Coordination of physicians' operational activities: a contingency perspective

Transferring, translating and transforming knowledge: the role of brokering in healthcare networks

PURPOSE

This research examines how knowledge and information are managed within two care networks. We develop a conceptual framework drawing on the notion of brokering and the 3T framework, which is used to describe the relative complexity of boundaries (referred to in the framework as syntactic, semantic and pragmatic) as well as capabilities and processes required to exchange information within the network. Previous research on brokering has focused on healthcare managers and professionals, but this research extends to patients and caregivers. Understanding knowledge exchange and brokering practices in healthcare is critical to the delivery of effective services.

DESIGN/METHODOLOGY/APPROACH

For this case research, non-participant observation and experienced-based interviews were undertaken with healthcare professionals, patients and caregivers within two care networks.

FINDINGS

The findings reveal brokering roles occupied by healthcare professionals, patients and caregivers support the transfer, translation and transformation of knowledge and information across functional and organisational boundaries. Enablers and disablers to brokering and the exchange of knowledge and information are also identified.

RESEARCH LIMITATIONS/IMPLICATIONS

The study is limited to two care networks for long-term conditions within the UK. Further research opportunities exist to examine similar care networks that extend across professional and organisational boundaries.

PRACTICAL IMPLICATIONS

This research informs healthcare professionals of the brokering capabilities that occur within networks and the enabling and disabling factors to managing knowledge across boundaries.

ORIGINALITY/VALUE

This paper provides a conceptual framework that categorises how increased levels of knowledge and information exchange and brokering practices are managed within care networks.

Silence is golden: the role of team coordination in health operations

Purpose

This study investigates the relationships between team dynamics and performance in healthcare operations. Specifically, it explores, through wearable sensors, how team coordination mechanisms can influence the likelihood of surgical glitches during routine surgery.

Design/methodology/approach

Breast surgeries of a large Italian university hospital were monitored using Sociometric Badges – wearable sensors developed at MIT Media Lab – for collecting objective and systematic measures of individual and group behaviors in real time. Data retrieved were used to analyze team coordination mechanisms, as it evolved in the real settings, and finally to test the research hypotheses.

Findings

Findings highlight that a relevant portion of glitches in routine surgery is caused by improper team coordination practices. In particular, results show that the likelihood of glitches decreases when practitioners adopt implicit coordination mechanisms rather than explicit ones. In addition, team cohesion appears to be positively related with the surgical performance.

Originality/value

For the first time, direct, objective and real time measurements of team behaviors have enabled an in-depth evaluation of the team coordination mechanisms in surgery and the impact on surgical glitches. From a methodological perspective, this research also represents an early attempt to investigate coordination behaviors in dynamic and complex operating environments using wearable sensor tools.

Contingency framework for understanding quality in public and private hospitals of India

Purpose

Health-care delivery organizations (hospitals) constitute a complex adaptive system; hence, a contingency perspective is imperative to guide the design of customized approaches to quality management in different health-care settings. Accordingly, this paper aims to propose a contingency framework to advance the understanding of the relationship between situational factors and effectiveness of quality approaches in health-care organizations (HCOs), such as hospitals in India.

Design/methodology/approach

Related literature was reviewed to identify existing research and theories related to quality and quality approaches, situational factors of the HCOs (hospitals) and some existing logical evidence on public and private hospitals in India. Then a contingencies framework for quality and quality approaches was conceptualized.

Findings

This paper proposes contingent determinants arise out of conceptualization of the HCOs (hospitals) from different system perspective such as rational system, natural system, open system and integrative system; uncertainty because of physicians’ behaviour, nurses’ approach and a dual line of authority; and the task environment such as patients, competition and economic pressure. These determinants represent situational constructs to the quality enhancement of any attempt at quality approaches. While these determinants have an influence on the quality and quality approaches of the HCOs (hospital), it is imperative to build any quality improvement strategy to work effectively, i.e., quality approach is dependent on determinants of the contingencies of the hospital’s environment, be it external or internal. Propositions for future research are also incorporated.

Research limitations/implications

This paper proposes a conceptual model as well as research propositions that need to be validated and confirmed empirically. It advances the research and theory related to quality and quality approaches in a health-care setting. It can enable policymakers, hospital managers to analyze and gauge the appropriateness of quality approaches in a given context before implementing them and could help to improve the introverted quality approaches and quality dimensions currently followed in HCOs (hospitals).

Originality/value

Contingency framework is a new approach for research on the effectiveness of quality approaches in hospitals. The fundamental idea behind this framework is that effectiveness of quality approaches can be understood best by examining its contingent determinants. Thus, it has the capacity to contribute to the efforts of government and policymakers to make the quality of care affordable to all in India. Essentially, we examine the contexts and variables that determine the effectiveness of quality approaches.

Service decomposition: a conceptual analysis of modularizing services

Purpose

– Applying “modularity” principles in services is gaining in popularity. The purpose of this paper is to enrich existing service modularity theory and practice by exploring how services are being decomposed and how the modularization aim and the routineness of the service(s) involved may link to different decomposition logics. The authors argue that these are fundamental questions that have barely been addressed.

Design/methodology/approach

– The authors first built a theoretical framework of decomposition steps and the design choices involved that distinguished six decomposition logics. The authors conducted a systematic literature search that generated 18 empirical articles describing 16 service modularity cases. The authors analysed these cases in terms of decomposition logic and two main contingencies: modularization aim and service routineness.

Findings

– Only three of the 18 articles explicitly addressed the service decomposition by reflecting on the underlying design choices. By unravelling the decomposition in each case, the authors were able to identify the decomposition logic and found four of the six theoretically derived logics: single-level process oriented; single-level outcome oriented; multilevel outcome oriented; and multilevel combined orientation. Although the authors did not find a direct relationship between the modularization aim and the decomposition logic, the authors did find that single-level decomposition logics seem to be mainly applied in non-routine service offerings whereas the multilevel ones are mainly applied in routine service offerings.

Originality/value

– By contributing to a common understanding of modular service decomposition and proposing a framework that explicates the design choices involved, the authors enable an enhanced application of the modularity concept in services.

An Exploratory Study of the Value of Project Management for Hospital Administration in Thailand

This study examines how physicians can recognise and utilise project management to improve their role as hospital administrators. Thirty physicians serving as hospital administrators in Thailand were asked to identify the skills necessary to successfully manage projects in the hospital, and problems encountered in their administrative roles in regards to project management. This article illustrates how the practices and tools of project management can be put to use in alleviating the problems identified, and offers potential applications for hospital administration. The implications go beyond physicians serving as hospital administrators and demonstrate value for all administrators striving for improved healthcare operations.