| Entry Date | Source | Link | Source Type | Domain | Subdomain1 | Subdomain2 | Key Points | Citns |
| 2023-07-25 | Degeling P, Maxwell S, Kennedy J, Coyle B. Medicine, management, and modernisation: a “danse macabre”? Bmj. 2003;326(7390):649. | Link | Empirical study | Groups | Staff - healthcare | Cultures - organisational | The tension that often inhibits the relationships and potential cooperation between health service managers and healthcare professionals especially doctors is well known and often the source of much lamentation but rarely measured in a form that might promote better understanding and remediation. This paper is a notable exception in that it measured and displayed in a convincing graphical form these differences in two key dimension - the priority afforded to budget integrity on one axis and to standardized pathways or processes of care on the other. This clearly demonstrates marked differences between clinicians and general managers with nurse managers and medical administrators falling somewhere in between | 347 |
| 2023-07-25 | Southon G, Perkins R, Galler D. Networks: a key to the future of health services. Australian Health Review. 2005;29(3):317-326 | Link | Review /Overview | Groups | Communties /networks | Networks - occupational | In any organisation reliant on the expertise and experience of a cadre of professional staff whether engineers or medical specialists there will always be a tension between managers who exert their influence and control through vertical hierarchies and professional who exert theirs through horizontal networks or communities of practice. This paper describes the increasing role of various forms of clinical networks and their strengths and weaknesses:, and the fundamental differences of the two models of governance and work practices . Quote: " In general, the differences between hierarchical and network relations can be summarised as follows:In hierarchies, people look to their superior for authority; in networks, people look to the most competent colleagues, wherever they may be. Hierarchies are focused on organisational coherence and viability, while networks are focused on expert achievement.Hierarchies are based on formal control, accountability and extrinsic motivation, while networks are based on expertise, collegial values and intrinsic motiation.Hierarchies bring structure, control and accountability, while networks bring knowledge, innovation and capability. Managers, politicians, and policymakers tend to be more comfortable with hierarchies while professionals gain more from networks" | 57 |
| 2023-07-25 | Teaching smart people how to learn Argyris C 1991 Harvard Business Review | Link | Essay /Article | Individuals | In general | Learning | The healthcare services industry is well supplied with a workforce of highly intelligent and highly educated healthcare professionals and other staff. This paper points out however that such individuals are not always as adept at learning new information or adapting to new circumstances as might be expected. It is reckoned that this is because they have usually had successful careers with not much opportunity to learn from failure, are therefore more adept at "single loop" learning which may serve them well enough for direct problem solving but less so at the sort of "double loop" learning that is needed when the assumptions that have been used to frame the problem need to be reconsidered. | |
| 2023-07-23 | Cameron KS, Quinn RE. Diagnosing and Changing Organizational Culture: Based on the Competing Values Framework. John Wiley & Sons; 2011 | Link | Book | Groups | Staff | Cultures - organisational | There is an extensive descriptive literature on the varieties, functions and dysfunctions of organizational cultures, but a less abundant one on practicable methods of measurement and management. This book is an honorable exception as it contains a wealth of useful information and advice on the classification, diagnosis and the management of four basic types of 'competing values; | |
| 2023-07-23 | Gaba DM, Singer SJ, Sinaiko AD, Bowen JD, Ciavarelli AP. Differences in safety climate between hospital personnel and naval aviators. Human Factors: The Journal of the Human Factors and Ergonomics Society. 2003;45(2):173 | Link | Empirical study | Groups | Staff - healthcare | Cultures - organisational | An interesting and disconcerting comparison of the safety climate between naval aviators and hospital staff - mostly consultants and managers but including other staff groups, and showing that the health care staff worked in environments and / or had attitudes to safety that were significantly more risky than those experienced by or manifest by aviators. This report is now 2 decades old and things may have improved in healthcare, but probably not as much as they should. The greater autonomy granted to healthcare professionals especially to medical consultants compared to those in military hierarchies may account for some of the differences. | 262 |
| 2023-07-22 | Wenger EC, Snyder WM. Communities of practice: The organizational frontier. Harvard business review. 2000;78(1):139-146 | Link | Review /Overview | Groups | Communties /networks | Communities of practice | How and why some groups form and perform at high levels simply because they are bound together by the pleasures of pursuing and achieving shared goals, and how they are fundamentally different from teams and other more easily identified and constructed organisational work groups | 7,598 |
| 2023-07-22 | McDaniel Jr RR, Driebe DJ. Complexity science and health care management. Advances in health care management. 2001;2:11-36 | Link | Review /Overview | Groups | Organisations - hospitals | Complex adaptive systems | Many problems can be understood and solved as simple linear cause and effect relationships, but many more in large organisations such as health care services arise from complex non-linear interactions among multiple factors and often conflicting objectives. Such interactions often manifest unexpected, ill-understood and usually unwanted emergent properties. This paper provides a good overview of these complex adaptive systems in health care services and how they need to be managed. | 418 |
| 2023-07-22 | Duckett SJ, Breadon P, Weidmann, B, Nicola I. Controlling Costly Care - a Billion Dollar Opportunity. Grattan Institute, Melbourne | Link | Report /White paper | Groups | Organisations - hospitals | Variation - unjustified | A comprehensive and detailed report on the widespread and often very wide variation in usage and costs of hospital services in Australia and the potential national saving at that time of around 2 Billion dollars | |
| 2023-07-22 | Mant J. Process versus outcome indicators in the assessment of quality of health care. International Journal for Quality in Health Care. 2001;13(6):475. | Link | Theory /Hypothesis | Groups | Organisations - hospitals | Outcomes | In comparisons of performance between clinical services it is natural and entirely justified to pay most attention to outcomes such as mortality in heart disease. The problem with this however is that adverse outcome are relatively rare which means that very large numbers of cases must be collected before valid comparisons can be made. Also final outcomes are sensitive to other variables such as demographic and casemix severity. Comparisons of the processes of care, provided these are of evidence based efficacy, can be made much more quickly as they are or should be used in all cases thus giving larger numbers as denominators. They are also not subject to casemix and other environmental confounding factors. | 749 |
| 2023-07-12 | Woolley AW, Chabris CF, Pentland A, Hashmi N, Malone TW. Evidence for a collective intelligence factor in the performance of human groups. Science. 2010;330(6004):686-688. | Link | Empirical study | Groups | Teams | Intelligence - collective | It is well known that in health care as in many other human activities and endeavors, some teams or groups perform better together than others. This study showed that in small groups successful accomplishment of a variety of tasks was much more closely related to a new measure of collective intelligence than to the average or maximal intelligence of the individuals that constituted the group, Collective intelligence was found to be related to the average social sensitivity of group members, the equality in distribution of conversational turn-taking, and the proportion of females in the group. | 3,036 |
| 2023-07-11 | Priesmeyer HR, Sharp LF, Wammack L, Mabrey JD. Chaos theory and clinical pathways: a practical application. Quality Management in Healthcare. 1996;4(4):63. | Link | Review /Overview | Groups | Organisations - hospitals | Complex adaptive systems | Although much has been written about the nature of many healthcare services as complex adaptive systems and the consequent 'wicked' problems and unexpected emergent properties, not a great deal of this literature gives much practical guidance in the development and use of useful analytical tools. This paper is an exception in that it explores the possible application of a very simple form of analysis and data display - the phase map. | 16 |
| 2023-07-11 | Priesmeyer HR. Organizations and Chaos : Defining the Methods of Nonlinear Management. Quorum Books; 1992. | Link | Book | Groups | Organisations | Complex adaptive systems | A lucid account with descriptions of several interesting and practicable analytical methods for investigating and managing non-linear phenomena in commercial environments. Expands on the paper on the use of phase maps by Priesmeyer and Sharp (Ref no 608) | |
| 2023-07-11 | Ludeman K, Erlandson E. Coaching the Alpha Male. Harvard Business Review. 2004;(May 2004). | Link | Review /Overview | Individuals | Leaders | Coaching | The highly competitive environment of hospital specialist training and recruitment inevitably leads to a disproportionate number of highly driven and competitive 'alpha' males ending up in these positions. This may be advantageous where bold innovation and boundary extending courage are required. Few ground breaking surgical techniques are introduced and nursed through the early learning curves of frequent failures by shrinking violets. We need this type of alpha males (and females, fewer in number tho' no less courageous or turbulent) for progress to be made. The down side ot 'alphadom' is that such individuals may not be easy to work with or be good team leaders or builders. At the extreme they can verge on dangerous narcissism - disruptive to their colleagues and dangerous to their patients because of their unshakable self confidence and over estimates of their own abilities. This paper gives some useful and practical advice for managing these individuals at the milder end of the spectrum. | 124 |
| 2023-07-10 | Simon HA. Bounded rationality and organizational learning. Organization science. 1991;2(1):125-134. | Link | Review /Overview | Groups | Organisations | Learning | A very readable essay by a polymath and Nobel prize winner on how organisations do or don't learn what they need to know. One of the most interesting and intriguing sections refers to Bavelas networks - studies of how groups communicate when configured in different ways and how one study purportedly shows that once particular patterns of using centralized or peripheral communications routines are established they persist despite complete changes of all staff involved. This is probably why some organizational cultures can be so hard to change. | 5,815 |
| 2023-07-09 | Simon HA. A behavioral model of rational choice. The quarterly journal of economics. 1955;69(1):99-118. | Link | Theory /Hypothesis | Individuals | In general | Rationality - bounded | A landmark paper that shifted thinking away from the traditional models of economic decision-making through rational quantitative assessment of all the relevant factors, and towards the reality that we cannot possibly take into account and integrate all the myriad pieces of information. We therefore 'bound' our scope of attention and decision-making to fit our limited cognitive abilities. This 'satisficing' model applies wherever complex decisions involving many factors have to be made such as in specialist medicine. The resultant narrowing of attention is unavoidable but can result in sub optimal and uncoordinated decision making where several specialists have to work together | 24,293 |
| 2023-07-09 | Hickson GB, Pichert JW, Webb LE, Gabbe SG. A complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors. Academic Medicine. 2007;82(11):1040. | Link | Empirical study | Individuals | Doctors | Behaviour - aberrant | A comprehensive and well validated model for addressing disruptive behaviour in medical staff. It uses specific training for staff delivering a program with a 4 four level graduated intervention : 1 informal conversations for single incidents,2 non-punitive “awareness” interventions when data reveal patterns, 3 leader-developed action plans if patterns persist, and imposition of disciplinary processes if all else fails | 413 |
| 2023-07-09 | Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine. 2009;360(5):491-499 | Link | Empirical study | Groups | Teams | Safety | This was the first major study to showing significant reductions in surgical mortality and complication rates in a wide range of hospital settings through the use of checklists.. Although the value of this approach has since been widely accepted some surgeons still are still reluctant to embed it in routine practice. Might this be a flag for other behavioral / performance issues ? | 6,655 |
| 2023-07-09 | Westrum R. A typology of organisational cultures. BMJ Quality & Safety. 2004;13(suppl 2):ii22-ii27. | Link | Theory /Hypothesis | Groups | Organisations | Cultures - organisational | An important classification of organizational cultures based upon their management of aberrations The differences reflect in large part leadership styles. The focus is upon the quality and safety of healthcare services but illustrations from other industries are given. Three categories of response are identified : Pathological, Bureaucratic and Generative which will be recognized by anyone called upon to investigate poorly performing or unsafe healthcare teams and services. The essence of the distinguishing features are neatly summarised in Table 1 and Figure 1 | 630 |
| 2023-07-09 | Noblet JP, Simon E, Parent R. Absorptive capacity: a proposed operationalization. Knowl Manage Res Pract. 2011;9(4):367-377. doi:10.1057/kmrp.2011.26 | Link | Review /Overview | Groups | Organisations | Learning | The concept of organisational learning has rather strangely received more attention in the commercial sector as an important driver of performance and innovation than in academic and healthcare institutions. In essence this paper builds upon and clarifies an earlier classification of this process into four stages : Acquisition, Assimilation,Transformation and Exploitation, stages that obviously mirror similar mechanisms of individual learning. It is clear that the capacity to absorb and effectively use information originating externally is much more important in performance enhancement both quantitatively and qualitatively than internal research and development. This website was developed in part to provide one set of tools to facilitate both organisational and individual learning from important but often overlooked external sources.As in most other human activities we learn and act more by copying the ideas and activities of others than though our own creative endeavours. | 177 |
| 2023-07-09 | Wennberg JE. Tracking Medicine: A Researcher’s Quest to Understand Health Care. Oxford University Press; 2010. | Link | Book | Groups | Organisations - hospitals | Variation | Should be required reading for any clinician or manager wanting to increase the value of the services they provide either by improving quality or reducing costs or both. The author has been a pioneer and leading researcher of unjustified variation in these variables for several decades, His major contributions include the development of the USA Dartmouth Atlas of geographic variation, and a tripartite classification of health care services into Effective, Supply-sensitive and Preference-sensitive categories as aid to aid to improvement. |