Modelling the impact of extreme weather events on healthcare infrastructure using rich picture diagrams

Healthcare infrastructure for a community comprises not only its hospital but also many other related facilities such as primary care clinics, community health centres, rural nursing posts, aged care centres, etc. These facilities form a complex set of relationships which need to work collectively for an effective response to climatechange related extreme weather events such as floods and storms. The aim of this research is to develop a conceptual understanding of the dynamic relationships of hospital facilities before, during and after an extreme weather event. This is an essential step in framing a systems model that will assist facility managers to maintain critical healthcare infrastructure during an emergency. Rich Picture Diagrams (RPDs) were used to map relationships between critical healthcare infrastructure components such as the base hospital; access roads; aged care facilities and remotely located supplies. The rich information on the inter-organisational, system and governance complexities associated with responding to extreme weather events was obtained from three hospital case studies (two in Australia and one in New Zealand). The main finding of this research is that RPDs have considerable potential in the development of soft systems models which will assist decision takers involved in the design and management of healthcare infrastructure particularly in the context of extreme weather events. The soft systems methodology which underpins this research challenges the conventional view of what constitutes a ‘facility’ and consequently has important implications for those constructing and managing facilities

The mediating effect of soft TQM on the relationship between lean practices and innovation skills in Lebanese hospitals

The main objective of this research is to study the mediating effect of soft total quality management on the relationship between lean practices and innovation skills among the staff of Lebanese hospitals. Lean practices are essential to eliminate wastes and advance the quality of healthcare services through the standardization and continuous improvement strategies of Total Quality Management (TQM). However, there is a need to sustain the effectiveness of such strategies by developing the innovation skills of employees and placing greater emphasis on the soft side of TQM. Thus, a theoretical framework was developed based on the theory of constraints and the resource based view theory. After identifying the gaps of previous literature, a quantitative methodology was applied by surveying 352 employees from public and private hospitals in Lebanon. Primary data collected by self-administered questionnaires was found to be valid and reliable when analyzed through SPSS and AMOS software. Based on the SEM analysis, six hypotheses were accepted while four were rejected. Lean practices through its two dimensions; lean strategies and standardization have shown a significant and positive influence on innovation skills. However, soft TQM has a non-significant influence on innovation skills. On the other hand, lean practices have a significant and positive influence on soft TQM through standardization but not through lean strategies. As for the mediating effect, it was proven that soft TQM mediates the relationship between lean practices and innovation skills at the level of standardization but not of lean strategies. This study contributes by offering good implications for healthcare practitioners at the Lebanese hospitals and healthcare organizations in general, to invest more efforts in implementing lean tools and soft TQM. Finally, future researches are suggested to extend this study at geographical factors and different methodological procedur

Data science, artificial intelligence and the third wave of digital era governance

This article examines the model of digital era governance (DEG) in the light of the latest-wave of data-driven technologies, such as data science methodologies and artificial intelligence (labelled here DSAI). It identifies four key top-level macro-themes through which digital changes in response to these developments may be investigated. First, the capability to store and analyse large quantities of digital data obviates the need for data ‘compression’ that characterises Weberian-model bureaucracies, and facilitates data de-compression in data-intensive information regimes, where the capabilities of public agencies and civil society are both enhanced. Second, the increasing capability of robotic devices have expanded the range of tasks that machines extending or substituting workers’ capabilities can perform, with implications for a reshaping of state organisation. Third, DSAI technologies allow new options for partitioning state functions in ways that can maximise organisational productivity, in an ‘intelligent centre, devolved delivery’ model within vertical policy sectors. Fourth, within each tier of government, DSAI technologies offer new possibilities for ‘administrative holism’ - the horizontal allocation of power and functions between organisations, through state integration, common capacity and needs-based joining-up of services. Together, these four themes comprise a third wave of DEG changes, suggesting important administrative choices to be made regarding information regimes, state organisation, functional allocation and outsourcing arrangements, as well as a long-term research agenda for public administration, requiring extensive and detailed analysis

Strengthening nursing, midwifery and allied health professional leadership in the UK - a realist evaluation

Purpose: This paper aims to share the findings of a realist evaluation study that set out to identify how to strengthen nursing, midwifery and allied health professions (NMAHP) leadership across all health-care contexts in the UK conducted between 2018 and 2019. The collaborative research team were from the Universities of Bangor, Ulster, the University of the West of Scotland and Canterbury Christ Church University. Design/methodology/approach: Realist evaluation and appreciative inquiry were used across three phases of the study. Phase 1 analysed the literature to generate tentative programme theories about what works, tested out in Phase 2 through a national social media Twitter chat and sense-making workshops to help refine the theories in Phase 3. Cross-cutting themes were synthesised into a leadership framework identifying the strategies that work for practitioners in a range of settings and professions based on the context, mechanism and output configuration of realist evaluation. Stakeholders contributed to the ongoing interrogation, analysis and synthesis of project outcomes. Findings: Five guiding lights of leadership, a metaphor for principles, were generated that enable and strengthen leadership across a range of contexts. – “The Light Between Us as interactions in our relationships”, “Seeing People’s Inner Light”, “Kindling the Spark of light and keeping it glowing”, “Lighting up the known and the yet to be known” and “Constellations of connected stars”. Research limitations/implications: This study has illuminated the a-theoretical nature of the relationships between contexts, mechanisms and outcomes in the existing leadership literature. There is more scope to develop the tentative programme theories developed in this study with NMAHP leaders in a variety of different contexts. The outcomes of leadership research mostly focussed on staff outcomes and intermediate outcomes that are then linked to ultimate outcomes in both staff and patients (supplemental). More consideration needs to be given to the impact of leadership on patients, carers and their families. Practical implications: The study has developed additional important resources to enable NMAHP leaders to demonstrate their leadership impact in a range of contexts through the leadership impact self-assessment framework which can be used for 360 feedback in the workplace using the appreciative assessment and reflection tool. Social implications: Whilst policymakers note the increasing importance of leadership in facilitating the culture change needed to support health and care systems to adopt sustainable change at pace, there is still a prevailing focus on traditional approaches to individual leadership development as opposed to collective leadership across teams, services and systems. If this paper fails to understand how to transform leadership policy and education, then it will be impossible to support the workforce to adapt and flex to the increasingly complex contexts they are working in. This will serve to undermine system integration for health and social care if the capacity and capability for transformation are not attended to. Whilst there are ambitious global plans (WHO, 2015) to enable integrated services to be driven by citizen needs, there is still a considerable void in understanding how to authentically engage with people to ensure the transformation is driven by their needs as opposed to what the authors think they need. There is, therefore, a need for systems leaders with the full skillset required to enable integrated services across place-based systems, particularly clinicians who are able to break down barriers and silo working across boundaries through the credibility, leadership and facilitation expertise they provide. Originality/value: The realist evaluation with additional synthesis from key stakeholders has provided new knowledge about the principles of effective NMAHP leadership in health and social care, presented in such a way that facilitates the use of the five guiding lights to inform further practice, education, research and policy development

Stakeholder Contradictions in Early Stages of eHealth Efforts

Use of information and communication technology (ICT) in healthcare has increased substantially over the past decades. Implementation of ICT in municipal health services (eHealth) involves a variety of stakeholders, and may lead to changes in the roles of providers and patients. Coordination, communication, early identification and involvement of key stakeholders in eHealth projects have been highlighted as important. However, research often takes a narrow perspective and pays scant attention to conflicting drivers. This study used a qualitative approach to identify and investigate contradictory stakeholder interests in the early phase of a municipal eHealth project. Analysis using Stakeholder Theory (ST) and Dialectic Process Theory revealed two important contradictions; 1) effective service versus efficient service and 2) technology enthusiasm versus reluctance to change. The analysis illustrated the usefulness of combining these theories in eHealth efforts. Implications from our research suggest that stakeholder management should be considered to prevent conflicts in eHealth projects

nalysing Change Resistance to an Information Systems-Supported Process in a South African Public Hospital

Introducing technological change to an organization’s normal processes can potentially bring about positive or negative results, depending mostly on the manner in which the change was facilitated and integrated into the organization. However, very little research has been done on information technology (IT) investment among hospitals, its effect on the personnel, as well as how it influences patient care and financial performance. Consequently, little is known about users’ resistance to new technologies and the precedents of technology rejection in healthcare. Therefore, this study seeks to fill the gap of understanding South African hospital staffs’ perceptions towards change, caused by introducing an information system into one of the hospital’s daily processes. Where resistance towards change is identified, the study aims to understand the reasons behind such resistance. Finally, it aims to find appropriate intervention strategies to deal with and minimize resistance. In doing so, the study seeks to contribute to the body of research regarding change resistance to information systems in public South African hospitals. By adopting a descriptive and exploratory interpretivist paradigm, in conjunction with an inductive approach, the study aims to get a better understanding of hospital staffs’ perceptions through shared meaning. The study adopted a case study research strategy, as it affords the researcher the opportunity to participate in the study, and as such contributes to the subjective interpretation of the findings. Data was collected using a mixed method approach, and was used to describe the difference between the current and proposed process. In addition, it was used to explore the reasons for change resistance to information system-supported change, and to explore methods of successfully introducing change to tertiary public hospitals in South Africa. Fourteen participants (7 medical interns and 7 ward clerks) who were directly involved in the process being studied, were interviewed. Two other participants (the head of the pharmacy and the patient flow manager), who were indirectly involved in the process, were interviewed, to verify the observed and mapped process. Interview data was analyzed qualitatively, firstly through coding techniques before using sentiment and thematic analysis. While the mapped process followed Business Process Modelling Notation conventions. In addition to a mapped proposed process, a change resistance conceptual model was developed from a conjunction of the findings and extensive review of literature. The conceptual model asserts that five main factors contribute to change resistance: unclearly defined duties; fear of job security and technology usage; years of service; resource availability and resource mismatch; as well as insufficient training resulting from the lack of a learning culture. These factors can be moderated by: the existing state of affairs referred to as status quo; management involvement; and communication. The conceptual model can be used to better understand the causes of change resistance, as well as how to minimize change resistance and successfully introduce change into a health organization. Change agents should aim to understand the status quo that exists in the organization and find ways of incorporating that into the change process. Furthermore, management should aim to involve and communicate with all affected stakeholders during a change process. This research has provided a better understanding of hospital staffs’ reactions to change, their reasons for resistance, and ways to minimize change resistance while successfully introducing change into a health organization

Untangling the complexity of connected health evaluations

Societal changes are forcing us to reconsider how healthcare is delivered and ICT can support this reimagining of healthcare delivery. One of the emerging trends in this area is Connected Health. However, the evaluation of Connected Health technologies is crucial to assess whether their implementation has had a positive impact on healthcare delivery. To support this assessment process, we developed, an exploratory framework for the evaluation of Connected Health technologies in healthcare settings. This framework was developed after having critically appraised the existing findings of health information system evaluation studies. It also builds on previous models of Information Systems evaluation, in particular, the Information Systems Success Model. Our framework incorporates the concept of assessment from multiple perspectives. Furthermore, the framework identifies the primary stakeholders and extends the assessment based on their concerns. Finally, we elaborate on the framework, detailing its application to a Connected Health solution for primary care based dementia patients in Ireland