Managing Conflict: A Constructivist Grounded Theory Exploring Collaborating Under Conditions of Mandate In English Health and Wellbeing Boards

The focus of this thesis is related to the interactions that occur between people collaborating under conditions of mandate and how these interactions are managed, in a health, social care and public health context in England. In adopting a constructivist approach to Grounded Theory (Charmaz, 2006) the basic social process of managing conflict was constructed which is a substantive theory grounded in the data. The substantive grounded theory was developed from the interviews and observations of thirty mandated collaborating members of a North East Health and Wellbeing Board, as they collaborated under conditions of mandate for the organising and provision of local care. The constant comparison analysis of the data revealed that when collaboratives in a health, social care and public health context are mandated, essential elements of the process are omitted and this allows conflict as a multifaceted issue to manifest within the interactions between individuals. Conflict in relation to this study was conceptualised as being located in, interacting identities, democratising the decision-making practices and coping with the traditions of others. Conflict for these participants developed as a result of health and social care professionals and democratically elected members, being mandated to collaborate for the integration of local care. Decision-making practises that had traditionally been left to the professional members of this group. The participants in this study were analysed as managing conflict through the three conceptual domains of: interacting orientations, interacting positions and interacting strategies.These findings represent the first study of mandated collaboration at the micro-sociological level which explores the interactions between people who collaborate under conditions of mandate

Polycentric Governance of Interorganizational Systems: Managerial and Architectural Arrangements

In an increasingly digital world, introducing new interorganizational systems requires establishing associations and relying on contributions of multiple actors that control existing technical solutions. This article examines the question: “how can large-scale system implementations across multiple organizations be governed in situations of distributed control over components?”. To answer this question, we present the findings of a longitudinal case study on the introduction of e-prescription in Norway over a 14-year period. The findings point to complementary architectural and managerial arrangements that make possible a polycentric governance approach. This work contributes to research on Information Systems Governance by providing insights relevant to mandating large-scale system implementations across organizations by mobilizing and orienting multiple contributors that control various pre-existing solutions

Integration and Continuity of Primary Care: Polyclinics and Alternatives, a Patient-Centred Analysis of How Organisation Constrains Care Coordination

Background An ageing population, increasingly specialised of clinical services and diverse healthcare provider ownership make the coordination and continuity of complex care increasingly problematic. The way in which the provision of complex healthcare is coordinated produces – or fails to – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational, relational). Care coordination is accomplished by a combination of activities by: patients themselves; provider organisations; care networks coordinating the separate provider organisations; and overall health system governance. This research examines how far organisational integration might promote care coordination at the clinical level. Objectives To examine: 1. What differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical coordination of care. 2. What difference provider ownership (corporate, partnership, public) makes. 3. How much scope either structure allows for managerial discretion and ‘performance’. 4. Differences between networked and hierarchical governance regarding the continuity and integration of primary care. 5. The implications of the above for managerial practice in primary care. Methods Multiple-methods design combining: 1. Assembly of an analytic framework by non-systematic review. 2. Framework analysis of patients’ experiences of the continuities of care. 3. Systematic comparison of organisational case studies made in the same study sites. 4. A cross-country comparison of care coordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics. 5. Analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute in-patient care. Results Starting from data about patients' experiences of the coordination or under-coordination of care we identified: 1. Five care coordination mechanisms present in both the integrated organisations and the care networks. 2. Four main obstacles to care coordination within the integrated organisations, of which two were also present in the care networks. 3. Seven main obstacles to care coordination that were specific to the care networks. 4. Nine care coordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than were care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care coordination because of its impact on GP workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions On balance, an integrated organisation seems more likely to favour the development of care coordination, and therefore continuities of care, than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings

Interagency training to support the liaison and diversion agenda

Background In England and Wales there are an unacceptably large number of people in prison or in contact with the criminal justice system who have mental health issues. Integrated and effective interagency collaboration is required between the criminal justice system and mental health services to ensure early diagnosis, treatment, appropriate sentencing or diversion of these individuals from the criminal justice systems into mental health services. Liaison and diversion schemes are proposed as a means to integrated service provision through positioning mental health professionals within the criminal justice system. These schemes were recommended by the Bradley Report (2009) to be rolled out for all police custody suites and courts by 2014 in a National Diversion Programme. Working within these schemes, at the interface of the criminal justice system and mental health services, has its challenges (Hean et al., 2009) and the workforce from both systems must be prepared to address these. This was recognised by Bradley when he recommended that: “where appropriate, training should be undertaken jointly with other services to encourage shared understanding and partnership working. Development of training should take place in conjunction with local liaison and diversion services (p111; Bradley, 2009). The form this joint training should take is as yet unexplored. We have proposed elsewhere that joint training should equip different agencies and professionals with the skills and knowledge required to collaborate effectively, and not only focus on mental health awareness courses for those in police, prison and courts services (Hean et al. 2011). The criminal justice system and mental health services need to come together to learn about, from, and with each other in interagency training. Aim We present in this report our vision of what this joint interagency training between the criminal justice and mental health services should contain, how it may be delivered and its potential benefits. We explore the receptiveness of professionals from the criminal justice and mental health services to interagency training and explore their perceptions of the challenges to interagency working between the two systems. We focus particularly on one particular dimension: an interagency crossing boundary workshop and its theoretical underpinnings. We explore professionals’ expectations of this type of intervention as well as their perceptions of the knowledge and skills required to deliver the emerging liaison and diversion agenda in general and the content and delivery of interagency training in the future. These findings are synthesized into a series of recommendations and a model of interagency training that will prepare professionals in both agencies to respond to the liaison and diversion agenda more effectively and work collaboratively in the interest of the mentally ill offender. Method A crossing boundary workshop (Engeström, 2001) was delivered in December 2011 to a sample of 52 professionals from a range of non-health professionals associated with criminal justice system (probation, police and courts) and professionals from the mental health system or health domain (learning disability, substance misuse and mental health services). The receptiveness of criminal justice system and mental health service professionals to interagency training was assessed through the Readiness for Interprofessional Learning Scale (Reid et al., 2005) administered to respondents before the workshop. Perceptions of the challenges facing interagency working and the expectations of the workshop were explored through interactive exercises. Professionals from both agencies participated in a series of 6 parallel focus groups to discuss how to prepare the workforce to respond effectively to the liaison/diversion agenda and the constraints they worked under in terms of commissioning, delivering and attending this training. Findings Professionals from both the mental health and criminal justice systems need to build empathic relationships with staff from other agencies. They stressed the importance of actual face-to-face contact between professionals from different agencies to achieve this and saw interagency relationships as being built through increased knowledge of other agencies and the orchestrating of formal facilitated contact between them. They were strongly in favour of interagency training and its contribution to enhanced collaborative competence across the workforce and, in the long term, improved offender mental health. They believed interagency training would develop in the workforce a greater knowledge of other agencies and help them understand other professionals’ roles and responsibilities. They believed interagency training should occur pre-qualification, through into continued professional development and contain a variety of interagency training experiences. Professionals from both systems shared a high level of person centredness in their approach to their practice and stressed the importance of training being grounded and delivered in a real world environment. Participants acknowledged that training opportunities are under threat due to financial and time limitations and that joint commissioning, shared resources and economies of scale must be considered. Recommendations • A training package should be developed to prepare professionals both from the mental health and criminal justice system for the liaison and diversion agenda and integrated service provision. This training must offer a strong interagency component aimed at developing interagency collaboration skills and interagency knowledge. A four-stage training model is proposed in this report. This incorporates pre-registration or undergraduate training for trainee professionals in the mental health services and criminal justice system, general awareness training, interagency training for continuing professional development and the development of interagency reflective practice opportunities. This model may be supplemented by a variety of on-line resources, some of which are described. • These interagency training models should be developed in partnership between universities and local facilitators from within the criminal justice system and mental health services to provide both the theoretical and evidence based rigour associated with developing collaborative practice curricula alongside the real world contextual knowledge required of these programmes. • In the long term, interagency training should be delivered in practice by practitioners to ensure the continued validity and sustainability of these programmes. Training should be sensitive to changes in the workforce due to turnover and the pressures of organisational change. • In times of economic constraint, training should be well targeted at staff and organisations essential to the liaison and diversion agenda. • An interagency commissioning approach will be required to deliver the training package outlined to support the liaison and diversion agenda, and especially if there is to be joint training and sharing of resources

Integration and continuity of primary care: polyclinics and alternatives - a patient-centred analysis of how organisation constrains care co-ordination

Background An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level. Objectives To examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care. Methods Multiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care. Results Starting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions On balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care

Worker voice and the health and safety regulatory system in New Zealand : an interpretivist case study inquiry in the commercial construction industry : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Management at Massey University, Palmerston North, New Zealand

Figures 2.1 and 3.2 are re-used with permission.The importance of involving workers in effective management of workplace health and safety (WHS) risks is well established. Transforming this rhetoric into sustainable practice continues to be a global problem. The siloed nature of industrial relations, WHS, human resource management and organisational behaviour debates has resulted in researchers talking past each other. Consequently, there is a dearth of literature drawing WHS research into contemporary debates exploring a broad range of direct and indirect forms of ‘worker voice’. The purpose of this thesis is to determine how and why the current statutory framework is contributing to enhancing workers’ involvement in workplace decisions that affect their WHS outcomes. This interpretivist constructivist multiple-case study applies a Multidisciplinary Analytical Model of Worker Voice to demonstrate how a multidisciplinary approach bridges divides and facilitates rich understanding of a contemporary phenomenon. The thesis clarifies the ambiguity and misunderstanding of terms that influence the interpretation and enactment of duties in the Health and Safety at Work Act 2015 (HSWA). It identifies and maps the different forms of worker engagement, participation and representation (EP&R) that exist under the current statutory provisions in New Zealand, and more importantly, the influence of worker voice. This research enables us to understand how and under what conditions worker EP&R can thrive. The two-phase study involved semi-structured interviews with 14 key stakeholders at the macro and industry levels, and 31 case study participants in three large commercial construction organisations at the meso level. Secondary qualitative data sources included 12 observations, and public and organisational documents. Hermeneutic analysis and interpretation revealed how the current HSWA stimulated improvements in leadership and risk management. The characteristics of effective worker voice systems were co-constructed with the key stakeholders and developed into an EP&R Compliance Maturity Model of Worker Voice. This model highlighted proactive and reactive responses to the HSWA in the organisations operating in a low-union, high-risk context. The overarching perceptions of the HSWA reinvigorating interest in worker voice underpinned improvements in macro level tripartism and meso level engagement. However, traditional representation structures have been eroded rather than strengthened

Cultural differences and corporate sustainability and responsibiblity in Norwegian-Russian business relations - the case of oil and gas industry

Masteroppgave i bedriftsledelse (MBA) - Universitetet i Nordland, 201

Institutionalising XBRL for financial reporting:resorting to regulation

By integrating and streamlining financial information within and among various organisations, eXtensible Business Reporting Language (XBRL) has been developed with a view to enhancing the efficiency, accuracy, and transparency of corporate accounting information. Taking an inter-organisational focus, this paper investigates the process of how XBRL was institutionalised. It explains and offers insights on how institutional arrangements emerge and become relevant as heterogeneous organisations consider adopting accounting innovations while evidence concerning their benefits is unavailable. The original and overall contribution of this study is that it improves current understanding of coal-face actors' perceptions, behaviours, and strategies as they interact in the organisational field and become engaged in developing accounting innovations to produce the macro-level observations documented in existing institutional theory studies

A STUDY OF GENDER IN SENIOR CIVIL SERVICE POSITIONS IN IRELAND. ESRI RESEARCH SERIES NUMBER 66 DECEMBER 2017

Women make up the majority of those employed in the civil service but are underrepresented at the most senior grades, where key policy and operational decisions are taken. Action 8 of the Civil Service Renewal Plan commits to improving gender balance at each level, including senior grades. The present study was commissioned by a high-level steering group set up to oversee implementation of this action. It draws on a combination of administrative data, reanalysis of the Civil Service Employee Engagement Survey conducted in 2015, and in-depth work history interviews with 50 senior civil servants across four departments. In addition, in-depth interviews were conducted with staff involved in recruitment and promotion within the public service. This rich combination of data yields new insights into the processes shaping gender differences in representation at the most senior grades of the civil service and thus provides a strong evidence base to inform future policy and practice

Micro-political aspects of mandate development and learning in local subsidiaries of multinational corporations

Beyond functional-structuralist approaches this paper sheds some light on micro political aspects of mandate development and learning processes in multinational corporations (MNC). As classical micro-political studies have shown, management behaviour and learning are not only constrained or enabled by certain structural and (national) cultural patterns, but have its own political agendas and are shaped by individual interests which leads to game playing, active or passive resistance and (re)negotiation of the 'rules of the game'. Based on the assumption that actors are neither the organs of given structures nor acting fully autonomous, the paper focuses on how subsidiary managers interpret and integrate individual, organisational as well as home and host country institutional factors into certain strategies of action. By discussing critical events in mini case studies on mandate development and learning in German subsidiaries in France we will highlight the interactive dynamics between key-actors micro-political strategies and particular institutional settings. Here we, firstly, discuss institutionalist approaches and investigate how different forms of home and host country embeddedness do influence the development of distinct managerial competences and decision making strategies at the subsidiary level. The paper refers then to the question how the overall strategy and multinational organisational design and policies relate to individual interests of key subsidiary actors. These can to higher or lower degrees be influenced by e.g. differences in nationalities, professional backgrounds as well as career stages, orientations and aspirations. By integrating these diverse relational layers, the paper will provide a more dynamic actor centred approach stressing both, the micro-political aspects and interactive construction of intra and intersubsidiary power relations, a key variable to explain mandate development and learning processes in MNCs. -- Über funktional-strukturalistische Ansätze hinausgehend, beschäftigt sich dieser Beitrag mit den mikropolitischen Aspekten von Mandatsentwicklungsprozessen in multinationalen Unternehmen. Im Zentrum der Betrachtung stehen die Strategien und Handlungsrationalitäten von Tochtergesellschaftsmanagern im Ausland. Anhand von drei Fallbeispielen zeigt der Beitrag wie Manager deutscher Auslandsgesellschaften in Frankreich individuelle, organisationale und institutionelle Faktoren (Heimat- und Gastlandeffekte) interpretieren und zu einer Handlungsstrategie verbinden. Ausgangspunkt ist dabei zunächst eine Diskussion relevanter Ansätze des Internationalen Managements und der international vergleichenden Organisationsforschung. Diese Ansätze werden um einen mikropolitischen Ansatz erweitert, der auf die spezifische Bedeutung von Nationalzugehörigkeit, professionellem Background und individueller Karriereorientierung bei Tochtergesellschaftsmanagern im Ausland abstellt.