Peter Tsasis

Organizational change through Lean Thinking

In production and manufacturing plants, Lean Thinking has been used to improve processes by eliminating waste and thus enhancing efficiency. In health care, Lean Thinking has emerged as a comprehensive approach towards improving processes embedded in the diagnostic, treatment and care activities of health-care organizations with cost containment results. This paper provides a case study example where Lean Thinking is not only used to improve efficiency and cost containment, but also as an approach to effective organizational change.

Management of complex chronic disease: facing the challenges in the Canadian health-care system

This paper discusses the challenges that those living with complex chronic disease present to the Canadian health-care system. The literature suggests home care and the management of complex chronic disease can together ease many of the present and future pressures facing the health-care system in dealing with this new health-care phenomenon. A review of current literature and dialogue with key informants reveals that the current level of investment and the present policy environment are not sustainable to support the health-care system. In this paper, changes to policy and resource allocation to the home care sector are suggested to help manage complex chronic disease and thus improve the effectiveness of the Canadian health-care system. A case is made for a reorganization and increased commitment to the home care sector for a more efficient and patient-centred health-care delivery system.

Outcome mapping for health system integration

Health systems around the world are implementing integrated care strategies to improve quality, reduce or maintain costs, and improve the patient experience. Yet few practical tools exist to aid leaders and managers in building the prerequisites to integrated care, namely a shared vision, clear roles and responsibilities, and a common understanding of how the vision will be realized. Outcome mapping may facilitate stakeholder alignment on the vision, roles, and processes of integrated care delivery via participative and focused dialogue among diverse stakeholders on desired outcomes and enabling actions. In this paper, we describe an outcome-mapping exercise we conducted at a Local Health Integration Network in Ontario, Canada, using consensus development conferences. Our preliminary findings suggest that outcome mapping may help stakeholders make sense of a complex system and foster collaborative capital, a resource that can support information sharing, trust, and coordinated change toward integration across organizational and professional boundaries. Drawing from the theoretical perspectives of complex adaptive systems and collaborative capital, we also outline recommendations for future outcome-mapping exercises. In particular, we emphasize the potential for outcome mapping to be used as a tool not only for identifying and linking strategic outcomes and actions, but also for studying the boundaries, gaps, and ties that characterize social networks across the continuum of care.

Chronic disease management and the home-care alternative in Ontario, Canada.

The pressure on our health-care system to deliver efficient, quality and cost-effective care is increasing. The debate on its sustainability is also expanding. These challenges can be managed with revisions to our health-care policy frameworks governing how and what public health-care services are delivered. Chronic disease management and home care can together ease many of the present and future pressures facing the health-care system. However, the current level of investment and the present policy are not effectively supporting movement in this direction. Updating the Canada Health Act to reflect the realities of our health-care system, and developing policies to support the areas of interdisciplinary teamwork and system integration are needed to facilitate chronic disease management and home care in Canada. This article lays out the challenges, highlights the impending issues and suggests a framework for moving forward.

Conceptualizing type 2 diabetes and its management.

Type 2 diabetes is growing worldwide due to population growth, increased rates of obesity, unhealthy diet, and physical inactivity. Risk assessment methods can effectively evaluate the risk of diabetes, and a healthy lifestyle can significantly reduce risk or prevent complications of type 2 diabetes. However, risk assessment alone has not significantly improved poor adherence to recommended medical interventions and lifestyle changes. This paper focuses on the challenge of nonadherence and posits that improving adherence requires tailoring interventions that explicitly consider the social determinants of health.

Using the balanced scorecard in the development of community partnerships.

The benefits of community partnerships have been well established in the health service literature. However, measuring these benefits and associated outcomes is relatively new. This paper presents an innovative initiative in the application of a balanced scorecard framework for measuring and monitoring partnership activity at the community level, while adopting principles of evidence-based practice to the partnership process. In addition, it serves as an excellent example of how organizations can apply scorecard methodology to move away from relationship-based partnerships and into new collaborations of which they can select – using a formal skill and competency assessment for partnership success.

Using the balanced scorecard to mobilize human resources in organizational transformation

Traditionally, the balanced scorecard (BSC) has been an effective tool in linking measurement to strategy. However, what is least understood is how the BSC can be used to redefine organizational relationships, re-engineer fundamental processes and transform organizational culture, for superior performance in an organization with the same people, services and technology that previously delivered dismal performance. This paper highlights the process and uses York Central Hospital in Toronto, Ontario, Canada as an illustrative example.

Trial and error, together: divergent thinking and collective learning in the implementation of integrated care networks

Hybrid networks that link disparate professionals and organizations are a common approach to deliver integrated care to patients. Recent literature argues that successful implementation of these networks demands a socio-cognitive perspective in which stakeholder mental frames and thought processes are prioritized, investigated, and compared. The aims of this article are to identify where mindsets diverge among clinical and managerial stakeholders involved in the implementation of integrated care networks known as ‘Health Links’ (HLs) in Ontario, Canada, and to describe strategies to support stakeholders’ capacity to collectively learn and develop more convergent views. Drawing from shared mental model theory and practice-based learning theory, a secondary analysis was conducted of interview data with 55 healthcare professionals and managers involved in the implementation of HLs. We identified examples of divergences in stakeholders’ conceptualization of the HL design and approach (‘strategy mental model’) and their perceptions of each other and how they work together (‘relationship mental model’). We also identified four strategies that facilitate learning and possibly mental model convergence. The results of the study may help guide stakeholder dialogue towards collective learning and coordinated action for integrated care delivery. Points for practitioners The findings suggest that in the implementation of large-scale change involving multiple stakeholder groups, there are predictable areas where divergent views are likely to occur and may have a negative impact on coordinated action. An awareness of these potential divergences can guide practitioners to examine them explicitly and regularly, and to proactively develop strategies to support practice-based learning and the development of a convergent perspective.

Afterword: Moving Forward in Healthcare Systems in the Twenty-First Century

In this section, we discuss salient implications of health systems complexity thinking and theoretical/methodological approaches to guide future research. With an emphasis on multidisciplinarity as a way forward, we single out some ideas for further development outside the limitations of disciplinarity thinking.

Working Together in a Complex Environment: Collaborative Behaviors and Social Capital

We investigate collaboration in a unique context: nongovernmental organizations (NGOs) working together to address a “wicked social problem” in a super-stressed environment. We interviewed NGO leaders involved in HIV/AIDS collaborative initiatives in South Africa. Seven collaborative behaviors were identified. The overarching theme was the influence of interpersonal and interprofessional ties (social capital) on the nature and tone of interorganizational relations. Our findings suggest that collaborative work in this context may differ in three key ways: (1) the timing of stages in the partnership life cycle, (2) the importance and type of trust needed for success, and (3) the interplay between social and collaborative capital.