Implementing strategies in complex systems: lessons from Brazilian hospitals

Meyer, Victor; Pascucci, Lucilaine; Murphy, Joseph

doi:10.1590/s1807-76922012000500003

Cited by 25 publications

(7 citation statements)

References 19 publications

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“…This complexity derives from their ambiguous objectives, the qualitative nature of their activities, the use of multiple and complex technologies, shared power and plurality of professionals involved in the activities. In these organizations, there can be significant disputes between highly qualified professionals, with great autonomy in their work, and that are not subordinated to senior management (Meyer Junior et al ). For these authors, the strategic management of complex systems such as hospitals requires greater attention than usual by strategy implementation process managers.…”

Section: Propositionsmentioning

confidence: 99%

Lean healthcare in developing countries: evidence from Brazilian hospitals

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et al. 2015

Int J Health Plann Mgmt

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The present study evaluates how five sectors of two Brazilian hospitals have implemented lean healthcare concepts in their operations. The main characteristics of the implementation process are analyzed in the present study: the motivational factor for implementation, implementation time, form (consultancy or internal), team (hospital and consultants), lean implementation continuity/sustainability, lean healthcare tools and methods implemented, problems/improvement opportunities, lean healthcare barriers faced during the implementation process, and critical factors that affected the implementation and the results obtained in each case. The case studies indicate that reducing patient lead times and costs and making financial improvements were the primary factors that motivated lean healthcare implementation in the hospitals studied. Several tools and methods were used in the cases studied, especially value stream mapping and DMAIC. The barriers found in both hospitals are primarily associated with the human factor. Additionally, the results obtained after implementation were analyzed and improvements in financial aspects, productivity and capacity, and lead time reduction of the analyzed sectors were observed. Further, this study also exhibited four propositions elaborated from the results obtained from the cases that highlighted barriers and challenges to lean healthcare implementation in developing countries. Two of these barriers are hospital organizational structure (and, consequently, how the senior management works with medical staff), and outsourcing hospital activities. This study also concluded that the initialization and maintenance of lean healthcare implementation rely heavily on external support because lean healthcare subject knowledge is not yet available in the healthcare organization, which represents a challenge. Copyright © 2015 John Wiley & Sons, Ltd.

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Section: Propositionsmentioning

confidence: 99%

Lean healthcare in developing countries: evidence from Brazilian hospitals

Costa

Filho

Rentes

et al. 2015

Int J Health Plann Mgmt

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“…There is also a wide spectrum of systemic challenges that emergency leadership must confront. These include emergency response systems (Launder and Perry, 2014;Scotter et al, 2012); emergency logistics (Hilgers et al, 2013;Kapucu, 2011); critical care systems (deMattos et al, 2012;Meyer Junior et al, 2012); social recovery (Tan, 2013); and civil defence systems (Survila and Valickas, 2012). Not only must leaders be adept at assessing risks (Abrahamsson and Tehler, 2013), but they must promote cultures of prevention and safety (Taber and Taber, 2013), while maintaining systemic efficiency (Checkland, 2014).…”

Section: Transformational Emergency Leadershipmentioning

confidence: 99%

Towards transformational leadership: the nexus of emergency management systems in Canada

H.J.

2016

IJEM

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This qualitative research study explores the leadership challenges in emergency management systems in Canada. Complex adaptive systems theory forms the theoretical paradigmatic perspective of emergency events, such as mass emergencies, disasters and catastrophes. Thematic analysis of a key informant study of emergency leaders identified 12 key leadership capabilities. From the grounded theory methodological approach, a theory of transformational emergency systems leadership emerged and is posited. The findings and implications are discussed in light of theoretical implications for humanistic and technologically driven leadership; inter-sectorial collaborative networks; adaptive learning and training of future emergency leaders; and future international emergency management research.

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“…[38,39] A systems perspective of emergency management is informed by the theory of open complex adaptive systems, whereby systems are organize themselves in response to external environmental stimuli in the form of small to catastrophic emergency events, all requiring systems intervention to safeguard lives and mitigate injuries. [40][41][42][43][44][45][46][47] Emergency management systems are composed of five complex subsystems, each with unique and specific internal self-organizing processes. These are summarized in Table 1.…”

Section: Theoretical Framework: a Triangulation Approachmentioning

confidence: 99%

Code red: Towards authentic transformational leadership of emergency management

2015

JHA

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In this 21st century of unprecedented global, national and regional threats and innovative technologies, this study underscores the unique authentic transformational leadership challenges posed in emergency management systems. These open complex systems adapt to a range of critical emergency events, including mass emergencies, disasters and catastrophes. This qualitative research study based on grounded theory examines the phenomenology of emergency management systems by deploying triangulation to isolate the particular theoretical underpinnings of authentic transformational leadership models relevant to this domain. Using a key informant approach and a semi-structured confidential questionnaire, the perspectives of 103 emergency, health care and technological leaders of diverse professional backgrounds on the challenges of emergency management systems are presented. The response rate was 83.5 percent from 81 organizations across Canada. This study underscores the need for authentic transformational leadership and identifies seven critical and specific leadership imperatives for this domain. The implications for hospital and health care administrators are also presented. This qualitative study of diverse emergency system leaders is original in that it has not hitherto been done across Canada nor internationally. This study underscores the relevance of leadership theory and principles in the extant literature, but extends this to highlight those that are critical and unique to leaders of emergency management systems. In so doing, calls on the need for authentic transformation leadership of an order and caliber yet to be fully potentiated to manage future emergency events in Canada.

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Implementing strategies in complex systems: lessons from Brazilian hospitals

Cited by 25 publications

References 19 publications

Lean healthcare in developing countries: evidence from Brazilian hospitals

Lean healthcare in developing countries: evidence from Brazilian hospitals

Towards transformational leadership: the nexus of emergency management systems in Canada

Code red: Towards authentic transformational leadership of emergency management

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