Reuben R. McDaniel

Interpreting Strategic Issues: Effects of Strategy and the Information-Processing Structure of Top Management Teams

Understanding how managers interpret strategic issues is important to understanding strategic action, organizational change, and learning. However, little is known about how the context in which st...

Nursing homes as complex adaptive systems: Relationship between management practice and resident outcomes

BackgroundDespite numerous clinical and regulatory efforts, problems of poor quality of care in nursing homes continue, suggesting a need for effective management practices. ObjectiveTo test complexity hypotheses about the relationship between management practices (communication openness, decision making, relationship-oriented leadership, and formalization) and resident outcomes (aggressive behavior, restraint use, immobility of complications, and fractures), while controlling for case mix, size, ownership, and director’s tenure and experience. MethodA cross-sectional correlational field study design was used. Primary data were obtained from directors of nursing and registered nurses employed in 164 Texas nursing homes. Investigators administered self-report surveys onsite. Secondary data were obtained from 1995 Medicaid Cost Reports and the Texas nursing home Minimum Data Set (MDS) and were linked to primary data using a unique identifier. ResultsHypotheses were supported in that each management practice explained one or more of the resident outcomes. Larger size and longer director of nursing tenure and experience also explained better resident outcomes. Predictors explained 11% ñ 21% of the variance. DiscussionComplexity science was used to explain the results. The findings open the door to rethinking nursing home management practice. Practices that increase communication and interaction among people are needed for better resident outcomes.

A field of study of the effect of interpersonal trust on virtual collaborative relationship performance

This article examines the relationship between interpersonal trust and virtual collaborative relationship (VCR) performance. Findings from a study of 10 operational telemedicine projects in health care delivery systems are presented. The results presented here confirm, extend, and apparently contradict prior studies of interpersonal trust. Four types of interpersonal trust-calculative, competence, relational, and integrated are identified and operationalized as a single construct. We found support for an association between calculative, competence, and relational interpersonal trust and performance. Our finding of a positive association between integrated interpersonal trust and performance not only yields the strongest support for a relationship between trust and VCR performance but also contradicts prior research. Our findings indicate that the different types of trust are interrelated in that positive assessments of all three types of trust are necessary if VCRs are to have strongly positive performance. The study also established that if any one type of trust is negative, then it is very likely that VCR performance will not be positive. Our findings indicate that integrated types of interpersonal trust are interdependent, and the various patterns of interaction among them are such that they are mutually reinforcing. These interrelationships and interdependencies of the different types of interpersonal trust must be taken into account by researchers as they attempt to understand the impact of trust on virtual collaborative relationship performance.

Case Study Research: The View From Complexity Science

Many wonder why there has been so little change in care quality despite substantial quality improvement efforts. Questioning why current approaches are not making true changes draws attention to the organization as a source of answers. The authors bring together the case study method and complexity science to suggest new ways to study health care organizations. The case study provides a method for studying systems. Complexity theory suggests that keys to understanding the system are contained in patterns of relationships and interactions among the system’s agents. They propose some of the “objects” of study that are implicated by complexity theory and discuss how studying these using case methods might provide useful maps of the system. They offer complexity theory, partnered with case study method, as a place to begin the daunting task of studying a system as an integrated whole.

Managing health care organizations: where professionalism meets complexity science.

This article examines the intersection of professionalism and complexity science as a source of new insights for improving the health care industry from both a clinical and business point of view. Viewing health care organizations as professional complex adaptive systems suggests eight leadership tasks for addressing the circumstances that engulf health care. Managers who adopt this view will be able to create new levers for positive movement in their organizations.

Process, Content and Context: Synergistic Effects on Organizational Performance

The traditional distinction between strategy process and strategy content has perhaps limited the ability of strategic management research to explain the determinants of organizational performance. In addition, empirical attention needs to be paid to the role of the context within which strategy is formed. This study examined the extent to which synergies between process, content, and context explained the peformance of a geographic segment of the hospital industry. Results showed that (a) both process and content were significantly related to performance; (b) including process/content interactions significantly enhanced explanation of performance; and (c) context is an important moderator of these relationships. Implications are drawn for both research and practice.

Organizational responses to complexity: The effect on organizational performance

This paper uses a complex adaptive systems view to examine two different organizational responses to turbulent, complex environments. We examined the internal make‐up of eight organizations that saw their environment the same way – as rapidly changing, complex and requiring aggressive change strategies. Half of these organizations chose a complexity absorption response to environmental turbulence, and half chose a complexity reduction response to environmental turbulence and complexity. The organizations pursuing a complexity absorption response outperformed those organizations with complexity reduction responses.

How Improving Practice Relationships Among Clinicians and Nonclinicians Can Improve Quality in Primary Care

BACKGROUND Understanding the role of relationships health care organizations (HCOs) offers opportunities for shaping health care delivery. When quality is treated as a property arising from the relationships within HCOs, then different contributors of quality can be investigated and more effective strategies for improvement can be developed. METHODS Data were drawn from four large National Institutes of Health (NIH)-funded studies, and an iterative analytic strategy and a grounded theory approach were used to understand the characteristics of relationships within primary care practices. This multimethod approach amassed rich and comparable data sets in all four studies, which were all aimed at primary care practice improvement. The broad range of data included direct observation of practices during work activities and of patient-clinician interactions, in-depth interviews with physicians and other key staff members, surveys, structured checklists of office environments, and chart reviews. Analyses focused on characteristics of relationships in practices that exhibited a range of success in achieving practice improvement. Complex adaptive systems theory informed these analyses. FINDINGS Trust, mindfulness, heedfulness, respectful interaction, diversity, social/task relatedness, and rich/lean communication were identified as important in practice improvement. A model of practice relationships was developed to describe how these characteristics work together and interact with reflection, sensemaking, and learning to influence practice-level quality outcomes. DISCUSSION Although this model of practice relationships was developed from data collected in primary care practices, which differ from other HCOs in some important ways, the ideas that quality is emergent and that relationships influence quality of care are universally important for all HCOs and all medical specialties.

Strategic leadership: a view from quantum and chaos theories.

Viewing health care from the perspective of chaos and quantum theories offers new insights into management techniques for effective and efficient delivery of health care services. This article introduces these concepts and gives specific prescriptions for managerial action.

Surprise, surprise, surprise! A complexity science view of the unexpected

Surprise can emanate from two sources: lack of sufficient information or knowledge and the basic dynamics of complex adaptive systems. The authors expand the traditional view of surprise with a complexity perspective that makes it possible to ask new questions and to consider new ways of understanding the world around us. They discuss creativity and learning as two strategies for capitalizing on the surprises that confront organizations.