Conflict across organizational boundaries: managed care organizations versus health care providers

Distributed leadership in healthcare: leadership dyads and the promise of improved hospital outcomes

PURPOSE

This paper aims to extend the consideration of distributed leadership in health-care settings. Leadership is typically studied from the classical notion of the place of single leaders and continues to examine distributed leadership within small teams or horizontally. The purpose is to develop a practical understanding of how distributed leadership may occur vertically, between different layers of the health-care leadership hierarchy, examining its influence on health-care outcomes across two hospitals.

DESIGN/METHODOLOGY/APPROACH

Using semi-structured interviews, data were collected from 107 hospital employees (including executive leadership, clinical management and clinicians) from two hospitals in Australia and the USA. Using thematic content analysis, an iterative process was adopted characterized by alternating between social identity and distributed leadership literature and empirical themes to answer the question of how the practice of distributed leadership influences performance outcomes in hospitals?

FINDINGS

The perceived social identities of leadership groups shaped communication and performance both positively and negatively. In one hospital a moderating structure emerged as a leadership dyad, where leadership was distributed vertically between hospital hierarchal layers, observed to overcome communication limitations. Findings suggest dyad creation is an effective mechanism to overcome hospital hierarchy-based communication issues and ameliorate health-care outcomes.

ORIGINALITY/VALUE

The study demonstrates how current leadership development practices that focus on leadership relational and social competencies can benefit from a structural approach to include leadership dyads that can foster these same competencies. This approach could help develop future hospital leaders and in doing so, improve hospital outcomes.

Functional Leadership in Interteam Contexts: Understanding 'What' in the Context of Why? Where? When? and Who?

Research on team leadership has primarily focused on leadership processes targeted within teams, in support of team objectives. Yet, teams are open systems that interact with other teams to achieve proximal as well as distal goals. This review clarifies that defining 'what' constitutes functionally effective leadership in interteam contexts requires greater precision with regard to where (within teams, across teams) and why (team goals, system goals) leadership processes are enacted, as well as greater consideration of when and among whom leadership processes arise. We begin by synthesizing findings from empirical studies published over the past 30 years that shed light on questions of what, where, why, when, and who related to interteam leadership and end by providing three overarching recommendations for how research should proceed in order to provide a more comprehensive picture of leadership in interteam contexts.

The Influence of Justice Perceptions and Affective States on Project Managers’ Responses to Client Opportunism

The contribution of psychological factors in project relationships has received limited attention. Taking the standpoint of vendor project managers, we examine their justice perceptions, affect, and consequent behavior in response to client opportunism. Data collected from 182 respondents from the information technology industry reveal that vendor project managers perceive reduced distributive and interpersonal justice, and experience lower positive and higher negative affective states, resulting in more venting and disengagement and less constructive discussion and passive acceptance. Findings suggest that psychological factors can bring about detrimental behavior in client–vendor relationships. This has long-term implications for project relationships where client opportunism occurs.

What are the perceived added values and barriers of regulating long-term care in the home environment using a care network perspective: a qualitative study

BACKGROUND

Changes in Dutch policy towards long-term care led to the Dutch Health and Youth Care Inspectorate testing a regulatory framework focusing on care networks around older adults living independently. This regulatory activity involved all care providers and the older adults themselves.

METHODS

Semi-structured interviews with the older adults, and focus groups with care providers and inspectors were used to assess the perceived added value of, and barriers to the framework.

RESULTS

The positive elements of this framework were the involvement of the older adults in the regulatory activity, the focus of the framework on care networks and the open character of the conversations with the inspectors. However, applying the framework requires a substantial investment of time. Care providers often did not perceive themselves as being part of a care network around one person and they expressed concerns about financial and privacy issues when thinking in terms of care networks.

CONCLUSIONS

The experiences of the client were seen as important in regulating long-term care. Regulating care networks as a whole puts cooperation between care providers involved around one person on the agenda. However, barriers for this form of regulation were also perceived and, therefore, careful consideration when and how to regulate care networks is recommended.

A new scale to measure cross-organizational cultural intelligence

Purpose

Cross-organizational cultural intelligence (COCI) is conceptualized as an ability of individuals to interact effectively with persons from different organizational cultures. To deal with culture differences in cross-organizational context, organizations need to select employees with high COCI. This study aims to develop an instrument to measure employees’ COCI in a cross-organizational context.

Design/methodology/approach

The present study was conducted in three steps to develop a scale to measure COCI. First, 39 statements were identified based on a series of interviews. Then, via a survey of 275 part-time MBA students, 18 statements were categorized into four dimensions, namely, cognition, motivation, collaborative communication and behavioral adaptability. Finally, convergent, discriminant, predictive and incremental validity of the scale were tested.

Findings

This study extends the cultural intelligence to the cross-organizational context. The COCI concept provides theoretical support for cultural intelligence research in the cross-organizational context. Therefore, the present study broadens the research field of cultural intelligence. A four-dimensional scale was developed to measure COCI, which includes cognition, motivation, collaborative communication and behavioral adaptability. High COCI can enhance employee’s performance in a cross-organizational context.

Research limitations/implications

This study still has several limitations. First, the self-report questionnaire indicated that the relationship between COCI and other constructs may be stronger because of single-source, self-reported data collection. Second, the new scale was developed in China. Although some respondents came from foreign companies, most surveyed employees belonged to Chinese enterprises. Based on the current results, COCI scale exhibits promise as a measurable criterion, but it requires more refinement and validation. Additional work in this area can explore factors that can influence or improve individual COCI. A theoretical network of COCI that includes predictors, consequences, mediators and moderators by theoretical research can be established.

Practical implications

The COCI scale can be used in organizational management. Also, the COCI scale can help organizations understand the meanings of the employees’ COCI and select employees with high COCI during the recruitment. It makes managers easier to choose qualified candidates for inter-organizational projects. Beyond that, organizations can develop employees’ COCI according to the proposed four dimensions.

Originality/value

The development of the valid COCI scale will facilitate future research on boundary spanning. The COCI scale can measure individual cultural intelligence in a cross-organizational context. The present study has verified that COCI is different from emotional intelligence and provided a new perspective to explore the importance of individual ability in boundary-spanning activities. The instrumental support can help researchers effectively understand COCI and explore its potentials in boundary-spanning activities.

The emotional labour of boundary spanning

Purpose

Within public services there is a widely recognised role for workers who operate across organisational and professional boundaries. Much of this literature focusses on the organisational implications rather than on how boundary spanners engage with citizens. An increased number of public service roles require boundary spanning to support citizens with cross-cutting issues. The purpose of this paper is to explicate the emotional labour within the interactions that boundary spanners have with citizens, requiring adherence to display rules and building trust.

Design/methodology/approach

This is a conceptual paper which draws on illustrative examples to draw out the emotional labour within two types of boundary spanning: explicit and emergent.

Findings

Emotional labour theory offers a way to classify these interactions as requiring high, medium or low degrees of emotional labour. Boundary spanning theory contributes an understanding of how emotional labour is likely to be differently experienced depending on whether the boundary spanning is an explicit part of the job, or an emergent property.

Originality/value

Drawing on examples from public service work in a range of advanced democracies, the authors make a theoretical argument, suggesting that a more complete view of boundary spanning must account for individual-level affect and demands upon workers. Such a focus captures the "how" of the boundary spanning public encounter, and not just the institutional, political and organisational dimensions examined in most boundary spanning literatures.

From boundaries to boundary work: middle managers creating inter-organizational change

Purpose

In healthcare, organizational boundaries are often viewed as barriers to change. The purpose of this paper is to show how middle managers create inter-organizational change by doing boundary work: the dual act of redrawing boundaries and coordinating work in new ways.

Design/methodology/approach

Theoretically, the paper draws on the concept of boundary work from Science and Technology Studies. Empirically, the paper is based on an ethnographic investigation of middle managers that participate in a Dutch reform program across health, social care, and housing.

Findings

The findings show how middle managers create a sense of urgency for inter-organizational change by emphasizing “fragmented” service provision due to professional, sectoral, financial, and geographical boundaries. Rather than eradicating these boundaries, middle managers change the status quo gradually by redrawing composite boundaries. They use boundary objects and a boundary-transcending vocabulary emphasizing the need for societal gains that go beyond production targets of individual organizations. As a result, work is coordinated in new ways in neighborhood teams and professional expertise is being reconfigured.

Research limitations/implications

Since boundary workers create incremental change, it is necessary to follow their work for a longer period to assess whether boundary work contributes to paradigm change.

Practical implications

Organizations should pay attention to conditions for boundary work, such as legitimacy of boundary workers and the availability of boundary spaces that function as communities of practice.

Originality/value

By shifting the focus from boundaries to boundary work, this paper gives valuable insights into “how” boundaries are redrawn and embodied in objects and language.

Networking with boundary spanners

Purpose

The purpose of this paper is to explore a potential mechanism through which gender segregation in the engineering profession is created and sustained. Specifically, boundary spanners for women and men were examined because they may be a source of valuable information to job seekers.

Design/methodology/approach

Applicant data for the role of a senior technical engineer (n=100) from an engineering organisation in the UK were analyzed.

Findings

A logistic regression analysis showed that women applicants were significantly less likely than men to be offered a job as a senior engineer. A mediation analysis revealed that women did not use networking with boundary spanners as a primary job search tool, providing a partial explanation for why women are less likely to be hired in senior engineering roles.

Originality/value

This study uses a dataset collected in 2009 to widen the investigative lens of processes that influence hiring outcomes for women in a male‐stereotyped job, namely, engineering.

Organizational and clinical implications of integrating an alcohol screening and brief intervention within non-substance abuse serving agencies

Although there have been efforts to advance evidenced-based practices into community-based organizations the limited successes of dissemination and poor implementation of efficacious treatments within these organizations are beginning to be documented. This article builds on the knowledge gained from organizational research and those internal structures (e.g., culture and climate), which possibly impede or enhance evidenced-based practice implementation within community-based organizations. While there are many evidenced-based practices available to human services organizations, there seems to be a gap between research and the implementation of these clinical practices. Recommendations are provided to better enable community-based organizations to integrate evidenced-based practice into its existing service structures.

The effects of the ARC organizational intervention on caseworker turnover, climate, and culture in children's service systems

OBJECTIVE

This study examines the effects of the Availability, Responsiveness, and Continuity (ARC) organizational intervention strategy on caseworker turnover, climate, and culture in a child welfare and juvenile justice system.

METHOD

Using a pre-post, randomized blocks, true experimental design, 10 urban and 16 rural case management teams were randomly assigned to either the ARC organizational intervention condition or to a control condition. The culture and climate of each case management team were assessed at baseline and again after the one-year organizational intervention was completed. In addition, caseworker turnover was assessed by identifying caseworkers on the sampled teams who quit their jobs during the year.

RESULTS

Hierarchical Linear Models (HLM) analyses indicate that the ARC organizational intervention reduced the probability of caseworker turnover by two-thirds and improved organizational climate by reducing role conflict, role overload, emotional exhaustion, and depersonalization in both urban and rural case management teams.

CONCLUSIONS

Organizational intervention strategies can be used to reduce staff turnover and improve organizational climates in urban and rural child welfare and juvenile justice systems. This is important because child welfare and juvenile justice systems in the U.S.A. are plagued by high turnover rates, and there is evidence that high staff turnover and poor organizational climates negatively affect service quality and outcomes in these systems.

The ARC organizational and community intervention strategy for implementing evidence-based children's mental health treatments

This paper reviews the implications of organizational and community intervention research for the implementation of effective mental health treatments in usual community practice settings. The paper describes an organizational and community intervention model named ARC for Availability, Responsiveness and Continuity, that was designed to support the improvement of social and mental health services for children. The ARC model incorporates intervention components from organizational development, interorganizational domain development, the diffusion of innovation, and technology transfer that target social, strategic, and technological factors in effective children's services. This paper also describes a current NIMH-funded study that is using the ARC intervention model to support the implementation of an evidence-based treatment, Multisystemic Therapy (MST), for delinquent youth in extremely rural, impoverished communities in the Appalachian Mountains of East Tennessee.

Understanding collaboration between social workers and physicians: application of a typology

This article builds on prior analyses of data collected from a qualitative study of 50 pairs of social worker-physician collaborators in. This article presents the elements of a typology of collaborators from both professions developed from those analyses. The typology was also applied to the entire sample and each respondent characterized according to type (traditional, transitional or transformational). Further analysis was done to evaluate the relationships between type and collaborative perspectives. The sample was primarily transitional (56%-58%) and there were more traditional social workers (22%) and transformational doctors (24%) than anticipated. Social workers, as a group, were much less satisfied with the doctors than the doctors were with them although both groups of traditional respondents were the most dissatisfied. Both groups were least transformational in relation to control over decision making.

The organizational context of children's mental health services

This paper reviews what is known about the organizational context of children's mental health services and describes organizational constructs, conceptual models, research methods, and intervention strategies that can be used to link organizational context to service quality and outcomes. Using evidence from studies of business and industrial organizations as well as studies of children's service organizations, the paper presents a model of organizational effectiveness that depends on several contextual characteristics that include organizational culture, structure, climate, and work attitudes. These characteristics are believed to affect the adoption of efficacious treatments (EBPs [evidence-based practices]), adherence to treatment protocols, therapeutic alliance, and the availability, responsiveness, and continuity of services. Finally, 10 components of the ARC(Availability Responsiveness and Continuity) organizational intervention are described as examples of strategies that can be used to develop organizational contexts with the prescribed characteristics. Mental health researchers are encouraged to consider including these constructs, conceptual models, research methods, and intervention strategies in dissemination, effectiveness, and implementation studies that address the gap between research-based knowledge about mental health treatment and what is actually offered in the community.