ABSTRACT
PURPOSE: Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation. DESIGN/METHODOLOGY/APPROACH: This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale. FINDINGS: The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure. PRACTICAL IMPLICATIONS: This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result. ORIGINALITY/VALUE: Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.
Subject(s)
Delivery of Health Care , State Medicine , Humans , Leadership , Health Facilities , United KingdomABSTRACT
BACKGROUND: Healthcare organisations differ in performance even if they are located in the same country or region. Suitable managerial practices and organisational processes can lead to better health outcomes. As a result, hospitals are constantly looking for managerial arrangements that can improve outcomes and keep costs down. This study aims to identify different managerial models in neonatal intensive care units (NICUs) and their impact on a large number of outcomes. METHODS: The research was conducted in Italy, within the SONAR project. SONAR's aim was to identify the characteristics of NICUs, monitor outcomes and promote best practices. This study includes 51 of the 63 NICUs that took part in the SONAR project. Questionnaires on the activities and managerial features were administered to doctors and nurses working in NICUs. A total of 643 questionnaires were analysed from doctors and a total of 1601 from nurses. A cluster analysis was performed to identify managerial models of NICUs. RESULTS: Three managerial models emerged from cluster analysis: traditional, collaborative and individualistic. In the "traditional" model the doctor is above the nurse in the hierarchy, and the nurse therefore has exclusively operational autonomy. The "collaborative" model has as key elements professional specialisation and functional coordination. The "individualistic" model considers only individual professional skills and does not concern the organisational conditions necessary to generate organisational effectiveness. The results also showed that there is an association between managerial model and neonatal outcomes. The collaborative model shows best results in almost all outcomes considered, and the traditional model has the worst. The individualistic model is in the middle, although its values are very close to those of traditional model. CONCLUSIONS: Health management needs to assess NICU strategically in order to develop models to improve outcomes. This study provides insights for management useful for designing managerial characteristics of NICUs in order to achieve better results. NICUs characterised by a collaborative model in fact show better neonatal outcomes.
Subject(s)
Intensive Care Units, Neonatal/organization & administration , Outcome Assessment, Health Care , Cluster Analysis , Humans , Infant, Newborn , Italy , Models, OrganizationalABSTRACT
Este artigo analisa a evolução organizacional de um instituto público de pesquisa tecnológica, o Instituto de Tecnologia de Alimentos (Ital) por meio de um estudo de caso, num período de 10 anos. Aplica pela primeira vez os conceitos de modelos institucional e gerencial. Por modelo institucional entende-se a evolução das características jurídicas que permitem a uma instituição o cumprimento de suas funções sociais. O modelo gerencial compreende dois componentes: o compulsório e o estratégico. O primeiro trata da gestão dos processos decorrentes do modelo institucional, e o segundo, daqueles que são frutos de suas decisões estratégicas. A principal característica do Ital é ser uma instituição híbrida, pois juridicamente é um instituto público de pesquisa, mas gerenciado, em alguns aspectos, como uma empresa privada altamente inovadora. Na sua trajetória institucional, o Ital adotou uma organização descentralizada, o que lhe permitiu aprofundar os laços com o setor produtivo e aumentar a participação das fontes extraorçamentárias no seu orçamento total. O componente estratégico de seu modelo gerencial teve um peso muito grande nesse desenvolvimento. No entanto, seu modelo organizacional começa a apresentar sinais de esgotamento, colocando desafios para a sua continuidade como instituição de referência.
