Managers shaping the service triangle: Navigating resident and worker interests through work design in nursing homes

Managers play a key role in shaping the service triangle and navigating stakeholder interests within this. In healthcare, labor shortages are prompting consideration of the consequences of care delivery for service users and staff. Here we consider how senior nursing home managers tasked with balancing resident and worker interests manage tensions using work design. Findings identify a five-cluster typology, reflecting variations in how managers from twenty Flemish nursing homes operationalize the same resident-centred care model. Managers purposively shape a different service triangle in each operationalization, variously prioritizing benefits for residents, seeking the golden mean or attempting to suppress tensions

Leadership, human resource management and the content of the psychological contract

This paper argues that, in combination, management leadership styles (transactional versus relational) and human resource management practices (flexibility versus commitment) play an important role in formulating the orientation and content of the psychological contract. The paper presents a theoretical framework of how this occurs, drawing upon and integrating prior research to develop a typology of psychological contract obligations based on a two-by-two matrix, with leadership style and HRM systems on opposing axes. The resultant obligations are termed as partnership, paternalistic, market-based and dynamic. Implications are discussed from the viewpoint of both individuals and organizations. Crucially, the paper posits that a failure to match leadership styles and human resource (HR) practices may lead to mismatched expectations between employees and employers. This may have negative consequences for an organization’s performance as, under the psychological contract, a breach of perceived obligations to employees by employers can have consequences for employee attitudes and behaviors

Reframing and reacting to employees' responses to change: A focus on resistance

Background A hallmark of a leader is their ability to manage change—an ever-present feature of organisational life. Indeed, all improvement requires change, and in this context navigating employees’ responses to progress change is a key part of leadership. To support this, research and leadership development have historically focused on how leaders can reduce resistance to change. This review highlights the value of reframing classic conceptions of resistance to change as something negative. Result Widening understanding of non-acceptance responses to change supports the provision of broader, yet more meaningful advice to leaders and managers about how to engage with employees in ways that can support improvement. To do this, the article identifies why resistance is important in the contemporary context and then outlines three current broad views within research on resistance to change identified by Robyn Thomas and Cynthia Hardy. These influence how resistance is seen and therefore how it is approached. The article considers what leaders can learn and do to more effectively navigate employees’ responses to change, and how reframing resistance applies to the specific context of healthcare

Conceptions of patients and their roles in healthcare: insights from everyday practice and service improvement

Purpose: The purpose of this paper is two-fold. First, it sets the context for the special issue by considering conceptions of patients and their roles in service delivery and improvement. Second, it introduces the contributions to the special issue, and identifies thematic resonance. Design/Methodology/Approach: The paper utilises a literature synthesis and thematic analysis of the special issue submissions. These emanated from the 9th International Organisational Behaviour in Healthcare Conference, hosted by Copenhagen Business School on behalf of the Learned Society for Studies in Organizing Healthcare (SHOC). Findings: The articles evidence a range of perspectives on patients’ roles in healthcare. These range from their being subject to, a mobilising focus for, and active participants in service delivery and improvement. Building upon the potential patient roles identified, this editorial develops five ‘ideal type’ patient positions in healthcare delivery and improvement. These recognise that patients’ engagement with health care services is influenced both by personal characteristics and circumstances, which affect patients’ openness to engaging with health services, as well as the opportunities afforded to patients to engage, by organizations and their employees. Originality/Value: The paper explores the relationally embedded nature of patient involvement in healthcare, inherent in the interdependence between patient and providers’ roles. The typology aims to prompt discussion regarding the conceptualisation patients’ roles in healthcare organisations, and the individual, employee, organisational and contextual factors that may help and hinder their involvement in service delivery and improvement. We close by noting four areas meriting further research attention, and potentially useful theoretical lenses

From bipartite to tripartite devolved HRM in professional service contexts: evidence from hospitals in three countries

This article explores the devolution of HRM in a hospital context. Based on secondary data and 128 interviews conducted in nine hospitals across three European countries (Ireland, the Netherlands and UK), we examine roles and responsibility for HRM under devolution and coordination between those delivering it. Findings challenge bi-partite conceptions of devolution, identifying a tripartite model with: (1) HR practitioners, (2) line managers and, (3) senior professionals (managers and specialists) implementing HRM. Involving senior professionals in HRM reflects longstanding concern regarding managerial legitimacy in overseeing professional work. In the tripartite relationship each party has scope to contribute to people-management: HR practitioners to formulate a strategic framework, HR practices, and provide advisory services; line managers to implement HR practices and interface between HR and front-line professionals and; senior professionals to act as line managers’ advocates and provide expert knowledge and credibility to inform people-related decision-making. However, lack of role clarity and tensions in coordination relate to the differing goals of, and distance between, the HR function, line managers and senior professionals. Our theoretical reframing of devolution notes potential for tripartite relational involvement to enhance HR performance in professional service contexts, the contingencies affecting this and potential implications for the HR architecture

Performance management in context: formative cross-functional performance monitoring for improvement and the mediating role of relational coordination in hospitals

Recent research suggests that to fully realise its potential, performance management should be bespoke to the social context in which it operates. Here we analyse factors supporting the use of performance data for improvement. The study purposively examines a developmentally oriented performance management system with cross-functional goals. We suggest that these system characteristics are significant in interdependent work contexts, such as healthcare. We propose and test that (a) relational coordination helps employees work effectively to resolve issues identified through formative and cross-functional performance monitoring and (b) that this contributes to better outcomes for both employees and patients. Based on survey data from management and care providers across Irish acute hospitals, the study found that perceptions of relational coordination mediated the link between formative cross-functional performance monitoring and employee outcomes and partially mediated the link between formative cross-functional performance monitoring and patient care respectively. Our findings signal potential for a more contextually driven and interdependent approach to the alignment of management and human resource management practices. While relational coordination is important in healthcare, we also note potential to identify other social drivers supporting productive responses to performance monitoring in different contexts

Configurations of new public management reforms and the efficiency, effectiveness and equity of public healthcare systems: a fuzzy-set qualitative comparative analysis

Fuzzy-set Qualitative Comparative Analysis identifies configurations of New Public Management (NPM) reforms (privatization, consumerism, performance management, and corporatization) associated with perceptions of improvements in healthcare efficiency, effectiveness and equity in 14 European countries. Although these outcomes are pursued concurrently, no combination of the considered reforms appears to support success or failure across the board and the inter-relations between reforms shape their effects. Three NPM reform profiles are evident in Europe; (1) strong reformers, adopting a comprehensive package of reforms that are perceived to perform better than (2) partial reformers, with (3) limited reformers also doing better than partial reformers

Hospital doctors in Ireland and the struggle for work–life balance

Ireland has a high rate of doctor emigration. Challenging working conditions and poor work–life balance, particularly in the hospital sector, are often cited as a driver. The aim of this study was to obtain insight into hospital doctors’ experiences of work and of work–life balance. In late 2019, a stratified random sample of hospital doctors participated in an anonymous online survey, distributed via the national Medical Register (overall response rate 20%; n = 1070). This article presents a qualitative analysis of free-text questions relating to working conditions (n = 469) and work–life balance (n = 314). Results show that respondent hospital doctors, at all levels of seniority, were struggling to achieve balance between work and life, with work–life imbalance and work overload being the key issues arising. Work–life imbalance has become normalized within Irish hospital medicine. Drawing on insights from respondent hospital doctors, this study reflects on the sustainability of this way of working for the individual doctors, the medical workforce and the Irish health system. If health workforce planning is about getting the right staff with the right skills in the right place at the right time to deliver care, work–life balance is about maintaining doctor wellbeing and encouraging their retention

‘That's just how medicine is': A remote ethnographic study of Ireland's failure to meet the core work needs of its hospital doctors

This study focuses on hospital doctors' experiences of work during the pandemic. The context is the Irish health system, under considerable strain due to the pandemic and a legacy of austerity/under-funding. Although medicine is considered a prestigious job, hospital doctors often endure challenging working conditions and work-life imbalance. In this paper we consider how a narrative of ‘medicine-as-vocation’ is used to excuse challenging working conditions and to impede change. West and Coia (2019) proposed a set of core work needs required to support doctor wellbeing and minimise work-related stress, i.e. autonomy/control, belonging and competence and these are applied as a lens to examine the everyday work experiences of respondent hospital doctors. Data collection was conducted in 2021 using a remote ethnographic method – Mobile Instant Messaging Ethnography (MIME) - developed by the research team to enable data collection at a time of pandemic restrictions (Humphries, Byrne, et al, 2022). Twenty-eight hospital doctors were recruited for the study. Each respondent was interviewed twice and engaged in a 12-week conversation with the research team via WhatsApp. We report hospital doctors' experiences of heavy workloads, weak line management and the challenges of influencing change at work. Overall, the findings presented demonstrate the myriad ways that Ireland is failing to meet the core work needs of its hospital doctors and how ‘medicine-as-vocation’ is used to justify organisational neglect