Defensive medicine through the lens of the managerial perspective: a literature review.

PURPOSE: Several studies have been carried out on defensive medicine, but research from the managerial viewpoint is still scarce. Therefore, the aim of the present study is to conduct a literature review to better understand defensive medicine from a managerial perspective. DESIGN/METHODOLOGY/APPROACH: A literature review was conducted of studies focusing on the organisational (meso) level of healthcare providers and managerial practices. A final sample of 28 studies was processed. FINDINGS: Defensive medicine has mainly been studied in the USA, and scholars have principally used quantitative surveys. High-risk specialities have been a critical field of investigation, and a large portion of the papers are published in journals that cover medicine, health policy, education and law fields. The analysis showed that operations and the organisation of staffing were the most discussed managerial practices. No study considered planning and budgeting aspects. ORIGINALITY/VALUE: The review confirmed that the managerial aspect of defensive medicine has not been fully addressed. Stimulated by this gap, this study analyses the managerial background of the defensive medicine phenomenon and shows which managerial practices have been most analysed. This paper also contributes to developing the literature on defensive medicine from the managerial side. Areas for future research include qualitative studies to investigate the behaviour of managers of healthcare companies to give a different perspective on defensive medicine and organisations' decision-making. RESEARCH LIMITATIONS/IMPLICATIONS: Some important publications might have been missed in this work because of the choice of only two databases. A further limit could be imposed by the use of the English language as an inclusion criterion.

Organization support as an antecedent of self-efficacy during the COVID-19 lockdown in Sri Lanka.

The objectives of this study were to investigate organization support received by employees during the COVID-19 lockdown and its effect on self-efficacy. The study was conducted in Sri Lanka during the COVID-19 lockdown; a sample of employees who performed work in the form of work-from-home responded to the survey questionnaire. The data were analysed using structural equation modelling techniques. The findings led to identify four organization support practices implemented during the COVID-19 lockdown. These were named as work collaboration and coordination, work direction, psychological wellness, and physical wellness. These four practices significantly enhanced the self-efficacy of employees. The findings of the study imply that the traditional theories of social cognitive theory and positive psychology have enduring theoretical resonance to better understand contemporary phenomena with novel applications.

Clinical Governance to Enhance User Involvement in Care: A Canadian Multiple Case Study in Mental Health.

BACKGROUND: Individuals with serious mental illness face challenges in managing their health, leading to the need for integrating their needs and preferences in care decisions. One way to enhance collaboration between users and providers is to improve clinical governance; a shared responsibility between managers and providers, supported by healthcare organizations (HCOs), policies, and standards. We applied the concept of clinical governance to understand (1) how managers and providers can enhance the involvement of users in mental health, (2) the contextual and organizational factors that facilitate user involvement in care, and (3) the users' perceptions of their involvement in care. METHODS: We conducted two, in-depth case studies from two clinical teams in Canada offering outpatient care for users with acute mental illness. A total of 25 interviews were carried out with managers, and four focus groups were held with providers. A measure of patient-reported experience was used to evaluate the users' perceptions of their involvement in care. RESULTS: The providers used two methods to involve users in the care planning process: encouraging users to identify their life goals and supporting them to define recovery-oriented objectives. To encourage the adoption of collaborative practices, the managers used various practices such as revising care protocols, strengthening providers' knowledge of best practices and integrating peer-support workers (PSWs) in the team. Compliance with organizational and external commitments/requirements for user involvement, access to specific training and the institutionalization of a culture promoting user involvement facilitated the adoption of collaborative practices. We found that mental health teams that adopt recovery and collaborative practices with users show a high degree of user-perceived involvement in care. CONCLUSION: This is the first study to apply the concept of clinical governance to understand how managerial and clinical practices, and other organizational and contextual factors, can enhance the involvement of mental healthcare users.

Cognições gerenciais sobre inovação gerencial e gestão de pessoas / Managerial cognitions regarding managerial innovation and people management

O objetivo geral desta pesquisa foi analisar o contexto da gestão de pessoas e a inovação gerencial numa empresa de comunicação, através da percepção de seus gestores. Os objetivos específicos foram: identificar mudanças ocorridas na área de gestão de pessoas, analisar a percepção de gestores a respeito das ações gerenciais que indicam inovação e analisar a relação entre o contexto da gestão de pessoas e da inovação gerencial. A metodologia foi qualitativa com a realização de 6 entrevistas semiestruturadas com gestores de alto cargo dentro da empresa. Os resultados foram analisados através da análise de conteúdo. As cognições gerenciais revelaram que as inovações estão presentes nas ações dos gestores e no processo evolutivo da gestão de pessoas da empresa. Também, foi observado a necessidade de alinhamento dos arranjos internos da empresa a fim de possibilitar o alcance das expectativas dos seus stakeholders. Este artigo contribui ao tratar da implementação de práticas que promovem a evolução da gestão de pessoas e estimulam a criação de inovações gerenciais. Além de promover melhor entendimento sobre a dinâmica gerencial de uma empresa de comunicação que enfrenta o desafio de ser competitiva e produzir informações de valor para seus clientes.

The general objective of this research was to analyze the context of people management and managerial innovation in a communication company, through the perception of its managers. The specific objectives were: to identify changes that occurred in the area of people management, analyze the perception of managers about management actions that indicate innovation and analyze the relationship between the context of people management and managerial innovation. The methodology was qualitative with the realization of 6 semi-structured interviews with senior managers within the company. The results were analyzed through content analysis. Management cognitions revealed that innovations are present in the actions of managers and in the evolutionary process of managing the company's people. Also, the need to align the company's internal arrangements in order to enable the achievement of the expectations of its stakeholders was observed. This article contributes by addressing the implementation of practices that promote the evolution of people management and stimulate the creation of managerial innovations. In addition, it promotes better comprehension about the management dynamics of a communication company that faces the challenge of being competitive and producing value information for its customers.

Partnering with patients in quality improvement: towards renewed practices for healthcare organization managers?

BACKGROUND: Around the world, many healthcare organizations engage patients as a quality improvement strategy. In Canada, the University of Montreal has developed a model which consists in partnering with patient advisors, providers, and managers in quality improvement. This model was introduced through its Partners in Care Programs tested with several quality improvement teams in Quebec, Canada. Partnering with patients in quality improvement brings about new challenges for healthcare managers. This model is recent, and little is known about how managers contribute to implementing and sustaining it using key practices. METHODS: In-depth multi-level case studies were conducted within two healthcare organizations which have implemented a Partners in Care Program in quality improvement. The longitudinal design of this research enabled us to monitor the implementation of patient partnership initiatives from 2015 to 2017. In total, 38 interviews were carried out with managers at different levels (top-level, mid-level, and front-line) involved in the implementation of Partners in Care Programs. Additionally, seven focus groups were conducted with patients and providers. RESULTS: Our findings show that managers are engaged in four main types of practices: 1-designing the patient partnership approach so that it makes sense to the entire organization; 2-structuring patient partnership to support its deployment and sustainability; 3-managing patient advisor integration in quality improvement to avoid tokenistic involvement; 4-evaluating patient advisor integration to support continuous improvement. Designing and structuring patient partnership are based on typical management practices used to implement change initiatives in healthcare organizations, whereas managing and evaluating patient advisor integration require new daily practices from managers. Our results reveal that managers at all levels, from top to front-line, are concerned with the implementation of patient partnership in quality improvement. CONCLUSION: This research adds empirical support to the evidence regarding daily managerial practices used for implementing patient partnership initiatives in quality improvement and contributes to guiding healthcare organizations and managers when integrating such approaches.

Senior charge nurses' leadership behaviours in relation to hospital ward safety: a mixed method study.

BACKGROUND: High standards of quality and patient safety in hospital wards cannot be achieved without the active role of the nursing leaders that manage these units. Previous studies tended to focus on the leadership behaviours of nurses in relation to staff job satisfaction and other organizational outcomes. Less is known about the leadership skills of senior charge nurses that are effective for ensuring safety for patients and staff in their wards. OBJECTIVES: The aim of the two studies was to identify the leadership behaviours of senior charge nurses that are (a) typically used and, (b) that relate to safety outcomes. METHODS: In study one, semi-structured interviews were conducted with 15 senior charge nurses at an acute NHS hospital. Transcribed interviews were coded using Yukl's Managerial Practices Survey (MPS) framework. In study two, self ratings of leadership (using the MPS) from 15 senior charge nurses (SCN) and upward ratings from 82 staff nurses reporting to them were used to investigate associations between SCNs' leadership behaviours and worker and patient-related safety outcomes. RESULTS: The interviews in study one demonstrated the relevance of the MPS leadership framework for nurses at hospital ward level. The SCNs mainly engaged in relations-oriented (n=370, 49%), and task-oriented (n=342, 45%) behaviours, with fewer change-oriented (n=25, 3%), and lead by example behaviours (n=26, 3%). In demanding situations, more task-oriented behaviours were reported. In study two, staff nurses' ratings of their SCNs' behaviours (Monitoring and Recognizing) were related to staff compliance with rules and patient injuries (medium severity), while the self ratings of SCNs indicated that Supporting behaviours were linked to lower infection rates and Envisioning change behaviours were linked to lower infection and other safety indicators for both patients and staff. CONCLUSION: This study provides preliminary data on the usability of a standard leadership taxonomy (Yukl et al., 2002), and the related MPS questionnaire, on a nursing sample. The findings indicate the relevance of several leadership behaviours of SCNs for ensuring a safer ward environment and contribute to the evidence base for their leadership skills training.