High performance work systems: the gap between policy and practice in health care reform

Leggat, Sandra G.; Bartram, Timothy; Stanton, Pauline

doi:10.1108/14777261111143536

Cited by 92 publications

(107 citation statements)

References 81 publications

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“…Pressures on governments and other funding sources to make better use of scarce resources to enhance productivity, efficiency and effectiveness and improve hospital performance (Leggat et al, 2011;Willis et al, 2006) have led to increasing moves towards managerialism into healthcare, the re-negotiation of jurisdictional boundaries and changed forms of governance. Hence, Lean healthcare (a term commonly applied by UK researchers) seems appealing to many healthcare managers (Waring & Bishop, 2010).…”

Section: Implementing Lm In Healthcarementioning

confidence: 99%

Implementing lean management/Six Sigma in hospitals: beyond empowerment or work intensification?

Stanton

Gough

Ballardie

et al. 2014

The International Journal of Human Resource Management

Self Cite

110

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This article analyses a process improvement project based on Lean Six Sigma (LSS) techniques in the emergency department (ED) of a large Australian hospital. We consider perspectives of the clinical and managerial staff involved in the project implementation, its implications for empowerment and work intensification. We find that the project appeared to improve patient flow from the ED to the wards and to have positive implications for some staff. However, these achievements tended to be the result of senior staff using the project to leverage resources and create desirable outcomes, rather than the result of the use of LSS, in particular. We found some evidence of work intensification, but this was attributable to wider systemic issues and budget constraints, rather than being a direct consequence of the use of LSS. We argue that translating LSS from a manufacturing context into the politicised and professionalised context of healthcare changes the usual questions about empowerment or work intensification to questions about the influences of powerful stakeholders.

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Section: Implementing Lm In Healthcarementioning

confidence: 99%

Implementing lean management/Six Sigma in hospitals: beyond empowerment or work intensification?

Stanton

Gough

Ballardie

et al. 2014

The International Journal of Human Resource Management

Self Cite

110

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“…This highlights the transitional and fragile state of its progressive institutionalisation across NHS Wales. We therefore contend that focus directed at the level of the 'micro-work system' [163][164][165][166][167][168][169][170][706][707][708][709][710][711] may offer greater insight into the impact of patient safety improvement programmes at the point of patient-centred care. Indeed, this may even help to challenge Pawson's iron law of evaluation: the expected value of any net impact assessment of any large-scale social program is zero.…”

Section: Discussionmentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…One of the main aims of policy makers and programmers in the health field in every country is to assure financial security for people against illnesses that lead to back-breaking costs and poverty (14). Although in recent years the health system could reach a striking progress in peoples' health levels and raise the related indexes (15), it is yet one of the biggest concerns of policy makers to establish justice in health services (16). Today, the importance of health as one of the biggest concerns has caused researchers to study the health care system orderly all over the world.…”

Section: Introductionmentioning

confidence: 99%

Hospital Managers’ Perception of Recent Health Care Reform in Teaching Hospitals of Qazvin, Iran

Kiaei¹,

Moradi²,

Hasanpoor³

et al. 2015

Biotech Health Sci

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Background: The main purpose of any government from a healthcare reform is to improve the service quality and raised public satisfaction. Objectives: As the important role of managerial human resources in any organizational changes, this paper tried to examine the point of view of this group about the recent reform in governmental hospitals of Qazvin. Patients and Methods: This cross-sectional study was conducted in January 2015. The statistical population consisted of 50 executive managers of Qazvin teaching hospitals. The data gathering instrument was a research-made questionnaire with approved reliability and validity (α = 0.84). Data analyse was performed in SPSS version 20 using descriptive and analytic statistics (analysis of variance (ANOVA), Pearson correlation test and one sample t-test). Results: A total of 43.2% of managers believed that this reform was a good restrictor for malpractices in healthcare and 31.8% believed that it will not be so useful to improve the society health status. The average score of resource preparation, insurance companies coordination, changing the routine workflows, and finally achieving the goals, had a meaningful difference (P ˂ 0.05) and the average score of these fields were upper than average. Conclusions:The findings showed that based on the managers' point of view, the reform plan was able to achieve its primary goals; however, it could not meet their exceptions in improving the society health status. Therefore, it is necessary to design some interventions for changing this perception.

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High performance work systems: the gap between policy and practice in health care reform

Cited by 92 publications

References 81 publications

Implementing lean management/Six Sigma in hospitals: beyond empowerment or work intensification?

Implementing lean management/Six Sigma in hospitals: beyond empowerment or work intensification?

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Hospital Managers’ Perception of Recent Health Care Reform in Teaching Hospitals of Qazvin, Iran

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