Strategic Flexibility in Not-For-Profit Acute Care Hospitals

ABSTRACT STRATEGIC FLEXIBILITY IN NOT-FOR-PROFIT ACUTE CARE HOSPITALS by Donna F. M. Jamieson Despite multiple industry cycles of rapid and complex changes in the last three decades, the body of research in health care services strategy has not addressed the idea of strategic flexibility, that is, when and how should strategy evolve under conditions of environmental turbulence. Strategic flexibility has been defined in the literature as the ability to adapt to rapidly changing conditions by leveraging internal resources and competencies to effectively compete. With increasing scope of responsibility in both nursing and non-nursing functional areas, nurse executives have not only participated as members of the executive team in setting strategic direction for hospitals but also developed specific strategic agendas for how nursing contributes to the overall value of a hospital\u27s services. With few studies available to guide practice development, a paucity of information exists on how nurse executives should conduct strategic planning and what particularly leads to effective adaptation. A multi-case study research approach explored how acute care hospitals manifested strategic flexibility in response to changing conditions and how nurse executives played a role in developing and using those flexibilities. Seventeen nurse executives from seven acute care hospitals in a midwestern metropolitan area participated in the study. Using interview data, document analysis and field observations, a combination of operational, tactical and strategic level types of strategic flexibility were noted at all seven hospitals. Strategic flexibility was associated with external environmental conditions related to policy changes, market dynamics and consumer perspectives. External conditions were associated with three internal conditions related to human resources, facility renovations and hospital culture. Nurse executives demonstrated various examples of tactical and strategic flexibilities, playing a major role in developing strategic flexibility. An unexpected finding was the discovery of five subcategories of tactical flexibilities. Results from the study provide a beginning description of strategic flexibility in hospitals. Examples of strategic flexibility identified in this study can be used to operationally define and, thus, measure strategic flexibility. The possibility of measuring strategic flexibility allows for other empiric studies of how strategic flexibility influences hospital performance such as patient care outcomes and quality of care

Control of Hospital Strategy in Small Multihospital Systems

Hospitals are joining multihospital systems (MHSs) with growing frequency. About 80% of MHSs are small, composed of 2-7 hospitals. An important management issue in MHSs is the extent to which member hospitals retain control over their own strategic directions. Using a contingency framework, this study uses both system and hospital—level determinants to explain the extent to which hospital members of MHSs control their own strategies. Survey and secondary data from 272 member hospitals of 62 small multi hospital systems (size 2-7 hospitals) are analyzed. System dispersion, size, ownership, strategic type, and age along with hospital occupancy, size, relationship to the MRS, and market factors are determinants of hospital control of strategy. Two types of hospital strategic decisions were revealed by factor analysis: tactical and periodic. For tactical decisions, such as those relating to hospital budgets, service additions, and formulation of strategies, Catholic system ownership is a significant predictor of greater hospital control. Prospector system strategy and older system age are significant predictors of reduced hospital control. For periodic decisions, such as appointment of hospital board members, sale of hospital assets, and changes in bylaws, older system age is negatively associated with hospital control, and a hospital which is owned by the system has significantly less control. The results are analyzed using the framework of the Hickson, Butler, Cray, Mallory, & Wilson (1986) typology of strategic decisions. Thus the results of this work can be useful to managers in identifying the nature of a decision and understanding its associated decision process

Developing A Personal Decision Support Tool for Hospital Capacity Assessment and Querying

This article showcases a personal decision support tool (PDST) called HOPLITE, for performing insightful and actionable quantitative assessments of hospital capacity, to support hospital planners and health care managers. The tool is user-friendly and intuitive, automates tasks, provides instant reporting, and is extensible. It has been developed as an Excel Visual Basic for Applications (VBA) due to its perceived ease of deployment, ease of use, Office's vast installed userbase, and extensive legacy in business. The methodology developed in this article bridges the gap between mathematical theory and practice, which our inference suggests, has restricted the uptake and or development of advanced hospital planning tools and software. To the best of our knowledge, no personal decision support tool (PDST) has yet been created and installed within any existing hospital IT systems, to perform the aforementioned tasks. This article demonstrates that the development of a PDST for hospitals is viable and that optimization methods can be embedded quite simply at no cost. The results of extensive development and testing indicate that HOPLITE can automate many nuanced tasks. Furthermore, there are few limitations and only minor scalability issues with the application of free to use optimization software. The functionality that HOPLITE provides may make it easier to calibrate hospitals strategically and/or tactically to demands. It may give hospitals more control over their case-mix and their resources, helping them to operate more proactively and more efficiently.Comment: 33 pages, 11 tables, 17 figure

Sustainable supply chain management in the digitalisation era: The impact of Automated Guided Vehicles

Internationalization of markets and climate change introduce multifaceted challenges for modern supply chain (SC) management in the today's digitalisation era. On the other hand, Automated Guided Vehicle (AGV) systems have reached an age of maturity that allows for their utilization towards tackling dynamic market conditions and aligning SC management focus with sustainability considerations. However, extant research only myopically tackles the sustainability potential of AGVs, focusing more on addressing network optimization problems and less on developing integrated and systematic methodological approaches for promoting economic, environmental and social sustainability. To that end, the present study provides a critical taxonomy of key decisions for facilitating the adoption of AGV systems into SC design and planning, as these are mapped on the relevant strategic, tactical and operational levels of the natural hierarchy. We then propose the Sustainable Supply Chain Cube (S2C2), a conceptual tool that integrates sustainable SC management with the proposed hierarchical decision-making framework for AGVs. Market opportunities and the potential of integrating AGVs into a SC context with the use of the S2C2 tool are further discussed

Physicians Scheduling In Polyclinics

Physician scheduling is an important part of hospital operation management. Fatigue, nervousness, high levels of stress and depression are common negative effects of inappropriate work schedules on physicians. A robust and automated personnel scheduling system, which satisfies physicians' preferences, not only improves the quality of life for physicians but also helps to provide a better care for patients and potentially makes significant savings in time and cost for hospitals. Polyclinics reduce the burden on hospitals and help bridge the gap between primary and secondary care. They provide various hospital services such as X-rays, minor surgeries and out-patient treatment and gather several practices under one roof to cooperate, interact and share available resources. In addition, this structure provides an opportunity for physicians of different disciplines to work together and enables patients with chronic and complex conditions to visit multiple clinics at the same place during the same visit. Our problem of interest is mainly motivated by an extension of physician scheduling problems arising in ambulatory polyclinics, where the interaction of clinics and its consequences in terms of sharing their scarce resources introduce new constraints and add complexity to the problem. In the first part of this thesis, we present an integrated physician and clinic scheduling problem arising in ambulatory cancer treatment polyclinics, where patients may be assessed by multiple physicians from different clinics in a single visit. The problem focuses on assigning clinic sessions and their associated physicians to shifts in a finite planning horizon. The complexity of this problem stems from the fact that several interdisciplinary clinics need to be clustered together, sharing limited resources. The problem is formulated as a multi-objective optimization problem. Given the inherent complexity for optimally solving this problem with a standard optimization software, we develop a hybrid algorithm based on iterated local search and variable neighborhood descent methods to obtain high quality solutions. In the second part we propose a comprehensive bi-level physicians planning framework for polyclinics under uncertainty. The first level focuses on clinic scheduling and capacity planning decisions, whereas the second level deals with physicians scheduling and operational adjustments decisions. In order to protect the generated schedules against demand uncertainty, the first level is modeled as an adjustable robust scheduling problem which is solved using an ad-hoc cutting plane algorithm. To cope with variability in patients' treatment times, we formulate the second level as a two-stage stochastic problem and use a sample average approximation scheme to obtain solutions with small optimality gaps. Moreover, we use a Monte-Carlo simulation algorithm to demonstrate the potential benefits of using our planning framework. In the last part of this thesis we investigate on the impact of physicians work schedules on patient wait-time under uncertain arrival pattern and treatment time of patients. We provide a methodology that combines discrete-event simulation with an optimization search routine to minimize patient wait-time and physician overtime subject to several scheduling/resource restrictions. We indicate the significant impact of adopting the proposed simulation optimization framework for physician scheduling on reducing the aforementioned key performance measures

The geography of strain: organizational resilience as a function of intergroup relations

Organizational resilience is an organization’s ability to absorb strain and preserve or improve functioning, despite the presence of adversity. In existing scholarship there is the implicit assumption that organizations experience and respond holistically to acute forms of adversity. We challenge this assumption by theorizing about how adversity can create differential strain, affecting parts of an organization rather than the whole. We argue that relations among those parts fundamentally shape organizational resilience. We develop a theoretical model that maps how the differentiated emergence of strain in focal parts of an organization triggers the movements of adjoining parts to provide or withhold resources necessary for the focal parts to adapt effectively. Drawing on core principles of theories about intergroup relations, we theorize about three specific pathways—integration, disavowal, and reclamation—by which responses of adjoining parts to focal part strain shape organizational resilience. We further theorize about influences on whether and when adjoining parts are likely to select different pathways. The resulting theory reveals how the social processes among parts of organizations influence member responses to adversity and, ultimately, organizational resilience. We conclude by noting the implications for organizational resilience theory, research, and practice.Accepted manuscrip