Kathy Eljiz

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.

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.

It Takes Two to Tango: Customization and Standardization as Colluding Logics in Healthcare; Comment on “(Re) Making the Procrustean Bed Standardization and Customization as Competing Logics in Healthcare”

The healthcare context is characterized with new developments, technologies, ideas and expectations that are continually reshaping the frontline of care delivery. Mannion and Exworthy identify two key factors driving this complexity, ‘standardization’ and ‘customization,’ and their apparent resulting paradox to be negotiated by healthcare professionals, managers and policy makers. However, while they present a compelling argument an alternative viewpoint exists. An analysis is presented that shows instead of being ‘competing’ logics in healthcare, standardization and customization are long standing ‘colluding’ logics. Mannion and Exworthy’s call for further sustained work to understand this complex, contested space is endorsed, noting that it is critical to inform future debates and service decisions.

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.

Patient journey modelling: using students as a vehicle for the diffusion of innovation.

This paper describes a case study involving third-year undergraduate computing students and their conduct of a patient journey modeling project for the Ambulatory Care department of a Regional Hospital in New South Wales, Australia. The goal of the research was to determine if students, given minimal training in an emerging patient journey modeling tool known as Essomenic, could be an effective vehicle for the diffusion of innovation to operational staff involved in a healthcare improvement project. Under academic supervision, students interacted directly with staff to develop models of the current system of care from GP referral to the completion of the patient consultation. The methodology also included model validation, identification of opportunities for improvement, investigation of alternative solutions and solution recommendations. Outcomes of the project, conducted over a 14 week semester, demonstrate that the students found the technique quick and easy to learn and that they could transfer their new found knowledge of this innovation to healthcare staff for the purposes of developing true and accurate representations of the current state patient journey. Staff were then able to interact directly with the student team, using the models as a communication medium, to identify opportunities for improvement and understand more deeply, how changes would impact their daily tasks and increase patient satisfaction in service delivery.

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.