Knowledge management and communities of practice in the private sector: lessons for modernising the National Health Service in England and Wales

The National Health Service (NHS) in England and Wales has embarked upon a radical and farreaching programme of change and reform. However, to date the results of organizational quality and service improvement initiatives in the public sector have been mixed, if not to say disappointing, with anticipated gains often failing to materialize or to be sustained in the longer term. This paper draws on the authors' recent extensive research into one of the principal methodologies for bringing about the sought after step change in the quality of health care in England and Wales. It explores how private sector knowledge management (KM) concepts and practices might contribute to the further development of public sector quality improvement initiatives in general and to the reform of the NHS in particular. Our analysis suggests there have been a number of problems and challenges in practice, not least a considerable naïvety around the issue of knowledge transfer and 'knowledge into practice' within health care organizations. We suggest four broad areas for possible development which also have important implications for other public sector organizations

Strategies Technology Development Marketing Leaders Used to Commercialize a New Product Innovation

Strategies for commercialization of a new product innovation are critical for gaining a sustainable level of customer acceptance and financial performance. The purpose of this single case study was to explore the commercialization strategies used by 5 technology development marketing leaders from a healthcare company in Washington state. The conceptual framework for this study was commercialization of innovation theory (CoI). The data were collected through semistructured interviews and company documentation, and analyzed using Yin\u27s 5-step data analysis process for case studies to identify and code themes. Analysis of data generated 3 major themes: strategies implemented during the prelaunch phase, strategies implemented during the pilot customer phase, and strategies implemented in the broader market launch phase of the CoI process. The results of this study revealed the set of commercialization decisions made by technology development marketing leaders in the case, the phase in which the CoI process-specific strategies were implemented, and some of the pitfalls of commercializing an innovation, especially a radical innovation. Results indicated the challenges with being a first-mover and having unclear positioning, branding, and messaging strategies. It is essential for technology development marketing leaders to gain a deeper understanding of the strategies that might influence commercial success and failure. Findings may contribute to social change by maximizing commercial success and the diffusion of new product innovations in healthcare, which might lead to better patient outcomes and enhanced ways of practicing medicine

Purposeful empiricism: how stochastic modeling informs industrial marketing research

It is increasingly recognized that progress can be made in the development of integrated theory for understanding, explaining and better predicting key aspects of buyer–seller relationships and industrial networks by drawing upon non-traditional research perspectives and domains. One such non-traditional research perspective is stochastic modeling which has shown that large scale regularities emerge from the individual interactions between idiosyncratic actors. When these macroscopic patterns repeat across a wide range of firms, industries and business types this commonality suggests directions for further research which we pursue through a differentiated replication of the Dirichlet stochastic model. We demonstrate predictable behavioral patterns of purchase and loyalty in two distinct industrial markets for components used in critical surgical procedures. This differentiated replication supports the argument for the use of stochastic modeling techniques in industrial marketing management, not only as a management tool but also as a lens to inform and focus research towards integrated theories of the evolution of market structure and network relationships

Mapping domain characteristics influencing Analytics initiatives: The example of Supply Chain Analytics

Purpose: Analytics research is increasingly divided by the domains Analytics is applied to. Literature offers little understanding whether aspects such as success factors, barriers and management of Analytics must be investigated domain-specific, while the execution of Analytics initiatives is similar across domains and similar issues occur. This article investigates characteristics of the execution of Analytics initiatives that are distinct in domains and can guide future research collaboration and focus. The research was conducted on the example of Logistics and Supply Chain Management and the respective domain-specific Analytics subfield of Supply Chain Analytics. The field of Logistics and Supply Chain Management has been recognized as early adopter of Analytics but has retracted to a midfield position comparing different domains. Design/methodology/approach: This research uses Grounded Theory based on 12 semi-structured Interviews creating a map of domain characteristics based of the paradigm scheme of Strauss and Corbin. Findings: A total of 34 characteristics of Analytics initiatives that distinguish domains in the execution of initiatives were identified, which are mapped and explained. As a blueprint for further research, the domain-specifics of Logistics and Supply Chain Management are presented and discussed. Originality/value: The results of this research stimulates cross domain research on Analytics issues and prompt research on the identified characteristics with broader understanding of the impact on Analytics initiatives. The also describe the status-quo of Analytics. Further, results help managers control the environment of initiatives and design more successful initiatives.DFG, 414044773, Open Access Publizieren 2019 - 2020 / Technische Universität Berli

Safer clinical systems : interim report, August 2010

Safer Clinical Systems is the Health Foundation’s new five year programme of work to test and demonstrate ways to improve healthcare systems and processes, to develop safer systems that improve patient safety. It builds on learning from the Safer Patients Initiative (SPI) and models of system improvement from both healthcare and other industries. Learning from the SPI highlighted the need to take a clinical systems approach to improving safety. SPI highlighted that many hospitals struggle to implement improvement in clinical areas due to inherent problems with support mechanisms. Clinical processes and systems, rather than individuals, are often the contributors to breakdown in patient safety. The Safer Clinical Systems programme aimed to measure the reliability of clinical processes, identify defects within those processes, and identify the systems that result in those defects. Methods to improve system reliability were then to be tested and re-developed in order to reduce the risk of harm being caused to patients. Such system-level awareness should lead to improvements in other patient care pathways. The relationship between system reliability and actual harm is challenging to identify and measure. Specific, well-defined, small-scale processes have been used in other programmes, and system reliability has been shown to have a direct causal relationship with harm (e.g. care bundle compliance in an intensive care unit can reduce the incidence of ventilator-associated pneumonia). However, it has become evident that harm can be caused by a variety of factors over time; when working in broader, more complex and dynamic systems, change in outcome can be difficult to attribute to specific improvements and difficulties are also associated with relating evidence to resulting harm. The overall aim of Phase 1 of the Safer Clinical Systems programme was to demonstrate proof-of-concept that using a systems-based approach could contribute to improved patient safety. In Phase 1, experienced NHS teams from four locations worked together with expert advisers to co-design the Safer Clinical Systems programme

Highly-Skilled Black African Immigrant Women’s Narratives on Healthcare Workplace Experiences and Socioeconomic Integration

Many highly skilled Black African immigrants are concentrated in low-wage positions among occupations in the healthcare industry. This education–occupation mismatch has contributed to substantial labor market hurdles affecting socioeconomic integration in the host country. The purpose of this qualitative narrative inquiry study was to gain a deeper understanding of highly skilled Black African immigrant women’s daily experiences within the U.S. healthcare workplace and the implication of these experiences on their socioeconomic integration. A qualitative narrative inquiry was conducted involving 7 highly skilled Black African immigrant women in the U.S. healthcare workplace. The study was framed by 2 fundamental concepts: talent management and integration needs of highly skilled women Black African immigrants. Five conceptual categories were revealed via thematic analysis of the narratives. The findings clearly demonstrated that the challenges facing highly-skilled Black African immigrant women with social integration, social class change, ethnicity and gender bias are faced by all African American women in the healthcare workplace. These issues were often compounded by marginalization of their talents and contributions simply because of their immigrant status. The findings should act as a catalyst for social change highlighting the professional challenges faced by highly-skilled Black African immigrant women in the healthcare workplace and its connection to their socioeconomic integration in their host country, which creates the potential for a positive outcome for the migrant women and the host society as well as better capture and utilization of the talent of these highly-skilled immigrant Black African migrant women

How can health care organizations create value? : business model explorations

Background: The Triple Aim posits that health care should strive to improve patient experience, improve population health, and maintain or lower costs. However, most organizations are not organized to achieve the Triple Aim. Attempts to improve the ability of health care organizations to deliver increased value through the introduction of management concepts, most recently Value-based Health Care (VBHC), have led to the emergence of a pattern of pseudoinnovation, where concepts are frequently replaced with similar content, but in new “packaging”. This suggests that organizations and their ability to adapt to their environment and integrate new management concepts could potentially be explored by looking at how the concepts themselves are understood and at how organizations deliver care. In management terms, the latter can be described as the business model (i.e., how an organization creates, delivers, and captures value). Aim: The overall aim of this thesis is to understand how management concepts about value are understood and to explore how health care organizations in a publicly financed health care system are organized so that they create, deliver, and capture value. Methodology: In Study I, citation registry data and literature were sequentially analyzed qualitatively and quantitatively to assess diffusion and understanding of VBHC as a nascent management concept in the literature. Study II, a systematic review, employed an explanatory synthesis approach to understand how business model frameworks have been applied in health care. Studies III and IV apply the Business Model Canvas (BMC) framework in a deductive content analysis of interviews with top managers (Study III) and with multiple data sources (Study IV) to conceptualize a hospital business model and to compare perinatal clinics’ business models in a publicly financed, Swedish health care setting. Findings: VBHC and business model frameworks are commonly and increasingly used to improve value in health care. VBHC is superficially understood in the literature (Study I). Business model frameworks are primarily applied in e-health. They include a broad range of elements and have been used to identify essential elements, assess finances, and classify, analyze, develop, and evaluate organizations (Study II). Managers conceptualized the hospital business model differently, primarily related to customer segments. A tension between espoused and de facto value propositions was identified (Study III). Four distinct perinatal business models were identified within the same regional health system (New Thinkers, a Local Service Provider, Continuous Capacity Keepers, and a Hybrid) (Study IV). Conclusions: The superficial understanding of VBHC and the ambiguity and lack of empirical data in business model applications risk diluting the potential benefits of both these management approaches. The multiple, co-existing business models within the same organization or health care system raise questions about how organizations are aligned and how we should view the role of different stakeholders in creating, delivering, and capturing value

Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research

Establishing and Developing B2B Partnerships in Healthcare Services Industry: A case study of a Swedish healthcare provider

This study’s purpose is to find out in what ways do healthcare providers in Sweden establish their B2B partnerships. This study seeks understanding of the practical deployment of relationship marketing as a process. To fulfill this purpose, in this study two theories are used – network theory and commitment-trust theory. It follows the qualitative research analytical design and the main tool for gathering empirical data are semi-structured interviews conducted with the representatives of Skåne Care, Swecare and the University Hospital in Lund and Malmö. The object of this study is Skåne Care and its B2B partnerships with the aforementioned healthcare organizations operating in the Swedish healthcare market. The purpose of this research was accomplished and led to new findings on the importance of personal encounters in the beginning of the relationship establishment and lack of power plays in the relationships under study. These findings were followed by a couple of theoretical and practical implications