Governance performance in complex environment: The case of a major transformation in a university hospital

Success factors for lean six sigma projects in healthcare

Identifying critical success factors (CSFs) of continuous improvement projects is crucial for management control and operations management domains. Despite the availability of manufacturing-related literature, studies on CSFs in more dynamic and complex healthcare-related operations are scarce. This study, based at a large public tertiary healthcare organization, identifies CSFs in implementing Lean Six Sigma (LSS). 62 LSS projects completed by Green Belts in consultation with Black Belts were analyzed for project success by a review team of practitioners (Black Belters) and academics. Using a grounded theory approach, numerous success factors were initially identified. A series of brainstorming sessions and workshops helped to narrow down and revise all the CSFs present in each of the 62 LSS projects to eight CSFs. The success of the 62 completed projects was assessed against each of the eight CSFs on a five-point Likert scale. Success was measured against whether the project met its stated aim and achieved the Key Performance Indicators that had initially been identified. Finally, the correlations of each factor rating against project success were analyzed to validate the relationship between each success factor and project success. The findings confirm that all eight CSFs identified are significantly correlated to project success. This study contributes to the management control, operations management, and healthcare literature by identifying CSFs of continuous improvement projects and introducing a relatively unique, rigorous, and practically proven evaluation method applied via an industry and academic partnership. Specified CSFs and the method used to identify these will benefit managers of continuous improvement projects.

Revisiting Organizational Design in the Light of Isomorphism and Equifinality: Insights from the Study of Three Major Transformation Projects

This article examines how governance mechanisms were put in place in three organizational transformation projects undertaken in university hospital centers. Our focus is guided by a theoretical discourse on the place of rational choices on organizational design versus the desire to imitate other organizations. The article presents two complementary points of view: a longitudinal study and a recent a posteriori reflection with five key players. A first result highlights efforts invested in the preparation stages and that these nevertheless resulted in comparable performances: hence, the concept of equifinality. However, a second result reveals complementarity between equifinality and institutional isomorphism.

Opening the Black Box of Benefits Management in the Context of Projects

Benefits management has recently gained in popularity but remains difficult to implement and conduct in organizations. Inspired by the practice perspective and building on an exploratory study, we reveal that defining benefits is a complex task, as the concept of benefit is understood in a variety of ways. We also expose the evolving nature of benefits management, highlighting that benefits management is far from a linear activity. Our study uncovers some of the social and political aspects of benefits management, which have up until now been neglected and may be connected to the challenges of this activity.

Lessons from a Surgical Center Satellite Warehouse in a Large Brazilian Public Hospital

Brazilian public hospitals face several operational problems not only related to poor public management practices and their complex nature, but also the economic, and social contexts. Considering this scenario and the fact that efforts in supply management might affect a hospital organization’s excellence, this research aims to identify improvements in the logistic operations at the surgical center satellite warehouse of a Public Hospital located in Brazil. A case study based on an exploratory and qualitative approach was conducted by employing document analysis, semi-structured interviews, and on-site observations. Seven major problems concerning lack of surgical material, the non-definition of crucial logistic parameters, low information flow, surgical supply control, and management problems were pointed and addressed by seven independent but complementary actions that considered the Brazilian healthcare system’s particularities. Given the nature of exploratory research, the results are not exhaustive and cannot be generalized to different contexts. However, they help understand that reducing the waste of the logistics processes makes it possible to improve the attention to the local population that uses public health services.

Tracing the Decisions That Shaped the Development of MyChart, an Electronic Patient Portal in Alberta, Canada: Historical Research Study

Background

Understanding how health organizations decide on information technology (IT) investments is imperative to ensure successful implementation and adoption. There is a high rate of failure and a tendency to downplay the complexity of implementation progression. Alberta Health Services introduced a patient portal called MyChart. Although MyChart allows patients to view appointments and selected laboratory results and to communicate with their providers, its uptake varies.

Objective

The study aimed to examine the institutional decision-making processes that shaped the development and implementation of MyChart.

Methods

A historical study was conducted based on the 7-step framework, where one engages in a rigorous archival critical analysis (including internal and external criticism) of documents and analysis of interviews. We reviewed and analyzed 423 primary and secondary sources and interviewed 10 key decision makers.

Results

Supportive leadership, project management, focused scope, appropriate technology and vendor selection, and quick decision making were some of the facilitators that allowed for the growth of proof of concept. The planning and implementation stages did not depend much on the technology itself but on the various actors who influenced the implementation by exerting power. The main barriers were lack of awareness about the technology, proper training, buy-in from diverse system leaders, and centralized government decision making.

Conclusions

Organizational priorities and decision-making tactics influence IT investments, implementation, adoption, and outcomes. Future research could focus on improving the applicability of needs assessments and funding decisions to health care scenarios.

A hermeneutic-phenomenological study of paediatric intensive care unit nurses' professional identity following hospital redesign: Lessons learned for managers

AIM

To provide insights for health care managers by exploring paediatric intensive care unit nurses' lived experience of professional identity in the context of organisational change.

BACKGROUND

While professional identity improves retention of nurses and provision of quality care, outcomes of importance for managers, organisational change perturbs this identity.

METHOD

The study used a hermeneutic-phenomenological design. Data were collected via individual interviews, photographs, participant observation and document review. A purposive sampling strategy was used to recruit paediatric intensive care unit nurses (n = 15) in a large Canadian paediatric hospital.

RESULTS

Nurses' critical care identity eroded in this organisation due to the interplay between hospital redesign and new eligibility criteria for patient admissions.

CONCLUSION

Interactions between multiple projects and the unit context, as well as nursing professional identity, need to be considered early on during project planning. This study fills an important gap in research concerning the management challenges brought about by the intersection of multiple changes.

IMPLICATIONS FOR NURSING MANAGEMENT

The results from this study bring to light three important lessons for nurse managers: 1) the specific unit context should be evaluated before a project is initiated; 2) the physical environment needs to be considered when determining staffing requirements; and 3) identity transitions need to be managed.

How Project Management and Top Management Involvement Affect the Innovativeness of Professional Service Organizations—An Empirical Study on Hospitals

This study investigates how top management involvement and project management professionalization affect firm innovativeness. We focus on hospitals as representative of professional service organizations characterized by pluralistic individual and organizational interests. A multiyear analysis of project management survey and objective performance data of 90 hospitals indicates that top management involvement in innovation projects reduces hospital innovativeness, and project management professionalization increases hospital innovativeness. However, increasing project management professionalization simultaneously strengthens top management involvement’s effectiveness. The results contribute to our understanding of potential interactions and different effects of project management efforts at different organizational levels in professional service organizations.

A Discursive Sensemaking Perspective on Project-Based Work in Public Healthcare

This study investigates project participants’ sensemaking of lived work experiences during periods of organizational change within Finnish public healthcare. It introduces a discursive sensemaking perspective to investigate lived experiences, that is, reflexive practitioners’ situational thinking. Drawing upon 17 interviews, the study identifies diverse repertoires through which the lived experiences are considered meaningful. These are repertoires of: (1) transformation, (2) realism, (3) politics, (4) individuality, (5) reflexivity, and (6) senselessness. The results show that project-based work in public healthcare differs from project participants’ expectations because projects are perceived to increase rather than decrease bureaucracy and include unsustainable working conditions that have to be endured.

A Health Care Project Management Office's Strategies for Continual Change and Continuous Improvement

Health care organizations need project and change management support in order to achieve successful transformations. A project management office (PMO) helps support the organizations through their transformations along with increasing their capabilities in project and change management. The aim of the present study was to extend understanding of the continuous improvement mechanisms used by PMOs and to describe PMO's strategies for continual change and continuous improvement in the context of major transformation in health care. This study is a descriptive case study design with interviews conducted from October to December 2015 with PMO's members (3 managers and 1 director) and 3 clients working with the PMO after a major redevelopment project ended (transition to the new facility). Participants suggested a number of elements including carefully selecting the members of the PMO, having a clear mandate for the PMO, having a method and a discipline at the same time as allowing openness and flexibility, clearly prioritizing projects, optimizing collaboration, planning for everything the PMO will need, not overlooking organizational culture, and retaining the existing support model. This study presents a number of factors ensuring the sustainability of changes.

Project Management Office Transformations: Direct and Moderating Effects that Enhance Performance and Maturity

This article aims at understanding organizational change through the study of project management office (PMO) transformations. This article suggests that performance resulting from a PMO transformation is moderated by the organizational context, change management, and by changes in coordination mechanisms—control or service orientation. This exploratory study adopted a quantitative methodology involving a sample of 184 PMO changes. It confirms the multifaceted nature of the context involved in a PMO transformation. External events play a key role in triggering change and improving performance. Key findings suggest that increasing the PMO's supportive role improves project performance, business performance, and project management maturity. Conversely, increasing the PMO's control role does not improve performance. This study's major contribution is to provide some empirical evidence concerning organizational change management.

Multi-Level Efficacy Evidence of a Combined Interprofessional Collaboration and Project Management Training Program for Healthcare Project Teams

Project work is essential for the improvement of healthcare organizations; yet, project management and collaboration in the project context are not taught to healthcare professionals. Three half-day training workshops integrating project management and collaboration were designed and delivered to 14 interprofessional healthcare project teams. Multivariate measures were taken over the course of 36 weeks. Individual, team, and project-level results showed high satisfaction and perceptions of utility; improved self-efficacy for project-specific task work and teamwork; increased goal clarity and coordination; and a significant impact on the functional performance of projects. This study provides initial benchmark measures regarding the pertinence of project management and interprofessional collaboration training for healthcare project teams.

Gestão dos Stakeholders na Captação de Recursos nos Hospitais Filantrópicos e Religiosos

Os hospitais sem fins lucrativos de origem religiosa constituem uma parte vital do sistema de saúde no Brasil. Pela natureza da atividade que desenvolvem, esses hospitais têm uma enorme pluralidade de stakeholders e um complexo processo de criação de valor. Este estudo tem por objetivo compreender a potencial associação entre a gestão dos stakeholders e o sucesso na captação de contribuições financeiras voluntárias. O tema em análise situa-se na área do comportamento organizacional e está pouco explorado na literatura, por isso optou-se por uma investigação qualitativa e exploratória. Com base em fontes documentais e em entrevistas semiestruturadas com os presidentes dos conselhos de administração, desenvolveu-se um estudo comparativo de dois casos (hospitais). O quadro teórico de referência cruza os fundamentos da Teoria dos Stakeholders com a Teoria da Dependência de Recursos. O estudo revelou que, em ambos os casos, a gestão dos stakeholders é ainda incipiente e pouco estruturada; consequentemente, não foi possível responder conclusivamente à questão de partida. Contudo esta pesquisa traz importantes esclarecimentos sobre a questão e abre novas possibilidades de investigação.