Data science in the design of public policies: dispelling the obscurity in matching policy demand and data offer

Data Science (DS) is expected to deliver value for public governance. In a number of studies, strong claims have been made about the potential of big data and data analytics and there are now several cases showing their application in areas such as service delivery and organizational administration. The role of DS in policy-making has, on the contrary, still been explored only marginally, but it is clear that there is the need for greater investigation because of its greater complexity and its distinctive inter-organizational boundaries. In this paper, we have investigated how DS can contribute to the policy definition process, endorsing a socio-technical perspective. This exploration has addressed the technical elements of DS - data and processes - as well as the social aspects surrounding the actors' interaction within the definition process. Three action research cases are presented in the paper, lifting the veil of obscurity from how DS can support policy-making in practice. The findings highlight the importance of a new role, here defined as that of a translator, who can provide clarity and understanding of policy needs, assess whether data-driven results fit the legislative setting to be addressed, and become the junction point between data scientists and policy-makers. The three cases and their different achievements make it possible to draw attention to the enabling and inhibiting factors in the application of DS.

Ayurveda education in India: Addressing the human resource barriers to optimize the delivery

Ayurveda currently is passing through a phase of global renaissance. Its growing popularity however is not matching with quality driven human resource development to meet the growing expectations. Teachers holding the responsibility of inspiring the newer generation for their adherence to quality are often de-motivated for various reasons and eventually fail to deliver optimally. Although promoting Ayurveda by increasing its visibility is a priority approach in policy and planning, much is desired to be done on the fronts of its actual delivery. Not much is done to ensure the quality driven human resource development in Ayurveda, accounting for a major cause of its dismal show on the fronts like education, practice and research. Ayurveda in India in general is still striving to achieve the minimal standards in these key functioning areas. Uncertain career opportunities, poor recruitment and discriminatory promotional policies, erratic salary structures, meager opportunities for early and mid-career advancements and negligible resources for in job skill enhancements are prominent reasons of de-motivation among Ayurveda teachers. An identity crisis of being unfit in the larger community of higher or medical education further adds to the misery as the advantages given to these communities are not generally shared with Ayurveda teachers. The outcome of an education imparted by a demotivated teacher can have its far reaching and diverse effects on the society. A poor performance of Ayurveda in the country of its origin has its roots in the inappropriate handling of its key functionaries like teachers. Ayurveda teachers playing the role of service providers and educators can create the foundation of quality driven education and health care in Ayurveda, if they themselves are harnessed well for their potential. The teachers are essentially the spine of any step related to qualitative benchmarking of Ayurveda and hence their miseries and misappropriations are needed to be accounted and addressed. Ayurveda teachers also deserve to be nurtured well to bloom to their fullest potential so to serve Ayurveda with all their strength and capacity.

Selecting talent using social networks: A mixed-methods study

Previous studies on the use of Social Networking Sites (SNS) in personnel selection generally focus on examining this phenomenon in the selection process as a whole. However, personnel selection is a macro-process composed of several activities. This paper aims to investigate how human resource professionals use SNS in hiring decisions during the different stages of the selection process. The research uses an explanatory sequential mixed-methods approach. The first study consisted of a questionnaire-based survey of hiring professionals with the intent to describe various aspects of current practice (n = 429). Survey data was analyzed using descriptive and inferential statistics. The second study comprised semi-structured interviews with hiring professionals to provide a more in-depth, richer analysis (n = 24). Interview data was analyzed via qualitative thematic analysis. Results uncovered two types of users. Single-stage users emphasized efficiency concerns, whereas multiple-stage users mentioned to access profiles on an as needed-basis. Participants reported that the patterns of use could be quite complex and dynamic, with selectors revisiting the profile of the same applicant several times for different purposes, or examining profiles of the same applicant in different SNS. The assessment of SNS information is typically non-systematic, but some employers reported using scales, mainly in pre-selection. Evidence emerged of potential adverse effects during the selection process. Overall, this paper contributes to theory and practice by providing a better understanding of the use of SNS across the different stages of personnel selection. To our best knowledge, this is the first mixed-methods study of its kind.

Managerial competences in public organisations: the healthcare professionals' perspective

Background

Human resources play a critical role in encouraging efficient performance within organisations, especially for public healthcare organisations, where competences of staff are key aspects of the quality of services provided. In this context, the enhancement of competences are strategic objectives for Human Resources Management (HRM) in order to achieve excellent and lasting results. However, competences of healthcare professionals are both clinical and managerial. This study identifies specific managerial competences perceived as crucial by healthcare professionals in order to improve their performance and develop suitable HRM practices.

Methods

The research methodology was divided into three main phases using mixed methods, commencing with literature review to identify the initial framework about managerial competences. Focus groups were then used to discuss evidence from the literature. Feedback from focus groups was used to draft the final questionnaire. Finally, the answers to the questionnaire were analysed through statistical software.

Results

The results show that managers and professionals share a view of what specific managerial competences for healthcare organisations should be. Main competences are: quality evaluation based on outcomes; enhancement of professional competences; programming based on process management; project cost assessment; informal communication style; and participatory leadership.

Conclusions

Although the issue of managerial skills in healthcare is widely discussed in literature, findings are often fragmentary. Our work includes a systematic literature review useful for more empirical studies. Furthermore, our results can support public managers who want to set up positive HRM practices for healthcare professionals.

Leadership styles, work engagement and outcomes among information and communications technology professionals: A cross-national study

The present study examined relationships among leadership styles, work engagement and work outcomes designated by task performance and innovative work behavior among information and communication technology professionals in two countries: Ethiopia and South Korea. In total, 147 participants from Ethiopia and 291 from South Korea were made to fill in the self-reporting questionnaire intended to assess leadership styles, work engagement, task performance, and innovative work behavior. To test the proposed hypotheses, multiple linear regression analysis was utilized. The results showed that transformational leadership style had a significant positive relationship with employees' work engagement and innovative work behavior, while transactional leadership style had a significant positive relationship with employees' task performance. However, laissez-faire leadership style had a significant negative relationship with task performance. Work engagement had significant positive relationships with the indicators of work outcomes. Besides, work engagement partially mediated the relationship between leadership styles and work outcomes. The observed associations and mediation were consistent across the two national samples considered, indicating the soundness of the assumptions across countries. The findings provide insights into how leadership styles correspond with employees’ work outcomes.

Developing a decision-making dependency (DMD) model for nurse managers

Decision making is an inherent, complex and vital component of the work of managers. Its importance and role in operationalizing the activities of an organisation are well-evidenced in management literature. Yet, there is a dearth of literature about the processes used by nurse managers to make decisions. The principal aim of this paper is to identify the different types of decisions made by nurse managers and explore the related decision-making processes. A ‘dependency model’ is proposed, which illustrates the factors affecting the art of decision making. Structured interviews were conducted to identify types of decisions made by nurse managers in different health-care settings and the factors underpinning these decisions. The research focused on an intensive study of a small group of nurse managers working in rural and regional health institutions in South Australia. The sample included nurse unit managers, after-hours coordinators and directors of nursing. Hermeneutic principles and interpretive research were used to conduct interviews with nurse managers who make numerous and varied types of decisions, though often without following a step-by-step approach. The study identified dependency factors that influence how decisions are made, and developed a model based on eight key variables: (1) the situation to be addressed; (2) the time period in which the decision has to be made; (3) required inputs from colleagues; (4) complexity of the task and the environment, (5) the duration and time it takes to make a decision, (6) availability of resources, (7) the decision-making environment, and (8) personal characteristics. These eight variables are interrelated and have both direct and indirect impacts on how decisions are made. Nurse managers make pragmatic decisions reflecting the complexity of their roles and responsibilities. Awareness of the factors on which decisions depend helps understanding of how they navigate through decision-making processes. The findings are presented as a model that can be used to support decision making by nurse managers in various health settings.

Applying artificial intelligence to explore sexual cyberbullying behaviour

Sexual cyberbullying is becoming a serious problem in today's society. In the workplace, this issue is more complex because of the power imbalance between potential perpetrators and victims. Preventing sexual cyberbullying in organizations is very important for a safety and respectful workplace. Occupational Safety and Health (OSH) standards establish certain policies to be considered to create an organizational culture based on zero tolerance to sexual cyberbullying. The research aims to broaden knowledge about personality and sexual cyberbullying. Therefore, this paper proposes a crucial tool to explore potential sexual cyberbullying behaviour. This study analysed how personality traits, particularly those related to the Dark Triad (psychopathy, Machiavellianism and narcissism), might influence this behaviour. Participants (N = 374) were Spanish young adults, using the convenience sampling to recruit them. The methodology focused on the use of structural equation modelling and ensemble classification tree. First, we tested the proposed hypotheses with structural equation method based on covariance using the Lavaan R-package. Second, for the ensemble of classification trees, we applied the package randomForest and Adabag (bagging and boosting) in R. Results proposed high levels of psychopathy and Machiavellianism are more likely to be related to sexual cyberbullying behaviours. Organizations could use the tool proposed in this research to develop internal policies and procedures for detection and deterrence of potential cyberbullying behaviours. By raising awareness about cyberbullying behaviour including its conceptualisation and measurement in training courses, organizations might build an organizational culture based on a respectful workplace without sexual cyberbullying behaviours.

Under-reporting of TB cases and associated factors: a case study in China

Background

Tuberculosis is a leading cause of death worldwide and has become a high global health priority. Accurate country level surveillance is critical to ending the pandemic. Effective routine reporting systems which track the course of the epidemic are vital in addressing TB. China, which has the third largest TB epidemic in the world and has developed a reporting system to help with the control and prevention of TB, this study examined its effectiveness in Eastern China.

Methods

The number of TB cases reported internally in two hospitals in Eastern China were compared to the number TB cases reported by these same hospitals in the national reporting systems in order to assess the accuracy of reporting. Qualitative data from interviews with key health officials and researcher experience using the TB reporting systems were used to identify factors affecting the accuracy of TB cases being reported in the national systems.

Results

This study found that over a quarter of TB cases recorded in the internal hospital records were not entered into the national TB reporting systems, leading to an under representation of national TB cases. Factors associated with underreporting included unqualified and overworked health personnel, poor supervision and accountability at local and national levels, and a complicated incohesive health information management system.

Conclusions

This study demonstrates that TB in Eastern China is being underreported. Given that Eastern China is a developed province, one could assume similar problems may be found in other parts of China with fewer resources as well as many low- and middle-income countries. Having an accurate account of the number of national TB cases is essential to understanding the national and global burden of the disease and in managing TB prevention and control efforts. As such, factors associated with underreporting need to be addressed in order to reduce underreporting.

Working well: a systematic scoping review of the Indigenous primary healthcare workforce development literature

BACKGROUND

Strong and effective workforce models are essential for improving comprehensive Indigenous primary healthcare service (PHC) provision to Indigenous peoples in Canada, Australia, New Zealand and the USA (CANZUS nations). This review systematically scoped the literature for studies that described or evaluated models and systems that support the sustainability, capacity or growth of the Indigenous PHC workforce to provide effective PHC provision.

METHODS

Eleven databases, 10 websites and clearinghouses, and the reference lists of 5 review articles were searched for relevant studies from CANZUS nations published in English from 2000 to 2017. A process of thematic analysis was utilised to identify key conditions, strategies and outcomes of Indigenous PHC workforce development reported in the literature.

RESULTS

Overall, 28 studies were found. Studies reported enabling conditions for workforce development as government funding and appropriate regulation, support and advocacy by professional organisations; community engagement; PHC leadership, supervision and support; and practitioner Indigeneity, motivation, power equality and wellbeing. Strategies focused on enhancing recruitment and retention; strengthening roles, capacity and teamwork; and improving supervision, mentoring and support. Only 12/28 studies were evaluations, and these studies were generally of weak quality. These studies reported impacts of improved workforce sustainability, workforce capacity, resourcing/growth and healthcare performance improvements.

CONCLUSIONS

PHCs can strengthen their workforce models by bringing together healthcare providers to consider how these strategies and enabling conditions can be improved to meet the healthcare and health needs of the local community. Improvement is also needed in the quality of evidence relating to particular strategies to guide practice.

Working while sick: validation of the multidimensional presenteeism exposures and productivity survey for nurses (MPEPS-N)

Background

Presenteeism is the employee behaviour of physically attending work with reduced performance due to illness or for other reasons. Nurses are four times more likely to exhibit presenteeism compared to other occupations, threatening patient safety through increased patient falls, medication errors and staff-to-patient disease transmission. There is a paucity of standardized instruments that quantify the association between presenteeism with its exposures and related productivity. This study aims to validate an instrument that comprehensively measures presenteeism workplace and personal exposures specifically for Asian nurses.

Methods

Questionnaire domain items were selected based on the JD-R framework and a previously conducted systematic review of pre-existing validated scales measuring work attendance exposures used in previous healthcare studies. The preliminary questionnaire consisted of two outcomes (presenteeism frequency, productivity) and five exposure domains: work resources, work demands, work stress, work engagement, personal traits and health.

Content validation and back translation (English-Cantonese Chinese-English) were carried out. Responses from full-time nurses working in two acute care hospitals (Preliminary questionnaire at Hospital 1: N = 295 and main round questionnaire at Hospital 2: N = 1146) were included in the validation study to ensure an adequate sample size of ten cases per indicator variable for CFA analysis. A random sample of 80 nurses from Hospital 1 were selected for test-retest reliability 4 weeks post the initial survey. Internal consistency, convergent and discriminant validity tests were also tested.

Results

Satisfactory internal consistency (Cronbach’s alpha > 0.7), test-retest reliability (ICC > 0.4); and construct validity - convergent and discriminant validity was achieved. Confirmatory factor analysis yielded satisfactory fitness indices (CFI and TLI > 0.95, RMSEA < 0.08). Presenteeism and productivity significantly associated with all work resources, work engagement and work stress constructs in Hospital 2.

Conclusion

A reliable Multidimensional Presenteeism Exposures and Productivity Survey (MPEPS-N) has been validated in two distinct hospital environments. The instrument helps to identify and quantify organizational or individual exposures that significantly associate with presenteeism and its related productivity, thus allowing hospital managers to set evidence-based intervention targets for wellness programs and formulate human resource policies in reducing presenteeism-related productivity loss.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4373-x) contains supplementary material, which is available to authorized users.

Entrepreneurial orientation, technological propensity and academic research productivity

To what extent are academics entrepreneurial, and to what extent does an entrepreneurial orientation contribute to higher research productivity in higher education? According to some schools of thought, academic research is conducted within 'paradigms' or circumscribed areas of study, with the implication that certain research might not be inherently innovative. This research sought to investigate the extent to which individuals with higher self-reported levels of entrepreneurial orientation (EO), as well as the propensity to apply novel technological methods (such as crowdfunding and crowdsourced R&D) in their research, have higher levels of research productivity. Applying a comprehensive purposive sampling process, a large South African university was sampled. A total of 292 usable responses were obtained, and these were analysed using ordinary least squares. In order to test the robustness of results, two further tests were applied, namely bootstrapping and negative binomial regression analysis. Findings suggest that individuals with higher endowments of entrepreneurial orientation may be more research productive. Interestingly, innovativeness is not found to be significantly related to academic research productivity. It is concluded that further synthesis between educational and entrepreneurship theory might offer useful insights for the improvement of societally important research productivity. It is also concluded, however, that novel technological methods such as crowdfunding may be underutilised in the academic context. Given the resource constraints faced by those in higher education, particularly in the developing-country context of this study, this underutilisation may point to important opportunities in the sector.

Lean bundles in health care: a scoping review

PURPOSE

The purpose of this paper is to review original research on lean management (LM) in health care to identify potential research gaps and present recommendations for future research. The paper also discusses the current state of implementing LM practices in health care. In addition, it presents and highlights "lean bundles" imported from manufacturing, namely, total quality management (TQM), human resource management, just-in-time and total productive maintenance, as a potential implementation strategy of LM in hospitals to optimize overall health care performance.

DESIGN/METHODOLOGY/APPROACH

The scoping review was conducted based on the guidelines specified by Arksey and O'Malley (2005). Relevant included studies were retrieved by searching various electronic databases. The PRISMA guidelines were applied to identify and select eligible studies.

FINDINGS

The majority of previous studies used selected practices to measure LM in health care. In most cases, these practices reflected a narrow and biased view of LM. Lean bundles which comprehensively view LM and reflect all its aspects have rarely been discussed in the health care literature. Evidence about the contribution of lean bundles to hospital performance needs to be addressed in future studies.

PRACTICAL IMPLICATIONS

This paper demonstrates the implementation of the four lean bundles in hospitals. It argues that, instead of adopting one dimension or selected practices of LM, hospitals viewing LM as a comprehensive multi-dimensional approach through the adoption of the four lean bundles are expected to maximize their performances.

ORIGINALITY/VALUE

This is one of the first works to comprehensively review and discuss lean bundles in the context of health care. It argues that the adoption of the four lean bundles by hospitals will enable them to yield the maximum LM performance benefits. In addition, a proposed survey questionnaire based on the literature review is provided to assist researchers in conducting future empirical studies.

[Nursing human resource management in the early phase of treatment of severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident]

In August 2nd Kunshan factory aluminum dust explosion accident 2014, 35 severe mass burn patients were admitted to our hospital, including 18 men and 17 women, aged 21 to 50 (38±9) years. Their severe injuries caused much difficulty to the treatment. In the early period of treatment, a series of measures of nursing human resource management were implemented, such as carrying out training program for non-burn speciality nurses of different levels and origin, grouping and task-dividing, organizing work schedule and assigning in a unified way, and establishing monitoring team of speciality quality. Except for 2 cases of deaths in the early period, the other 33 patients were treated and nursed timely and effectively in the early period. The rescue rate arrived at 94.3% (33/35) on the 17th day post burn. In this period, no such nursing adverse event and complication occurred as bed-dropping, unplanned extubation, coagulation in veins of lower limb, catheter-related infection, or cross infection.

Competences management for improving performance in health organizations

Purpose The purpose of this paper is to describe the design and construction of a privilege mapping system (clinical and organizational competences) of the medical staff of the Niguarda Hospital in Milan, Italy. The second aim is to measure and assess the impact of implementing an evaluation process of clinical competences at the same hospital. Design/methodology/approach The paper retraces the development and implementation of the evaluation of the privilege system, highlighting the subjects involved, the phases and outputs. Moreover, a questionnaire was distributed to 50 heads of unit involved in the planning, building and implementation of competences mapping. Five areas were investigated: competences evaluation for professional development; the impact on work organization and professional roles; professional collaboration; its impact according to context (hospital or unit) and time scale (short or long term); and ability to evaluate clinical outcome. Findings Results reveal success factors for the development and implementation of a privilege mapping system. Furthermore, the survey revealed that clinical leaders are aware of the importance of competences evaluation. In particular, they consider it as a management tool useful for professional development, for identifying excellence and planning operational activities. Originality/value Literature and practical evidence recognize the need to assess the clinical and organizational competences in order to assign tasks and responsibilities. However, there are no studies that describe the construction of systems of evaluation of privileges, as it has never been investigated as professionals perceive these tools.

Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda

Background: Health worker retention in rural and underserved areas remains a persisting problem in many low and middle income countries, and this directly affects the quality of health services offered.

Objective: This paper explores the drivers of long-term retention and describes health worker coping mechanisms in rural Uganda.

Methods: A descriptive qualitative study explored the factors that motivated health workers to stay, in three rural districts of Uganda: Kamuli, Pallisa, and Kibuku. In-depth interviews conducted among health workers who have been retained for at least 10 years explored factors motivating the health workers to stay within the district, opportunities, and the benefits of staying.

Results: Twenty-one health workers participated. Ten of them male and 11 female with the age range of 33–51 years. The mean duration of stay among the participants was 13, 15, and 26 years for Kamuli, Kibuku, and Pallisa respectively. Long-term retention was related to personal factors, such as having family ties, community ties, and opportunities to invest. The decentralization policy and pension benefits also kept workers in place. Opportunities for promotion or leadership motivated long stay only if they came with financial benefits. Workload reportedly increased over the years, but staffing and emoluments had not increased. Multiple job, family support, and community support helped health workers cope with the costs of living, and holding a secure pensionable government job was valued more highly than seeking uncertain job opportunities elsewhere.

Conclusion: The interplay between the costs of leaving and the benefit of staying is demonstrated. Family proximity, community ties, job security, and pension enhance staying, while higher costs of living and an unpredictable employment market make leaving risky. Health workers should be able to access investment opportunities in order to cope with inadequate remuneration. Promotions and leadership opportunities only motivate if accompanied by financial benefits.

'We are planning to leave, all of us'-a realist study of mechanisms explaining healthcare employee turnover in rural Ethiopia

BACKGROUND

We study healthcare employees' turnover intentions in the Afar National Regional State of Ethiopia. This rural region is experiencing the globally felt crisis in human resources, which is inhibiting its ability to meet health-related sustainable development goals.

METHODS

Realist case study which combines literature study and qualitative analysis of interview and focus group discussion data, following a realist case study protocol.

RESULTS

A large majority of employees has turnover intentions. Building on Herzberg's two-factor theory, person-environment fit theory, as well as recent sub-Saharan evidence, analysis of the collected data yields four turnover mechanisms: (1) lack of social and personal opportunities in the region, (2) dissonance between management logic and professional logic, (3) standards of service operations are hard to accept, and (4) lack of financial improvement opportunities.

CONCLUSIONS

While the first and fourth mechanisms may be out of reach for local (human resource) management interventions, the second and third mechanisms proposed to explain health workforce turnover appear to be amenable to local (human resource) management interventions to strengthen healthcare. These mechanisms are likely to play a role in other remote sub-Saharan regions as well.

The implementation of problem-based learning in health service management training programs

Purpose Strengthening management capacity within the health care sector could have a significant impact on population health. However, many training programs in this area are still delivered using a classic lecture-based approach. The purpose of this paper is to evaluate and better understand the feasibility of using a problem-based learning (PBL) approach in health services management training programs. Design/methodology/approach A PBL teaching approach (based on the Maastricht University model) was tested with second-year postgraduate students from the Master in Public Health Management program at the Lithuanian University of Health Sciences. Students' opinions about PBL were investigated using a questionnaire with eight open-ended questions. Thematic content analysis was chosen to reflect the search for patterns across the data. Findings Respondents stated that the main advantage of PBL was that it was a more interesting and effective way of learning: "It is easier to remember, when you study by yourself and discuss with all peers". In addition, it was mentioned that PBL initiated a rapid exchange of ideas and sharing of personal experience. Students stressed that PBL was a good tool for developing other skills as well, such as "public speaking, communication, logic thinking". All students recommended delivering all other courses in the health services management program using PBL methodologies. Originality/value Findings from our study suggest that PBL may be an effective approach to teaching health services management. Potential problems in implementation are noted.

Human Resource Management Challenges to Develop Pharmaceutical Industry: Evidence from Developing Countries

Human resource management has increasingly become one of the most important challenging issues in the pharmaceutical industry in general and in developing countries in particular to increase the access of societies to needed medicines. In this study, an attempt was made to explore the challenges of human resource management practices surrounding pharmaceutical firms in Iran, as a developing country. To answer the research question, a qualitative descriptive study using thematic analysis was performed through 22 semi-structured interviews with the key informants of Iranian pharmaceutical industry. Extracted themes of interviews were categorized into three main groups namely ability, motivation, and opportunity challenges based on the AMO model and briefly discussed separately. This is the first study investigating HRM challenges in the pharmaceutical industry; the research contributes to developing knowledge of human resource practices and assist pharma managers with better understanding how well implement human resource practices.

Doctor-patient relationships (DPR) in China

Purpose The purpose of this paper is twofold: first, to develop and test theory on how commitment human resource (HR) practices affect hospital professionals' job satisfaction that motivates them to generate desirable patient care and subsequently improve doctor-patient relationships (DPR) and second, to examine how commitment HR practices influence hospital managers and clinicians in different ways. Design/methodology/approach Using a cross-sectional survey, the authors collected data from 508 clinicians and hospital managers from 33 tertiary public hospitals in China. Structural equation model was employed to test the relationships of the variables in the study. Findings Commitment HR practices positively affect the job satisfaction of the healthcare professionals surveyed and a positive relationship is perceived between job satisfaction and DPR. Overall, the model shows a reversal on the strongest path linking job satisfaction and DPR whereby managers' main association operates through extrinsic job satisfaction while for clinicians it occurs through intrinsic satisfaction only. Practical implications DPR might be improved by applying commitment HR practices to increase healthcare professional's intrinsic and extrinsic satisfaction. In addition, while recognizing the importance of compensation and benefits to address the underpayment issue of Chinese healthcare professionals, empowerment and autonomy in work, and the use of subjects' expertise and skills may serve as stronger motivators for clinicians rather than hard economic incentives in achieving DPR improvements. Originality/value This study contributes to the small but growing body of research on human resource management (HRM) in the healthcare sector with new evidence supporting the link between commitment HR practice and work attitudes, as well as work attitudes and patient care from the perspective of clinicians and hospital managers. This study represents an initial attempt to examine the associations among commitment HR practices, job satisfaction and DPR in the Chinese healthcare sector. The findings provide evidence to support the value of commitment HR practices in Chinese hospital context, and demonstrate the importance of effective HRM in improving both hospital managers and clinicians' work attitudes.

Dealing with a changing work environment: hospital job type contingencies

Purpose The purpose of this paper is twofold: first, to examine whether workers in various hospital job groups differ in their perceptions of the provision of managerial support, and of their up-to-date expertise (UDE), willingness to change (WTC) and employment opportunities (EO). Second, to examine whether and how the relationships between managerial support, workers' UDE, WTC and their EO are moderated by hospital job type. Design/methodology/approach Survey data were collected from 1,764 employees of three Dutch hospitals. ANOVAs and structural equation modeling were used to test the hypotheses. Findings The research findings indicate significant differences between the hospital job groups with regard to UDE, WTC and EO. No support was found for differences on managerial support nor for a moderating effect of hospital job type. The latter means that the relationships of managerial support with workers' UDE, WTC and EO are independent of job type. Originality/value Based on the findings, a classification system is constructed that shows how hospital workers' UDE, WTC and EO can be explained by the combination of the educational level required by a job and its degree of specialization.

It's all about the money? A qualitative study of healthcare worker motivation in urban China

BACKGROUND

China's healthcare reform programme continues to receive much attention. Central to these discussions has been how the various financial incentives underpinning reform efforts are negatively impacting on the healthcare workforce. Research continues to document these trends, however, qualitative analysis of how these incentives impact on the motivation of healthcare workers remains underdeveloped. Furthermore, the application of motivational theories to make sense of healthcare worker experiences has yet to be undertaken.

METHODS

The purpose of our paper is to present a comparative case study account of healthcare worker motivation across urban China. It draws on semi structured interviews (n = 89) with a range of staff and organisations across three provinces. In doing so, the paper analyses how healthcare worker motivation is influenced by a variety of financial incentives; how motivation is influenced by the opportunities for career development; and how motivation is influenced by the day to day pressures of meeting patient expectations.

RESULTS

The experience of healthcare workers in China highlights how a reliance on financial incentives has challenged their ability to maintain the values and ethos of public service. Our findings suggest greater attention needs to be paid to the motivating factors of improved income and career development. Further work is also needed to nurture and develop the motivation of healthcare workers through the building of trust between fellow workers, patients, and the public.

CONCLUSIONS

Through the analysis of healthcare worker motivation, our paper presents a number of ways China can improve its current healthcare reform efforts. It draws on the experience of other countries in calling for policy makers to support alternative approaches to healthcare reform that build on multiple channels of motivation to support healthcare workers.

Process redesign for time-based emergency admission targets

Purpose Hospitals have used process redesign to increase the efficiency of the emergency department (ED) to cope with increasing demand. While there are published studies suggesting a positive outcome, recent reviews have reported that it is difficult to conclude that these approaches are effective as a result of substandard research methodology. The purpose of this paper is to explore the perceptions of hospital staff on the impact of a process redesign initiative on quality of care. Design/methodology/approach A retrospective qualitative case study examining a Lean Six Sigma (LSS) initiative in a large metropolitan hospital from 2009 to 2010. Non-probability sampling identified interview subjects who, through their participation in the redesign initiative, had a detailed understanding of the implementation and outcomes of the initiative. Between April 2012 and January 2013 26 in-depth semi-structured interviews were conducted and analysed with thematic content analysis. Findings There were four important findings. First, when asked to comment on the impact of the LSS implementation, without prompting the staff spoke of quality of care. Second, there was little agreement among the participants as to whether the project had been successful. Third, despite the recognition of the need for a coordinated effort across the hospital to improve ED access, the redesign process was not successful in reducing existing divides among clinicians and among managers and clinicians. Finally, staff expressed tension between production processes to move patients more quickly and their duty of care to their patients as individuals. Originality/value One of the first studies to explore the impact of process redesign through in-depth interviews with participating staff, this study adds further evidence that organisations implementing process redesign must ensure the supporting management practices are in place.

Understanding human resource management practices in Botswana's public health sector

Purpose The purpose of this paper is to assess the management of the public sector health workforce in Botswana. Using institutional frameworks it aims to document and analyse human resource management (HRM) practices, and make recommendations to improve employee and health system outcomes. Design/methodology/approach The paper draws from a large study that used a mixed methods approach to assess performance of Botswana's Ministry of Health (MOH). It uses data collected through document analysis and in-depth interviews of 54 key informants comprising policy makers, senior staff of the MOH and its stakeholder organizations. Findings Public health sector HRM in Botswana has experienced inadequate planning, poor deployment and underutilization of staff. Lack of comprehensive retention strategies and poor working conditions contributed to the failure to attract and retain skilled personnel. Relationships with both formal and informal environments affected HRM performance. Research limitations/implications While document review was a major source of data for this paper, the weaknesses in the human resource information system limited availability of data. Practical implications This paper presents an argument for the need for consideration of formal and informal environments in developing effective HRM strategies. Originality/value This research provides a rare system-wide approach to health HRM in a Sub-Saharan African country. It contributes to the literature and evidence needed to guide HRM policy decisions and practices.

Performance management in healthcare: a critical analysis

Purpose - The purpose of this paper is to explore the underlying theoretical assumptions and implications of current micro-level performance management and evaluation (PME) practices, specifically within health-care organizations. PME encompasses all activities that are designed and conducted to align employee outputs with organizational goals. Design/methodology/approach - PME, in the context of healthcare, is analyzed through the lens of critical theory. Specifically, Habermas' theory of communicative action is used to highlight some of the questions that arise in looking critically at PME. To provide a richer definition of key theoretical concepts, the authors conducted a preliminary, exploratory hermeneutic semantic analysis of the key words "performance" and "management" and of the term "performance management". Findings - Analysis reveals that existing micro-level PME systems in health-care organizations have the potential to create a workforce that is compliant, dependent, technically oriented and passive, and to support health-care systems in which inequalities and power imbalances are perpetually reinforced. Practical implications - At a time when the health-care system is under increasing pressure to provide high-quality, affordable services with fewer resources, it may be wise to investigate new sector-specific ways of evaluating and managing performance. Originality/value - In this paper, written for health-care leaders and health human resource specialists, the theoretical assumptions and implications of current PME practices within health-care organizations are explored. It is hoped that readers will be inspired to support innovative PME practices within their organizations that encourage peak performance among health-care professionals.

Linking educational leadership styles to the HR architecture for new teachers in primary education

This study aims to gain insight in the relationship between principals' leadership styles and the configuration of different HR practices for new teachers in primary education. Besides the longstanding interest in educational leadership as a key element in teacher and student performance, there is a growing interest in strategic human resource management (SHRM) in the educational sector. However, few educational studies link educational leadership to SHRM. In particular, this study examines the relationship between principals' instructional and transformational leadership style and principals' strategic and HR orientation in configuring HR practices for new teachers. Data were gathered using a mixed methods approach, including interviews with 75 principals as well as an online survey of 1058 teachers in Flemish primary education. Qualitative interview data were transformed and analysed together with the quantitative survey data using logistic regression and ANOVA analyses. The results indicate that both instructional and transformational leadership is associated with the strategic orientation of principals. The HR orientation, on the other hand, is not reflected in the principals' leadership style. Recommendations for further research in this area are discussed.