Using Positive Organizational Scholarship in Healthcare and Video Reflexive Ethnography to Examine Positive Deviance to New Public Management in Healthcare

Abstract

Following increased interest in and use of new public management (NPM), greater regulation has been introduced into many Western health systems. Yet, the effects have revealed the negative aspects of NPM. Positive organizational scholars have argued that adversity can give rise to positive deviance. Yet as a form of noncompliance, positive deviance can be difficult to examine. This methodological article demonstrates how the combined methodologies of positive organizational scholarship in healthcare (POSH) and video reflexive ethnography (VRE) can help examine positive deviance. This study illustrates the methodological utility of POSH VRE to respectfully study the impact of NPM-inspired expectations on public health clinicians, positively reframe how clinicians constructively respond to and manage obstruction, and reveal the unintended effects of NPM-inspired expectations. As a participatory methodology, POSH VRE can promote trust between researchers and clinicians, thereby unveiling instances of positive deviance to NPM in healthcare.

Gaming the system to care for patients: a focused ethnography in Norwegian public home care

“…In this article, we seek to understand and explain this witnessed phenomenon. Similar disobedient behaviors have been found among team leaders of home care areas, palliative care teams, nurses and residential care workers and managers in previous studies [9, 49–51], and have been interpreted as proof that employees do not comply with all predefined decisions [39]. This indicates that despite NPM influences, home-care cultures based on nursing- and caring values still exist [18].…”

“…Findings indicate cultural patterns regarding nurses’ somewhat-disobedient behaviors and manipulations of the organizational systems that they perceive are based on economic rather than caring values. Similar forms of “culture clash” between NPM and nursing is documented in several healthcare settings [1, 6, 17, 49, 51, 63], and it is plausible that types of disobedient practices also could be found in other settings, by other healthcare personnel or leaders, and potentially taking different forms [9, 49, 51]. Furthermore, findings indicate that patients share nurses’ perceptions of what constitutes high-quality nursing.…”

What does it mean to conduct participatory research with Indigenous peoples? A lexical review

“…For scholars, given the importance of impact, this review would suggest that there is much scope and opportunity to actively engage Indigenous peoples in all research phases to improve public health initiatives and redress longstanding health inequalities. Several methodologies have a demonstrated capacity to enhance engagement – consider for instance, citizen social science [76] and video reflexive ethnography (VRE, [77, 78]). Informed by both crowdsourcing and citizen science, citizen social science involves avocational researchers who examine social phenomena by collecting and analyzing data, disseminating the associated findings, and translating these into practice.…”

Exchange variables, organizational culture and their relationship with constructive deviance

“…This environment will, in turn, reflect positively on organizational outcomes, including productivity and a readiness to innovate. Therefore, one can expect that all organizational justice componentsprocedural, distributive, and interactional justiceplay a significant role in explaining the variance in employees' perceptions of how innovative the environment is (Suliman, 2013;Dadich et al, 2018). The more satisfied the employees are with the methods, procedures, and policies of the organization, as well as the quality of the relationships that they have with their superiors, the more prepared they will be to create and innovate.…”