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Rizzo MG. Exploring the relationship between performance feedback and medical managers' budgetary performance:The role of managerial self-efficacy. Health Serv Manage Res 2024; 37:135-142. [PMID: 37247431 DOI: 10.1177/09514848231179177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study addresses recent calls for more research on the potential intervening role exerted by certain individual variables in the relationship between performance feedback and performance. Specifically, this study selects medical managers' sense of managerial self-efficacy as a potential mediational variable in the feedback-performance relationship. A mediational model examining how the effect of performance feedback on medical managers' budgetary performance is influenced by their sense of managerial self-efficacy was established based on survey data from 60 medical managers working in a hospital. Data analysis was conducted using the partial least squares technique, and the results confirmed the hypothesised relationships. Specifically, performance feedback was positively associated with managerial self-efficacy, and managerial self-efficacy exerted a positive influence on medical managers' budgetary performance. Further, performance feedback was determined not to be directly associated with budgetary performance; however, a full mediating effect of managerial self-efficacy was found. These findings make several contributions to the literature and can help healthcare managers have a better understanding of the consequences and importance of the technical features of performance feedback reports.
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Affiliation(s)
- Marco Giovanni Rizzo
- Dipartimento di Scienze dell'economia e della gestione aziendale, Facoltà di Economia, Universita Cattolica del Sacro Cuore, Milano, Italy
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Prenestini A, Calciolari S, Rota A. Keep-or-drop multidimensional control systems in professional organisations: evidence on the use of the balanced scorecard in healthcare. J Health Organ Manag 2024; 38:157-174. [PMID: 38623886 PMCID: PMC11345843 DOI: 10.1108/jhom-09-2023-0287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/17/2024] [Accepted: 02/21/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE During the 1990s, Italian healthcare organisations (HOs) underwent a process of corporatisation, and the most innovative HOs introduced the balanced scorecard (BSC) to address the need for broader accountability. Currently, there is a limited understanding of the dynamics and outcomes of such a process. Therefore, this study aims to explore whether the BSC is still considered an effective performance management tool and analyse the factors driving and hindering its evolution and endurance in public and non-profit HOs. DESIGN/METHODOLOGY/APPROACH We conducted a retrospective longitudinal analysis of two pioneering cases in the adoption of the BSC: one in a public hospital and the other in a non-profit hospital. Data collection relied on accessing institutional documents and reports from the early 2000s to the present, as well as conducting semi-structured interviews with the internal sponsors of the BSC. FINDINGS We found evidence of three main categories of factors that trigger or hinder the adoption and development of the BSC: (1) the role of the internal sponsor and professionals' commitment; (2) information technology and the controller's technological skills; and (3) the relationship between the management and professionalism logics during the implementation process. At the same time, there is no evidence to suggest that specific technical features of the BSC influence its endurance. ORIGINALITY/VALUE The paper contributes to the debate on the key factors for implementing and sustaining multidimensional control systems in professional organisations. It emphasises the importance of knowledge-based assets and distinctive internal capabilities for the success of the business. The implications of the BSC legacy are discussed, along with future developments of multidimensional control tools aimed at supporting strategy execution.
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Affiliation(s)
- Anna Prenestini
- Department of Economics, Management and Quantitative Methods,
Università degli Studi di Milano, Milan,
Italy
| | - Stefano Calciolari
- Department of Economics, Management, and Statistics,
Università degli Studi di Milano-Bicocca,
Milan, Italy
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Sartirana M, Giacomelli G. Hybridity enabled: A research synthesis of the enabling conditions for hybrid professionalism in healthcare. Health Serv Manage Res 2024; 37:2-15. [PMID: 36651108 DOI: 10.1177/09514848231151829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hybrid professionals in healthcare organizations play a critical role, the characteristics, processes and implications of which have been thoroughly studied by scholars in the field. However, not as much attention has been paid to the conditions under which such roles might be taken by professionals entering the ground of management. This gap results into a lack of conceptual clarity and eventually ends being an obstacle in framing and ameliorating the tools needed to act such a role in its different phases. This is a research area worthy of a finer-grained understanding: the ability of organizations to effectively support role hybridization, in fact, is a requisite for professionals-managers' willingness to stay in the role and cope with the complexity that such a two-fold position entails, no matter what. Based on the results of a scoping literature review, this paper presents the enabling conditions for hybrid professionalism in healthcare, and proposes a classification of them into categories corresponding to different facets of hybrid role-taking: opportunities for interaction with management, tools supporting sense-making, and provision of delegation and autonomy. For each of these categories, organizational and management tools discussed in the literature are presented. The results of the study provide a road-map of the enabling conditions for hybrid professionalism that aims to be of practical convenience for managers and policy-makers in health care. Eventually, suggestions for organizational design and personnel management, as well as directions for further research, are highlighted.
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Affiliation(s)
- Marco Sartirana
- CERGAS (Centre for Research on Healthcare Management), SDA Bocconi School of Management, Milan, Italy
| | - Giorgio Giacomelli
- GHNP Government, Health & Not for Profit, SDA Bocconi School of Management, Milan, Italy
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Prenestini A, Palumbo R, Grilli R, Lega F. Exploring physician engagement in health care organizations: a scoping review. BMC Health Serv Res 2023; 23:1029. [PMID: 37749568 PMCID: PMC10521513 DOI: 10.1186/s12913-023-09935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 08/18/2023] [Indexed: 09/27/2023] Open
Abstract
RATIONALE Enhancing health system effectiveness, efficiency, and appropriateness is a management priority in most world countries. Scholars and practitioners have focused on physician engagement to facilitate such outcomes. OBJECTIVES Our research was intended to: 1) unravel the definition of physician engagement; 2) understand the factors that promote or impede it; 3) shed light on the implications of physician engagement on organizational performance, quality, and safety; and 4) discuss the tools to measure physician engagement. METHOD A scoping review was undertaken. Items were collected through electronic databases search and snowball technique. The PRISMA extension for Scoping Reviews (PRISMA-ScR) statement and checklist was followed to enhance the study replicability. RESULTS The search yielded 16,062 records. After an initial screening, 300 were selected for potential inclusion in this literature review. After removing duplicates and records not meeting the inclusion criteria, full-text analysis of 261 records was performed, yielding a total of 174 records. DISCUSSION Agreement on the conceptualization of physician engagement is thin; furthermore, scholars disagree on the techniques and approaches used to assess its implementation and implications. Proposals have been made to overcome the barriers to its adoption, but empirical evidence about implementing physician engagement is still scarce. CONCLUSIONS Our scoping review highlights the limitations of the extant literature about physician engagement. Physician engagement is a relatively ill-defined concept: developing an evidence base for its actual implementation is necessitated to provide reliable guidance on how the governance of health care organizations could be improved. Although we did not assess the quality or the robustness of current empirical research, our findings call for further research to: 1) identify potential drivers of physician engagement, 2) develop dependable assessment tools providing health care organizations with guidance on how to foster physician engagement, and 3) evaluate engagement's actual impact on health care organizations' performance.
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Affiliation(s)
- Anna Prenestini
- Department of Economics, Management and Quantitative Methods (DEMM) and Center of Research and Advanced Education in Health Administration (CRC HEAD), Università Degli Studi Di Milano, Milan, Italy.
| | - Rocco Palumbo
- Department of Management & Law, Università Degli Studi Di Roma Tor Vergata, Rome, Italy
| | - Roberto Grilli
- Health Services Research, Evaluation and Policy Unit, Local Health Authority of Romagna, Ravenna, Italy
| | - Federico Lega
- Department of Biomedical Sciences for Health (SCIBIS) and Center of Research and Advanced Education in Health Administration (CRC HEAD), Università Degli Studi Di Milano, Milan, Italy
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Neuber L, Englitz C, Schulte N, Forthmann B, Holling H. How work engagement relates to performance and absenteeism: a meta-analysis. EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2021. [DOI: 10.1080/1359432x.2021.1953989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lina Neuber
- Department of Psychology, University of Münster, Münster, Germany
| | - Colinda Englitz
- Department of Psychology, University of Münster, Münster, Germany
| | - Niklas Schulte
- Department of Psychology, University of Münster, Münster, Germany
- Niklas Schulte Is Now at the Department of Psychology at Ulm University, Ulm, Germany
| | - Boris Forthmann
- Department of Psychology, University of Münster, Münster, Germany
| | - Heinz Holling
- Department of Psychology, University of Münster, Münster, Germany
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Savage M, Savage C, Brommels M, Mazzocato P. Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature. BMJ Open 2020; 10:e035542. [PMID: 32699130 PMCID: PMC7375428 DOI: 10.1136/bmjopen-2019-035542] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The influx of management ideas into healthcare has triggered considerable debate about if and how managerial and medical logics can coexist. Recent reviews suggest that clinician involvement in hospital management can lead to superior performance. We, therefore, sought to systematically explore conditions that can either facilitate or impede the influence of medical leadership on organisational performance. DESIGN Systematic review using thematic synthesis guided by the Enhancing Transparency in Reporting the synthesis of Qualitative research statement. DATA SOURCES We searched PubMed, Web of Science and PsycINFO from 1 January 2006 to 21 January 2020. ELIGIBILITY CRITERIA We included peer-reviewed, empirical, English language articles and literature reviews that focused on physicians in the leadership and management of healthcare. DATA EXTRACTION AND SYNTHESIS Data extraction and thematic synthesis followed an inductive approach. The results sections of the included studies were subjected to line-by-line coding to identify relevant meaning units. These were organised into descriptive themes and further synthesised into analytic themes presented as a model. RESULTS The search yielded 2176 publications, of which 73 were included. The descriptive themes illustrated a movement from 1. medical protectionism to management through medicine; 2. command and control to participatory leadership practices; and 3. organisational practices that form either incidental or willing leaders. Based on the synthesis, the authors propose a model that describes a virtuous cycle of management through medicine or a vicious cycle of medical protectionism. CONCLUSIONS This review helps individuals, organisations, educators and trainers better understand how medical leadership can be both a boon and a barrier to organisational performance. In contrast to the conventional view of conflicting logics, medical leadership would benefit from a more integrative model of management and medicine. Nurturing medical engagement requires participatory leadership enabled through long-term investments at the individual, organisational and system levels.
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Affiliation(s)
- Mairi Savage
- Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Carl Savage
- Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Mats Brommels
- Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Pamela Mazzocato
- Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Liu S, Zhou H. The Role of Sense of Power in Alleviating Emotional Exhaustion in Frontline Managers: A Dual Mediation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2207. [PMID: 32218332 PMCID: PMC7177885 DOI: 10.3390/ijerph17072207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/10/2020] [Accepted: 03/21/2020] [Indexed: 11/17/2022]
Abstract
Frontline managers have many responsibilities and often suffer from emotional exhaustion. Drawing on the job demands-resources model, this research proposes and examines a cognitive-affective dual mediation model to explain how frontline managers' sense of power affects their emotional exhaustion through managerial self-efficacy (cognitive path) and affective commitment (affective path). A cross-sectional study design was employed, and the theoretical model was tested using a three-wave survey among 227 on-the-job Master of Business Administration (MBA) students (52.86% male) in China, who serve as frontline managers in different kinds of organization. The regression and bootstrapping analysis results showed that the frontline managers' sense of power was significantly negatively related to emotional exhaustion. In other words, the more powerful they felt, the less exhausted they felt. Furthermore, having a sense of power enhanced managerial self-efficacy, which mitigated emotional exhaustion. Sense of power also boosted frontline managers' affective commitment, alleviating emotional exhaustion. We conclude with a discussion of this study's theoretical and practical contributions and future research directions.
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Affiliation(s)
| | - Hao Zhou
- Business School, Sichuan University, 29 Wangjiang Road, Chengdu 610064, China;
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Korlén S, Amer‐Wåhlin I, Lindgren P, Thiele Schwarz U. Exploring staff experience of economic efficiency requirements in health care: A mixed method study. Int J Health Plann Manage 2019; 34:1439-1455. [DOI: 10.1002/hpm.2813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sara Korlén
- Medical Management Centre, Department of LIME Karolinska Institutet Stockholm Sweden
| | - Isis Amer‐Wåhlin
- Medical Management Centre, Department of LIME Karolinska Institutet Stockholm Sweden
| | - Peter Lindgren
- Medical Management Centre, Department of LIME Karolinska Institutet Stockholm Sweden
- The Swedish Insitute for Health Economics Sweden
| | - Ulrica Thiele Schwarz
- Medical Management Centre, Department of LIME Karolinska Institutet Stockholm Sweden
- School of Health, Care and Social Welfare Mälardalen University Västerås Sweden
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Zonatto VCDS, Weber A, Nascimento JC. Efeitos da Participação Orçamentária na Assimetria Informacional, Estresse Ocupacional e Desempenho Gerencial. RAC: REVISTA DE ADMINISTRAÇÃO CONTEMPORÂNEA 2019. [DOI: 10.1590/1982-7849rac2019170327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Resumo A pesquisa investiga os efeitos da participação orçamentária na assimetria de informação, no estresse ocupacional e no desempenho gerencial junto a 121 gestores com responsabilidade orçamentária em organizações industriais brasileiras. Pesquisa descritiva, realizada por meio de levantamento, cuja abordagem é quantitativa. Os resultados evidenciam que na amostra observada os níveis de participação orçamentária diferem entre os gestores, assim como seu desempenho. A participação e o desempenho estão negativamente associados à ambiguidade de papéis e ao estresse no trabalho. Estes achados sugerem que maiores níveis de participação orçamentária contribuem para a redução da ambiguidade de papéis, dos níveis de estresse ocupacional e o alcance de melhor desempenho. As relações entre assimetria de informação e conflito de papéis com a participação e o desempenho não foram estatisticamente significativas. Estas evidências permitem concluir que a participação orçamentária influencia a ambiguidade de papéis, o estresse no trabalho e o desempenho gerencial, não sendo possível inferir conclusivamente sobre seus efeitos em relação à assimetria de informação e ao conflito de papéis. Fornece evidências de que os efeitos da participação no desempenho ocorrem de maneira direta e indireta, quando mediados pela variável de ambiguidade de papéis.
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Korlén S, Richter A, Amer-Wåhlin I, Lindgren P, von Thiele Schwarz U. The development and validation of a scale to explore staff experience of governance of economic efficiency and quality (GOV-EQ) of health care. BMC Health Serv Res 2018; 18:963. [PMID: 30541537 PMCID: PMC6292102 DOI: 10.1186/s12913-018-3765-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/23/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In publicly funded health care systems, governance models are developed to push public service providers to use tax payers' money more efficiently and maintain a high quality of service. Although this implies change in staff behaviors, evaluation studies commonly focus on organizational outputs. Unintended consequences for staff have been observed in case studies, but theoretical and methodological development is necessary to enable studies of staff experience in larger populations across various settings. The aim of the study is to develop a self-assessment scale of staff experience of the governance of economic efficiency and quality of health care and to assess its psychometric properties. METHODS Factors relevant to staff members' experience of economic efficiency and quality requirements of health care were identified in the literature and through interviews with practitioners, and then compared to a theoretical model of behavior change. Relevant experiences were developed into sub-factors and items. The scale was tested in collaboration with the Department of Rehabilitation Medicine at a university hospital. 93 staff members participated. The scale's psychometric properties were assessed using exploratory factor analysis, analysis of internal consistency and criterion-related validity. RESULTS The analysis revealed an eight factor structure (including sub-factors knowledge and awareness, opportunity to influence, motivation, impact on professional autonomy and organizational alignment), and items showed strong factor loadings and high internal consistency within sub-factors. Sub-factors were interrelated and contributed to the prediction of impact on clinical behavior (criterion). CONCLUSIONS The scale clearly distinguishes between various experiences regarding economic efficiency and quality requirements among health care staff, and shows satisfactory psychometric quality. The scale has broad applications for research and practice, as it serves as a tool for capturing staff members' perspectives when evaluating and improving health care governance. The scale could also be useful for understanding the underlying processes of changes in provider performance and for adapting management strategies to engage staff in driving change that contributes to increased economic efficiency and quality, for the benefit of health care systems, patients and staff.
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Affiliation(s)
- Sara Korlén
- Medical Management Centre, LIME, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Anne Richter
- Medical Management Centre, LIME, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Isis Amer-Wåhlin
- Medical Management Centre, LIME, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Peter Lindgren
- Medical Management Centre, LIME, Karolinska Institutet, 171 77 Stockholm, Sweden
- The Swedish Institute for Health Economics, Box 2017, 220 02 Lund, Sweden
| | - Ulrica von Thiele Schwarz
- Medical Management Centre, LIME, Karolinska Institutet, 171 77 Stockholm, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23 Västerås, Sweden
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Examining the role of value congruence, professional identity, and managerial job engagement in the budgetary participation-performance link. Health Care Manage Rev 2018; 45:290-301. [PMID: 30475259 DOI: 10.1097/hmr.0000000000000231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In health care, important phenomena of perceived incompatibility between professional and managerial values have emerged as consequences of New Public Management reforms. Although there is a growing evidence on the variation in the enactment of hybrid roles by medical managers, existing research in health care management is mostly descriptive with little emphasis on the conditions under which hybrid roles are enacted and, importantly, on the effects of this variation on performance. PURPOSE In this article, we seek to fill this research gap by empirically examining (a) whether budgetary participation aligns professional and organizational values, (b) the impact of this alignment on employees' work-related feelings and managerial performance, and (c) the effect of professional identity on value congruence. METHODOLOGY Data were collected by a survey conducted in an Italian hospital, and partial least square was used to test the relationships among variables. RESULTS Overall, results show that (a) high involvement in budgeting is instrumental in facilitating medical managers' value congruence, and this, in turn, positively effects managerial job engagement; (b) the effect of budgetary participation on value congruence depends on the extent of professional identity; and (c) as a result of enhanced value congruence and managerial job engagement, employees tend to deliver superior role performance. PRACTICE IMPLICATION Findings of this study provide some guidance for managers on how organizations can take steps to guarantee effective support to hybrid professionals.
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