Getting Lost to be Found: The Insider-Outsider Paradoxes in Relational Ethnography

Purpose: The paper draws on the direct experience of a practitioner undertaking real-time research in his organization to offer insights into the dual role of practical insider and theoretical outsider. The duality helps the researcher to live ‘in’ and think ‘out’ of the research context to develop a theory for practice and then transpose it to a practice for theory through the collaboration of an external theoretical insider. Design/Methodology/Approach: This is a theoretical account of the reflexive experience of the practitioner reintroducing relational ethnography, where the researcher regards processes and spaces as the objects of analysis rather than bounded groups and places. It emphasizes the relational significance of the researcher, researched, and theoretical insider in exploring the structures of relations and meanings in the field of professional practice. Findings: The paper argues that understanding the complementariness and paradoxes of the dual role helps the researcher to identify knowledge gaps and contest commonsense knowledge in search of critical knowledge and theoretical insights. Transition between the bounded (restrained) and unbounded (unrestrained) selves occurs in the holding space of research, influencing the position from which the researcher views himself, his subjects, and his social world. Originality/Value: The paper extends the dimension of ethnographic research, which de-centers the authority and control of the researcher to that of the relationship between the researcher and informants, by focusing on the relational significance between the researcher, researched, and theoretical insider. This perspective gives rise to a deeper understanding of relational ethnography, seen largely in sociological research, as relevant to organizational research, where structures of relations and actions explored in real-time could account for the configuration, conflict, and coordination of work practices

The role of chief executive officers in a quality improvement initiative: a qualitative study

Objectives: To identify the critical dimensions of hospital Chief Executive Officers’ (CEOs) involvement in a quality and safety initiative and to offer practical guidance to assist CEOs to fulfil their leadership role in quality improvement (QI). Design: Qualitative interview study. Setting: 20 organisations participating in the main phase of the Safer Patients Initiative (SPI) programme across the UK. Participants: 17 CEOs overseeing 19 organisations participating in the main phase of the SPI programme and 36 staff (20 workstream leads, 10 coordinators and 6 managers) involved in SPI across all 20 participating organisations. Main outcome measure: Self-reported perceptions of CEOs on their contribution and involvement within the SPI programme, supplemented by staff peer-reports. Results: The CEOs recognised the importance of their part in the SPI programme and gave detailed accounts of the perceived value that their involvement had brought at all stages of the process. In exploring the parts played by the CEOs, five dimensions were identified: (1) resource provision; (2) staff motivation and engagement; (3) commitment and support; (4) monitoring progress and (5) embedding programme elements. Staff reports confirmed these dimensions; however, the weighting of the dimensions differed. The findings stress the importance of particular actions of support and monitoring such as constant communication through leadership walk rounds and reviewing programme progress and its related clinical outcomes at Board meetings. Conclusions: This study addressed the call for more research-informed practical guidance on the role of senior management in QI initiatives. The findings show that the CEOs provided key participation considered to significantly contribute towards the SPI programme. CEOs and staff identified a number of clear and consistent themes essential to organisation safety improvement. Queries raised include the tangible benefits of executive involvement in changing structures and embedding for sustainability and the practical steps to creating the ‘right’ environment for QI

On the tension between standardized and customized policies in healthcare: The case of length-of-stay reduction

Hospitals increasingly adopt standardized policies as a way to improve the efficiency of healthcare delivery. One key policy has been to reduce a patient's length of stay, which is commonly perceived as an effective means of improving patient outcome, as well as reducing the cost per procedure. We put this notion to the empirical test by using a database of 183,712,784 medical records of patients in the English NHS between 1998 and 2012, studying the effects of the NHS's policy of decreasing length of stay for hernia patients. While we found it to be an effective way of reducing the cost per procedure, on aggregate, we also found that it increases the risk of readmission and of death for vulnerable and elderly patients, unduly increasing the long-term failure costs of the operation for these patient groups. Based on our findings we propose a differentiated policy to selectively decrease length of stay, which we estimate could save up to US$565 per non-emergency hernia procedure (a 19.97% reduction in the cost per procedure). We outline the implications of our findings for medical practice, and discuss the wider theoretical contributions to the wider standardization-customization debate in healthcare operations management

The impact of leadership and leadership development in higher education: a review of the literature and evidence

Leadership development and its effectiveness has not been explored in depth empirically, especially across university settings. It is therefore timely that the Leadership Foundation has sought to invest in exploring what is known in the area of the impact of leadership development in higher education settings

Epistemic fit and the mobilisation of management knowledge in health care

We discuss the mobilisation of management knowledge in health care, drawing on six qualitative case studies in a diverse range of health care settings. Drawing on theory about management knowledge and practices’ ‘fit’, and emergent theory about ‘epistemic stances’, we explain how cultural/institutional, political and epistemic fit and clashes between the norms, interests and epistemic stances of different communities affected knowledge mobilisation in these settings. We also highlight the key role of knowledge brokers in ‘fitting’ knowledge within contexts as part of their own identity work. Yet we note that knowledge brokers’ ability to mobilise and fit knowledge depended on having a senior role or senior level support, and credibility/legitimacy with dominant communities. We suggest that our novel concepts of ‘epistemic fit’ and ‘fitting’ are useful in explaining the process of knowledge mobilisation, particularly in complex pluralistic health care contexts containing multiple epistemic communities which produce, use and value knowledge in different ways

The impact of leadership and leadership development in higher education : a review of the literature and evidence

Leadership development and its effectiveness has not been explored in depth across university settings. Few studies link leadership development programmes to organisational outcomes in Higher Education (HE) or performance assessment exercises, such as the UK Research Excellence Framework (REF). This review explores what is known in the area of the impact of leadership development in HE settings and offers a contribution to further thinking in this field

The political economy of management knowledge : management texts in English healthcare organizations

Have generic management texts and associated knowledges now extensively diffused into public services organizations? If so, why? Our empirical study of English healthcare organizations detects an extensive presence of such texts. We argue that their ready diffusion relates to two macro-level forces: (i) the influence of the underlying political economy of public services reform and (ii) a strongly developed business school/management consulting knowledge nexus. This macro perspective theoretically complements existing explanations from the meso or middle level of analysis which examine diffusion processes within the public services field, and also more micro literature which focuses on agency from individual knowledge leaders