The deferred model of reality for designing and evaluating organisational learning processes: A critical ethnographic case study of Komfo Anokye teaching hospital, Ghana

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.The study proposed an evidence-based framework for designing and evaluating organisational learning and knowledge management processes to support continuously improving intentions of organisations such as hospitals. It demarcates the extant approaches to organisational learning including supporting technology into ‘rationalist’ and ‘emergent’ schools which utilise the dichotomy between the traditional healthcare managers’ roles and clinicians’ roles, and maintains that they are exclusively inadequate to accomplish transformative growth intentions, such as continuously improving patient care. The possibility of balancing the two schools for effective organisational learning design is not straightforward, and fails; because the balanced-view school is theoretically orientated and lack practical design to resolve power tensions entrenched in organisational structures. Prior attempts to address the organisational learning and knowledge management design and evaluation problematics in actuality have situated in the interpretivist traditions, only focusing on explanations of meanings. Critically, this is uncritical of power relations and orthodox practices. The theory of deferred action is applied in the context of critical research methods and methodology to expose the motivations behind the established organisational learning and knowledge management practices of Komfo Anokye Teaching Hospital (KATH) which assumed rationality design conceptions. Ethnographic data was obtained and interpreted with combined critical hermeneutics and narrative analyses to question the extent of healthcare learning and knowledge management systems failures and unveil the unheard voices as force for change. The study makes many contributions to knowledge but the key ones are: (i) Practically, the participants accepted the study as a catalyst for (re)-designing healthcare learning and knowledge management systems to typify the acceptance of the theory of deferred action in practice; (ii) theoretically, the cohered emergent transformation (CET) model was developed from the theory of deferred action and validated with empirical data to explain how to plan strategically to achieve transformative growth objectives; and (iii) methodologically, the sense-making of the ethnographic data was explored with the combined critical hermeneutics and critical narrative analyses, the data interpretation lens from the critical theory and qualitative pluralism positions, to elucidate how the unheard emergent voices could bring change to the existing KATH learning and knowledge management processes for improved patient care

Risk factors affecting maternal health outcomes in Rivers State of Nigeria: towards the PRISMA model

Existing research suggests that Nigeria accounts for about 23% of the world’s maternal mortality ratio, with negative impact on women’s wellbeing and the country’s socio-economic development. The underlying risk factors of the problem can be categorized into political influences, poor access to healthcare, inadequate utilization of health facilities, poor family planning support and complex pregnancy-related illness. Yet, the complex interrelations amongst the factors makes it difficult to ascertain the riskiest ones that affect women’s reproduction and child death, with the existing intervening strategies failing to address the problem. This study identifies maternal health risk factors and prioritizes their management in Rivers State of Nigeria, using the Prevention and Recovery Information System for Monitoring and Analysis (PRISMA) model. Taking a quantitative turn, we applied exploratory factor analysis to analyze 174 returned questionnaires from healthcare professionals working in Rivers State and used the results to establish the relationships between maternal health risk factors and prioritized the riskiest factors. The outcomes indicate that the PRISMA model provides an effective framework for identifying and managing maternal mortality risks that can enable healthcare experts and managers to address the avoidable risk factors and mitigate the unavoidable patient-related risk factors in Nigeria. The implications for theory, practice and policy are discussed

Diaspora Entrepreneurs’ Push and Pull Institutional Factors for Investing in Africa: Insights from African Returnees from the United Kingdom

Applying the institution-based views, this article conceptualises how diaspora entrepreneurs take stimuli from the push and pull institutional factors to develop business enterprises in their countries of origin. Using cases of African diaspora entrepreneurs in the UK and the grounded theory methodological approach, our conceptualised model demonstrates that the diasporas use the new knowledge, skills and wealth they have gained in the UK in tandem with support from trusted family, kinship and business ties at home to develop enterprises. It further demonstrates that diaspora entrepreneurs foster resilience to withstand weak formal institutions in their countries of origin and the discriminatory obstacles in the UK. We also found that institutional barriers which served as push factors that encouraged or forced migrants to leave their home countries to seek greener pastures abroad may later become pull factors that enable them to engage in diaspora entrepreneurship which is often characterised by paradoxes. Particularly, the informal institutions that constrain foreign investors can become assets for African diaspora entrepreneurs and help them set up new businesses and exploit market opportunities in Africa. The implications of the study for diaspora entrepreneurship literature are outlined

Improving the ‘manager-clinician’ collaboration for effective healthcare ICT and telemedicine adoption processes – a cohered emergent perspective

Existing research shows that the adoption of information and communication technologies (ICTs) for healthcare development in developing countries is largely dominated by donor and international agencies, but the actual organizational-level decisions are often driven by corporate healthcare managers. The consequences of the strategic-driven healthcare ICT adoption practices are that they fail to match clinician users’ requirements and cause them to disuse ICTs for clinical practices and healthcare development. Prior attempts to bring local and globally-distributed actors together to implement ICTs innovatively for healthcare development have emphasized less on synthesizing the diverse information system approaches that inform our understanding of how to narrow the ‘manager-clinician’ tensions in ICT adoption for development in emergent situations. To fill this gap, this article explains the process of shifting healthcare ICT adoption from top-down planning to collective user involvement to enhance clinicians’ acceptance of ICTs for clinical practices and development in a Ghanaian teaching hospital, using the cohered emergent transformation model. Action research was used to engage the hospital’s corporate managers, clinician managers and clinicians, and elicit their views and experiences of the hospital’s ICT adoption for healthcare delivery improvement. Together with observations and document analysis, the data was analyzed to understand the hospital’s information and communication technologies for development (ICT4D) adoption issues and identify ways of managing them. The outcomes provide alternative theoretical and practical ways of adopting healthcare technology systems that shift the excessive use of managers’ powers in ICT adoption towards clinicians’ involvement, to enable technology acceptance for clinical practices and healthcare developmen

Participating in Critical Discourse: A Critical Research Study of Clinicians’ Concerns for a Ghanaian Hospital E-mail System

The file attached to this record is the author's final peer reviewed version.A growing body of information systems (IS) literature advocates the explicit use of suitable critical theories to explore power issues in developing countries and make IS research findings more accessible to systems’ users and the wider audiences for consumption. We respond to this debate in IS by applying critical research perspectives to discuss the power implications of Internet and e-mail resource distribution in a Ghanaian teaching hospital in a way that addresses clinicians’ concerns of using Internet services for healthcare practices. We applied critical qualitative approaches to collect and analyse data from clinicians, healthcare managers and the hospital’s internal documents. It was found that managers exercised their powers to allocate Internet facilities selectively on the contestable account that clinicians might misuse the Internet if they were given access while clinicians sought to empower themselves as co-planners who could make technology choices and add new value to the existing normative decisions of the managers. The outcomes show that critical researchers can directly relate to decision-making powers, recognise their powers and expose structures that surround them, and emancipate people whose Internet resource needs are restricted to co-involve in technology adoption and distribution processes

Reframing Service Sector Privatisation Quality Conception with the Theory of Deferred Action

Economics explanation for privatisation, drawing on neo-liberal market structures and technical efficiency principles has failed to address social imbalance and, distribute the efficiency benefits accrued from privatisation equitably among service users and different classes of people in society. Stakeholders' interest, which cover ethical values and changing human needs are ignored due to shareholders' profit maximising strategy with higher service charges. The consequence of these is that, the existing justifications for privatisation have fallen short of customer quality expectations because the underlying plan-based models fail to account for the nuances of customer expectations. We draw on the theory of deferred action to develop a context-based privatisation model, the deferred-based privatisation model, to explain how privatisation could be strategised for the emergent reality of the wider stakeholders' interests and everyday quality demands of customers which are unpredictable

Sustainability and consumer behaviour: Toward a cohered emergent theory

Existing research suggests that sustainable strategies of many corporate organizations are internally focused and aim to boost companies’ brand images, improve their competitive positions and to increase wealth for their shareholders. Such sustainable initiatives lack a genuine commitment to long-term green production, ecological integrity, human welfare and green buying behaviour. Yet, not many consumers have developed the mindset to buy green products even when companies strive hard to preserve sustainable standards through externally-focused initiatives to promote fair trade, ecological protection and social justice. While consumers’ demand for products can be analyzed and predicted through economic models, their green consumption behaviour is not always predictable and goes far beyond simple rational analysis. Some consumers even take sustainability matters less seriously due to complex and sometimes divisive sustainability discussions by world leaders

Cohered emergent theory for designing and implementing multinational mining sustainability practices in Ghana

This chapter applies cohered emergent theory to explain how multinational mining corporations operating in Africa can design and implement their sustainability practices to equalize the economic, environmental and social dimensions of sustainability. We used thematic analysis to analyze the interview data from 16 diverse stakeholders of a multinational mining company case in Ghana. The findings suggest that the company’s economic, environmental and social sustainability practices were designed and implemented as a social inclusivity process that revolved around rational planning and power, critique from ‘less powerful’ stakeholders and emergent events, and regular adjustments to senior managers’ planned actions. These design and implementation processes will help senior managers to manage business activities ethically and mitigate potential sustainability implementation risks that can damage organizational reputation, harm community welfare and destroy the environment. The study also has implications for governments and policy think tanks of developing countries to rectify corporate sustainability policies that can foster fair allocation of royalties and taxes from multinational mining companies to the mining communities and to reduce rural poverty. The outcome of the study manifests the theoretical value of the cohered emergent discipline in practice

Comparing For-Profit and Not-For-Profit Collaboration: Cohered Emergent Theory Application

This chapter applies Cohered Emergent Theory to explain how for-profit and not-for-profit collaborations can manage the challenges facing their collaborative activities, benefit from each other and satisfy the interest of their diverse stakeholders. The structure, scope and governing arrangements of collaborations are shaped by the underlying values and objectives of the organizations and partners forming such collaborative relationships. The complexities therein have influenced the existing understanding of for-profit and not-for-profit collaborations. Yet, the challenges of these collaborations and how they are resolved to give way for the two categories of collaborations to benefit from each other is less studied. Through the discipline of Cohered Emergent Theory, the chapter problematizes the need for cross-fertilizing the literature on for-profit and not-for-profit collaborations to generate a collaborative synergy for partners in both sectors. The findings indicate that Cohered Emergent Theory offers a capability and flexible mechanisms to implement collaborations that can potentially resolve power asymmetry, conflicting interests, mistrust, asset redundancies and uncertainties in collaborative arrangements. The implication of these for for-profit and not-for-profit collaborations is to learn from each other through cross-sector collaborations and safeguard against collaborative failures