A realist evaluation of the management of a well- performing regional hospital in Ghana

<p>Abstract</p> <p>Background</p> <p>Realist evaluation offers an interesting approach to evaluation of interventions in complex settings, but has been little applied in health care. We report on a realist case study of a well performing hospital in Ghana and show how such a realist evaluation design can help to overcome the limited external validity of a traditional case study.</p> <p>Methods</p> <p>We developed a realist evaluation framework for hypothesis formulation, data collection, data analysis and synthesis of the findings. Focusing on the role of human resource management in hospital performance, we formulated our hypothesis around the high commitment management concept. Mixed methods were used in data collection, including individual and group interviews, observations and document reviews.</p> <p>Results</p> <p>We found that the human resource management approach (the actual intervention) included induction of new staff, training and personal development, good communication and information sharing, and decentralised decision-making. We identified 3 additional practices: ensuring optimal physical working conditions, access to top managers and managers' involvement on the work floor. Teamwork, recognition and trust emerged as key elements of the organisational climate. Interviewees reported high levels of organisational commitment. The analysis unearthed perceived organisational support and reciprocity as underlying mechanisms that link the management practices with commitment.</p> <p>Methodologically, we found that realist evaluation can be fruitfully used to develop detailed case studies that analyse how management interventions work and in which conditions. Analysing the links between intervention, mechanism and outcome increases the explaining power, while identification of essential context elements improves the usefulness of the findings for decision-makers in other settings (external validity). We also identified a number of practical difficulties and priorities for further methodological development.</p> <p>Conclusion</p> <p>This case suggests that a well-balanced HRM bundle can stimulate organisational commitment of health workers. Such practices can be implemented even with narrow decision spaces. Realist evaluation provides an appropriate approach to increase the usefulness of case studies to managers and policymakers.</p

Making better use of information to drive improvement in local public services: A report for the Audit Commission

This report on making better use of information to drive improvement in local public services was commissioned from the School of Public Policy at the University of Birmingham, by the Audit Commission. It explores how decision makers use information when making decisions. These decision makers can be politicians, top managers, operational managers, planners etc. The focus of this report is not on the use of performance indicators sensu stricto, but on the use of information more generally. Rather than studying how existing information is used or not used in decision making, this report is looking at how decision makers go about searching, analysing, summarising, processing and interpreting information when they need to make a decision. The report consists of three main chapters. - A summary of key government policy initiatives in the UK to stimulate the use of information in decision making - A review of the relevant research literature. This is the main section of the report. In it, we review the role of information in decision making theories, the organisational and structural context of information use, and psychological factors in the use of information in decision making - A presentation of a number of international perspectives on the use of information in public sector decision makin