews with radiology and emergency personnel about scheduling procedures, mapping patient appointment processes and document analysis were used over three years and then complemented with retrospective interviews with key hospital staff. The multiple data sources and methods were combined in a pragmatic and reflexive manner to explore an extreme case that provides potential to act as an instructive template for effective change. FINDINGS Computer simulation of process change ideas offered by staff to improve patient-flow accelerated the adoption of the process changes, largely because animated computer simulation permitted experimentation (trialability), provided observable predictions of change results (observability) and minimized perceived risk. RESEARCH LIMITATIONS/IMPLICATIONS The difficulty of making accurate comparisons between time periods in a health care setting is acknowledged. PRACTICAL IMPLICATIONS This work has implications for policy, practice and theory, particularly for inducing the rapid diffusion of process innovations to address challenges facing health service organizations and national health systems. Originality/value - The research demonstrates the value of animated computer simulation in presenting the need for change, identifying options, and predicting change outcomes and is the first work to indicate the importance of trialability, observability and risk reduction in individual adoption decisions in health services.

How best practices are copied, transferred, or translated between health care facilities: a conceptual framework

Introduction: In spite of significant investment in quality programs and activities, there is a persistent struggle to achieve quality outcomes and performance improvements within the constraints and support of sociopolitical parsimonies. Equally, such constraints have intensified the need to better understand the best practice methods for achieving quality improvements in health care organizations over time. This study proposes a conceptual framework to assist with strategies for the copying, transferring, and/or translation of best practice between different health care facilities. Purpose: Applying a deductive logic, the conceptual framework was developed by blending selected theoretical lenses drawn from the knowledge management and organizational learning literatures. Findings: The proposed framework highlighted that (a) major constraints need to be addressed to turn best practices into everyday practices and (b) double-loop learning is an adequate learning mode to copy and to transfer best practices and deuteron learning mode is a more suitable learning mode for translating best practice. We also found that, in complex organizations, copying, transferring, and translating new knowledge is more difficult than in smaller, less complex organizations. We also posit that knowledge translation cannot happen without transfer and copy, and transfer cannot happen without copy of best practices. Hence, an integration of all three learning processes is required for knowledge translation (copy best practice–transfer knowledge about best practice–translation of best practice into new context). In addition, the higher the level of complexity of the organization, the more best practice is tacit oriented and, in this case, the higher the level of K&L capabilities are required to successfully copy, transfer, and/or translate best practices between organizations. Practice Implications: The approach provides a framework for assessing organizational context and capabilities to guide copy/transfer/translation of best practices. A roadmap is provided to assist managers and practitioners to select appropriate learning modes for building success and positive systemic change.

Business and research forms of debate: argumentation and dissent as barriers to the commercialisation of innovations in hybrid industry-research organisations

Commercialisation activities combining the discoveries of one occupational group, such as scientists, with the commercial skills of managers involve interactions across occupational cultures. This article considers how dissent can be interpreted as a sign of dysfunction or cause for concern. The context of the study is Australian hybrid industry-research organisations composed of academic, government and industry personnel. Semi-structured interviews of a total of 20 scientists, engineers and managers focused on their experiences and perceptions of occupational culture, including styles of debate, and the potential of assumptions and norms to facilitate or obstruct commercialisation. 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 commercialisation.

Organisational change: communicating to Schein's operator, engineer and executive occupational subcultures

There has been substantial academic interest surrounding innovation, change management and the individual attributes that permit and promote learning, organisational change and innovative behaviour. This research uses a psychometric tool known as the Instinctive Drives System® to measure preferred working styles in 3943 employees from a range of international companies. These employees were then classified into three groups (engineers, operators and executives) following Scheins classification of occupational subcultures. This study reveals significant differences between the occupational subcultures, suggesting that executives are more inclined towards variety, flexibility and change rather than routine and structure. In contrast, operators and engineers demonstrated preferences for logic and certainty. These results have a range of implications, for researchers and practitioners. Researchers can extend the results of this study, and further explore the differences found between executives and managers from different subcultures. Practitioners may use the results to initiate change to integrate preferred working styles.

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

Patient-journey modelling and simulation in computed tomography: An integrated framework

Purpose – The purpose of this paper is to present a business process reengineering (BPR) framework of process and data integration with patient journey as the basis for process evaluation and the improvement of patient-flow. Design/methodology/approach – A BPR framework is developed using a mixed-method research design, which incorporated a case study to demonstrate a healthcare scenario with associated processes and data elements, using process models based on event-driven process chain methodology as well as patient and data models, based on unitary structuring technique. The framework includes key processes including patient booking and rebooking, and associated inputs, outputs, and control parameters. In this case, the framework is demonstrated through application to computed tomography (CT) services in a hospital to improve patient-flow, with numerical simulation of CT data collected over time. Findings – The framework supports flexible patient scheduling and the associated planning of healthcare ope...

Brilliant health service management: challenging perceptions and changing HR practices in health services

To redress the scholarly preoccupation with problems, there is a need to focus on practices that exceed expectation. This study is the first to explicate healthcare professionals’ perceptions of brilliance within their health service. Via online discussions, 78 postgraduate health management students from an Australian university shared their experiences with, and perceptions of brilliant health services in their organisation. Researchers thematically analysed the text and workshopped the findings to extend current understandings of human resource management using positive organisational scholarship in health‐care (POSH). Preliminary codes organised well into six key themes – teamwork, leadership, innovation, exceptional individuals, empowerment and patient‐centred care. Although the results reflect health service management research, POSH helped to clarify those aspects of people management that are associated with brilliant health services. These include developing interagency networks; adopting an understanding of innovation; and recognising the extraordinary in the seemingly ordinary.