Organisational resilience in UK acute hospitals: an exploratory case study and empirical analysis

Organisational resilience in healthcare is important if hospitals are to recover effectively from unexpected events, such as infection outbreaks and manage successfully the continuous pressure from hospital associated infections. Yet studies of resilience in hospital organisations are rare and organisational resilience theory is insufficiently developed. The aim of this thesis is to examine organisational resilience in UK acute hospitals, through a case study and empirical analysis. The objectives are to investigate what is known about the concept, associated factors and application of organisational resilience to hospitals, to explore theoretically and empirically the two contexts for organisational resilience (expected conditions and unexpected events) and finally to design and test a tool to measure organisational resilience in the context of an unexpected event. A multi-methods approach was adopted to examine organisational resilience. A literature and systematic review were carried out to establish the evidence-base for organisational resilience. These reviews informed two health care studies of organisational resilience; a micro and meso-level case study exploring an unexpected infection outbreak and a macro-level study assessing the system response to infections as continuous stressors on routine practice. The case study informed the design and testing of an organisational resilience questionnaire. The key contributions to the literature were: firstly a novel multidisciplinary resilience questionnaire from which a framework of organisational resilience constructs was developed; secondly, a modest theoretical contribution of an intermediate resilience category within a framework that identifies levels of resilient practice and associated sensemaking characteristics; and thirdly, a positive example of ICT-enabled national surveillance programmes that increased hospitals’ resilience to infection through the enrolment of clinical leaders in self-surveillance. In conclusion, this research has generated novel, empirically-derived theoretical developments to this field of study that facilitate the measurement, application and improved conceptualisation of organisational resilience.Open Acces

Public Health

Public health can be thought of as a series of complex systems. Many things that individual living in high income countries take for granted like the control of infectious disease, clean, potable water, low infant mortality rates require a high functioning systems comprised of numerous actors, locations and interactions to work. Many people only notice public health when that system fails. This book explores several systems in public health including aspects of the food system, health care system and emerging issues including waste minimization in nanosilver. Several chapters address global health concerns including non-communicable disease prevention, poverty and health-longevity medicine. The book also presents several novel methodologies for better modeling and assessment of essential public health issues

An Ethical Model for Mandatory Reporting to Avoid Preventable Adverse Harm in Health Care

The goal of the dissertation is to undertake an analysis in healthcare ethics that focuses upon organizational ethics to resolve problems related to medical error in the U.S. The ethical argument focuses upon justifying a model of mandatory reporting nationally. While countless others have argued in favor of the implementation of a mandatory reporting system, this dissertation presents its model through the lens of organizational theory; arguing first that healthcare organizations are ethically required to invest in patient safety. This premise frames the foundation for this dissertation\u27s central argument; namely, that U.S. healthcare organizations have an ethical imperative to protect the public from undue harm. Only after having established this normative foundation does this dissertation address the primary obstacle to improving patient safety (the current culture of medicine) and offer suggestions for how to begin to build a business case to incentivize decisive action to develop a culture of safety. The ethical argument explores the justification for developing a centralized, mandatory, non-punitive reporting system that can collect and disseminate adverse event information to a national audience. The analysis relates two foundational concepts to advance this argument: namely, the system-based approach to patient safety and institutional moral agency. The discussion of the systems-based approach to patient safety informs the stance that healthcare organizations are uniquely situated to intervene to reduce medical error. This approach emphasizes the role of system defenses, barriers, and safeguards in preventing errors; recognizing that, because humans are fallible and cannot be made perfect, reform efforts need to focus on system design to prevent harm. The second concept provides a normative framework to hold healthcare organizations morally accountable for failures in system design. Without moral agency, organizations cannot be held accountable for their institutional practices or use of systems. Together, these concepts provide an ethical framework to advocate for greater transparency and the nationwide implementation of a mandatory reporting system for preventable adverse harm