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PurposeGovernment imperatives that drive integrated care are challenging corporate executive leadership. Conspicuous by its absence in both government's imperatives and the literature, is any reference to corporate executive leadership in transitioning a hierarchically oriented health system to a laterally integrated health system referred to, in this paper, as an integrated health system. This lack of reference to executive leadership involvement conveys either significant consequences or opportunities for corporate healthcare executives. The purpose of this qualitative, multi-case study is to explore corporate executive leadership in transitioning a hierarchically oriented health system to an integrated health system.Design/methodology/approachBetween December 2017 and February 2018, a qualitative methodology and multi-case study design facilitated one hour telephone interviews with 11 presidents and four senior vice presidents. Critical case sampling was used to select the study sample from a target population of 246 corporate healthcare executives representing Ontario's major acute healthcare organizations/systems.FindingsCorporate healthcare executives possess the requisite skills and knowledge to transition a hierarchically oriented to a laterally integrated the health system but are constrained by an undefined partnership role with government and fear of government changes.Originality/valueThis paper provides corporate executive leaders with a systematic leadership approach to organizational readiness, in transitioning to an integrated health system. Features and outcomes of the approach are illustrated.
PurposeGovernment imperatives that drive integrated care are challenging corporate executive leadership. Conspicuous by its absence in both government's imperatives and the literature, is any reference to corporate executive leadership in transitioning a hierarchically oriented health system to a laterally integrated health system referred to, in this paper, as an integrated health system. This lack of reference to executive leadership involvement conveys either significant consequences or opportunities for corporate healthcare executives. The purpose of this qualitative, multi-case study is to explore corporate executive leadership in transitioning a hierarchically oriented health system to an integrated health system.Design/methodology/approachBetween December 2017 and February 2018, a qualitative methodology and multi-case study design facilitated one hour telephone interviews with 11 presidents and four senior vice presidents. Critical case sampling was used to select the study sample from a target population of 246 corporate healthcare executives representing Ontario's major acute healthcare organizations/systems.FindingsCorporate healthcare executives possess the requisite skills and knowledge to transition a hierarchically oriented to a laterally integrated the health system but are constrained by an undefined partnership role with government and fear of government changes.Originality/valueThis paper provides corporate executive leaders with a systematic leadership approach to organizational readiness, in transitioning to an integrated health system. Features and outcomes of the approach are illustrated.
This article analyzes Poupatempo, a recent bureaucratic reform in Brazil. We argue that it offers insight into a potentially successful strategy to promote institutional reforms. After analyzing the design of the project and the obstacles to its implementation, we conclude that Poupatempo's most innovative feature was the fact that it did not try to reform existing institutions. Instead it created a new pathway around an inefficient bureaucracy. This type of reform -the institutional bypass -has not been considered by the academic literature on institutional change but, as the case of Poupatempo suggests, it should be further investigated and analyzed.
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