Uncertainty in Health Care Environments

Begun, James W.; Kaissi, Amer

doi:10.1097/00004010-200401000-00005

Cited by 40 publications

(47 citation statements)

References 33 publications

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“…Medical practices' environmental uncertainty relates to the level and unpredictability of change in external factors such as patients' expectations, governments' regulatory behavior, medical and IT, and sources of clinical supply and knowledge (Duncan, ; Miller & Dröge, ; Oldham & Rutter, ). As the health care environment has become more volatile and unpredictable, the different ways in which this environment is characterized (objectively) by medical practices, and perceived (subjectively) by physicians and nurses, determine different responses with regard to IT capability‐building for knowledge management purposes (Makadok, ; Pavlou & El Sawy, ); in turn, such responses have a different effect upon the performance of these organizations (Begun & Kaissi, ). Moreover, as clinical uncertainty in primary health care “borders the edges of knowledge” (Gerrity, Earp, DeVellis, & Light, , p. 1022), an understanding of its impact on organizational learning should translate to clinical practice (Han, Klein, & Arora, ), and to “evidence‐based practice” in particular (Ghosh, ; Schoenfeld, Harris, & Davis, ).…”

Section: Theoretical Backgroundmentioning

confidence: 99%

“…We may thus assume that the development of IT‐based clinical knowledge management capabilities in primary care medical practices is essential to their innovation and clinical performance (Nicolini, Powell, Conville, & Martinez‐Solano, ; Paul, ). This development is also considered to be strongly influenced by the uncertainty that exists in the environment of these organizations (Begun & Kaissi, ; Siegel Sommers, ). Increasing uncertainty thus requires medical practices to develop a greater absorptive capacity, that is, a dynamic organizational learning capability to deal with the external sources of this uncertainty (Van den Bosch, Volberda, & de Boer, ).…”

Section: Introductionmentioning

confidence: 99%

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IT‐based clinical knowledge management in primary health care: A conceptual framework

Raymond

Paré

Maillet

2017

Knowl Process Manag

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Primary health care medical practices have made sizable information technology investments in recent years, primarily deploying electronic medical record (EMR) systems as well as Web‐based e‐learning applications. The basic assumption here is that developing information technology‐based knowledge management capabilities may significantly improve the innovation and clinical performance of these organizations. Increasing uncertainty in their environment requires them to develop greater absorptive capacity (ACAP), that is, an organizational learning capability to deal with the external sources of this uncertainty. In applying ACAP theory to primary care settings, this study seeks to answer the following research questions: What are the e‐learning and EMR capabilities developed by primary care medical practices in response to increasing environmental uncertainty? To what extent does the development of an e‐learning capability influence the development of an EMR capability? To what extent does building ACAP contribute to positive outcomes in terms of medical practices' innovation and clinical performance?

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Section: Theoretical Backgroundmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

IT‐based clinical knowledge management in primary health care: A conceptual framework

Raymond

Paré

Maillet

2017

Knowl Process Manag

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“…Although the Lebanese healthcare system, with its complex and mixed setting of private–public mix in delivery and financing, may share some similarities with the American healthcare system, it is still a very unique system, especially when the constant economic and political turmoil of the country is considered. Given this complexity, hospitals in Lebanon can arguably benefit from strategic planning to alleviate the adverse impact of uncertainty in their environments and steer their operations towards improved performance (Begun and Kaissi, ). It is important to note that as a requirement of the Lebanese national accreditation system which started in 2002, hospitals are required to have a “five‐year strategic plan […] that indicates future directions/initiatives for the hospital…” with advisory input from the Senior Management (MoPH, ).…”

Section: Introductionmentioning

confidence: 99%

Strategic planning processes and financial performance among hospitals in Lebanon

Saleh

Kaissi

Semaan

et al. 2012

Health Planning & Management

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“…In contrast to how healthcare generally works by reducing patients to single diseases, caring for this patient group necessitates embracing the challenge of variations and uncertainties (Lillrank, 2003). Variations and uncertainties can however be managed by practices aimed at minimising or enhancing their influence on care delivery (Begun andKaissi, 2004, Eddy, 1984).…”

Section: Managing Variation and Uncertaintymentioning

confidence: 99%

Managing care pathways for patients with complex care needs

Smeds

2019

Linköping Studies in Science and Technology. Licentiate Thesis

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One of the central challenges for the healthcare system today is how to manage care for patients with complex needs. This patient group is not well-defined but covers patients with serious diseases and comorbidities, or with a limited ability to perform basic daily functions due to physical, mental or psychosocial challenges. This group has a high service and resource utilisation resulting in high costs for the healthcare system and, typically, poor health outcomes. To improve care for these patients, it is necessary to implement strategies to manage the differentiated care needs, the additional support needs, the uncertainty in care delivery, and the coordination needs of the involved providers and the patient. Care pathways are increasingly used internationally to make care more patient-centred and to structure and design care processes for individual patient groups. Important elements in care pathways include structuring care activities, by defining their content and sequence; coordinating between providers and professionals; and involving patients in their care process. In this thesis, care pathways are proposed as the overall strategy for managing care for patients with complex care needs. The purpose of this thesis is thus to contribute with knowledge on how care pathways can be managed for patients with complex care needs. This is achieved by analysing how the practices coordination, standardisation, customisation and personalisation can support management of care pathways and by discussing how these practices influence quality of care. The quality of care dimensions discussed are accessible, timely, equitable, and patient-centred care. The empirical context in this thesis is the Standardised Cancer Care Pathways (CCPs) which were implemented in Sweden from 2015 to 2018. CCPs is the umbrella term for the national initiative to shorten waiting times, decrease regional differences and reduce fragmentation in care processes. CCPs include elements such as diagnosis-specific pathways and guidelines, introduction of CPP coordinators, and mandatory reporting of waiting times. Focus has been on implementing care pathways for 31 cancer diagnoses in all Swedish healthcare regions. Both qualitative and quantitative research methods have been used. A case study was conducted to examine standardised and customised care pathways, and coordination and multidisciplinary work in care pathways. A document study of regional reports on CCPs was analysed to study effects of care pathways on accessibility, timeliness and equitability. Finally, a national survey was conducted to deepen the understanding of the role of coordination, as performed by coordinators, in care pathways. This thesis argues that standardised and customised care pathways should be combined to manage care for patients with complex care needs. The customised pathway in particular benefits patients with serious unspecific symptoms, unknown primary tumour or more complex care needs, while patients with care needs that can be treated independently of the main d...

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Uncertainty in Health Care Environments

Cited by 40 publications

References 33 publications

IT‐based clinical knowledge management in primary health care: A conceptual framework

IT‐based clinical knowledge management in primary health care: A conceptual framework

Strategic planning processes and financial performance among hospitals in Lebanon

Managing care pathways for patients with complex care needs

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