Abstract
Background
Process improvement in healthcare is informed by knowledge from the private sector. Skilled individuals may aid the adoption of this knowledge by frontline care delivery workers ...through knowledge brokering. However, the effectiveness of those who broker knowledge is limited when the context they work within proves unreceptive to their efforts. We therefore need greater insight into the contextual conditions that support individuals to broker process improvement knowledge to the frontline of care delivery, and how policy makers and organizations might generate such conditions.
Methods
Our research took place in a healthcare system within an Australian State. We undertook a qualitative, embedded single case study over the four year period of a process improvement intervention encompassing 57 semi-structured interviews (with knowledge brokers, policy makers, and executive sponsors), 12 focus groups, and 137 h of observation, which included the frontline implementation of actual process improvement initiatives, where knowledge brokering took place.
Results
We identified four phases of the process improvement intervention that moved towards a more mature collaboration within which knowledge brokering by improvement advisors began to emerge as effective. In the first phase knowledge brokering was not established. In the second phase, whilst knowledge brokering had been initiated, the knowledge being brokered lacked legitimacy amongst frontline practitioners, resulting in resistance. Only in the fourth and final phase of the intervention did the collective experience of policy makers result in reflections on how they might engender a more receptive context for knowledge brokering.
Conclusion
We highlight a number of suggested actions that policy makers might consider, if they wish to engender contextual conditions that support knowledge brokering. Policy makers might consider: ensuring they respect local context and experience, by pulling good ideas upward, rather than imposing foreign knowledge from on high; facilitating the lateral diffusion of knowledge by building cultural linkages between people and organizations; strengthening collaboration, not competition, so that trans-organisational flow of ideas might be encouraged; being friend, not foe, to healthcare organizations on their knowledge integration journey. In sum, we suggest that top-down approaches to facilitating the diffusion and adoption of new ideas ought to be reconsidered.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Background
Large-scale partnerships between universities and health services are widely seen as vehicles for bridging the evidence–practice gap and for accelerating the adoption of new ...evidence in healthcare. Recently, different versions of these partnerships – often called academic health science centres – have been established across the globe. Although they differ in structure and processes, all aim to improve the integration of research and education with health services. Collectively, these entities are often referred to as Research Translation Centres (RTCs) and both England and Australia have developed relatively new and funded examples of these collaborative centres.
Methods
This paper presents findings from a rapid review of RTCs in Australia and England that aimed to identify their structures, leadership, workforce development and strategies for involving communities and service users. The review included published academic and grey literature with a customised search of the Google search engine and RTC websites.
Results
RTCs are complex system-level interventions that will need to disrupt the current paradigms and silos inherent in healthcare, education and research in order to meet their aims. This will require vision, leadership, collaborations and shared learnings, alongside structures, processes and strategies to deliver impact in the face of complexity. The impact of RTCs in overcoming the deeply entrenched silos across organisations, disciplines and sectors needs to be captured at the systems, organisation and individual levels. This includes workforce capacity and public and patient involvement that are vital to understanding the evolution of RTCs. In addition, new models of leadership are needed to support the brokering and mobilisation of knowledge in complex organisations.
Conclusions
The development and funding of RTCs represents one of the most significant shifts in the health research landscape and it is imperative that we continue to explore how we can progress the integration of research and healthcare and ensure research meets stakeholder needs and is translated via the collaborations supported by these organisations. Because RTCs are a recent addition to the healthcare landscape in Australia, it is instructive to review the processes and infrastructure needed to support their implementation and applied health research in England.
Abstract
Background
Over the past decade, Research Translation Centres (RTCs) have been established in many countries. These centres (sometimes referred to as Academic Health Science Centres) are ...designed to bring universities and healthcare providers together in order to accelerate the generation and translation of new evidence that is responsive to health service and community priorities. This has the potential to effectively ‘flip’ the traditional research and education paradigms because it requires active participation and continuous engagement with stakeholders (especially service users, the community and frontline clinicians). Although investment and expectations of RTCs are high, the literature confirms a need to better understand the processes that RTCs use to mobilise knowledge, build workforce capacity, and co-produce research with patients and the public to ensure population impact and drive healthcare improvement.
Methods
Semi-structured interviews were conducted with selected leaders and members from select RTCs in England and Australia. Convenience sampling was utilised to identify RTCs, based on their geography, accessibility and availability. Purposive sampling and a snowballing approach were employed to recruit individual participants for interviews, which were conducted face to face or via videoconferencing. Interviews were recorded, transcribed verbatim and analysed using a reflexive and inductive approach. This involved two researchers comparing codes and interrogating themes that were analysed inductively against the study aims and through meetings with the research team.
Results
A total of 41 participants, 22 from England and 19 from Australia were interviewed. Five major themes emerged, including (1) dissonant metrics, (2) different models of leadership, (3) public and patient involvement and research co-production, (4) workforce development and (5) barriers to collaboration.
Conclusions
Participants identified the need for performance measures that capture community impact. Better aligned success metrics, enhanced leadership, strategies to partner with patients and the public, enhanced workforce development and strategies to enhance collaboration were all identified as crucial for RTCs to succeed.
The conventional negative understanding of the scientific management movement has been challenged in recent decades by heterodox scholars who hold that the movement supported the democratization of ...the management process and in so doing worked closely with unions and with progressives within and around Roosevelt’s New Deal administration. This paper seeks to strengthen this challenge to orthodoxy by documenting how the leadership of the Taylor Society, a body established by Frederick Taylor’s inner circle as a vehicle to develop and promote their mentor’s ideas, strove to internationalize the diffusion of participatory management in tandem with the International Labour Organization, a body whose core purpose was and is to promote codetermination both in workplaces and in wider society.
We attempt to reconcile top‐down and bottom‐up perspectives on bureaucratic discretion to understand how actors ‘caught in the middle’, such as middle level public managers, negotiate conflicting ...demands to exercise discretion in the Bangladesh public administration. To do this, we employ the institutional logics framework, a theoretical lens that conceptualises how regulative, cultural forces bear down on actors, and also acknowledges actor agency. Based on 32 interviews with current and former public servants and local public administration experts, supported by secondary documentary analysis, we identify a new way in which discretion may be enacted in institutionally complex settings, offering a way to reconcile top‐down and bottom‐up perspectives. We term this response selective bridging—a sense‐making approach to exploit the complementarities of competing institutional forces from the top to exercise discretion for bottom‐up needs.
This registered report aims to evaluate the extent to which the human resources function can change public attitudes toward a controversial social issue. Focusing on the employment of formerly ...incarcerated people, we explore the novel concept of “human resources social advocacy” (HRSA), an interventionist approach through which HR might pro‐actively change and/or shape people's minds on social issues via the communication and conveyance of ideas related to HR matters of public interest. We seek to test the effectiveness of two HRSA interventions in reducing public stigma toward the employment of formerly incarcerated people. One makes a moral case (“Changing Hearts”) and the other makes an instrument case (“Changing Minds”) for including formerly incarcerated people in the labor market. We also explore which of the two interventions is more effective at achieving normative change. This research will have important implications for the “societal effects” of human resource management.
IntroductionHealthcare service redesign and improvement has become an important activity that health system leaders and clinicians realise must be nurtured and mastered, if the capacity issues that ...constrain healthcare delivery are to be solved. However, little is known about the critical success factors that are essential for sustaining and scaling up improvement initiatives. This situation limits the impact of these initiatives and undermines the general standing of redesign and improvement activity within healthcare systems. The conduct of the doctoral research detailed in this study protocol will be nested within a broader parent study that seeks to address this problem by drawing on the theory of ‘institutional entrepreneurship’. The doctoral research will apply this idea to understanding the capacities and capabilities required at the organisation level to bring about transformational change in healthcare services.Methods and analysisThe parent study is predominantly qualitative, is multilevel in nature and has been codesigned with five partner healthcare organisations. The focus is a sector-wide attempt in an Australian state jurisdiction to transfer new redesign and improvement knowledge into the public healthcare system. The doctoral research will focus on the implementation of the sector-wide approach in one healthcare service in the jurisdiction. This research involves interviews with project team members and stakeholders involved in two improvement initiatives undertaken by the health service. It will involve interviews with redesign and improvement leaders and senior managers responsible for the overall health service improvement approach. The methods will also include immersive fieldwork, interviews and focus groups. Appropriate methods for coding and thematic extraction will be applied to the qualitative data.Ethics and disseminationEthical approval has been granted by the health service and Monash University Human Research Ethics Committee. Dissemination will be facilitated via academic publication, industry reports and workshops and dissemination events as part of the broader project.
Like other public organizations, hospitals face increasing calls to innovate in the way they deliver services. However, health care continues to grapple with bridging knowledge 'transfer gaps'. ...Failure to bridge these gaps prevents knowledge generated outside of health care that might inform such innovation from embedding and scaling. We explore how 'improvement facilitators' in one jurisdiction-wide intervention view the organizational factors that support their role as knowledge brokers. We conclude that 'bridging' new ideas and practices to the front line is a problem of legitimation, rather than just a matter of the relevance of the 'foreign' knowledge concerned.
Affirmative action has been a particularly contentious policy issue that has polarised contributions to the debate. Over recent times in most western countries, support for affirmative action has, ...however, been largely snuffed out or beaten into retreat and replaced by the concept of 'diversity management'. Thus, any contemporary study that examines the development of affirmative action would suggest that its opponents have won the battle. Nonetheless, this article argues that because the battle has been won on dubious ethical grounds it is important that we do not allow affirmative action to sink unnoticed. This article explores and challenges the ethical and philosophical underpinnings of opponents' views and finds their cases against affirmative action are not ethically sound. The article concludes there are strong ethical grounds for those organisations which seek to do well, to reassert affirmative action programmes in the global efforts to eradicate systemic discrimination and disadvantage.
In this article, we contend that employers’ willingness to provide former prisoners with integrative forms of employment is related to the extent to which liberal societies abstract, idealise and ...prioritise the interests of the self over the interests of society. Using the United States of America as a critical case to illustrate this argument, we unite the neoinstitutional sociology of organisations with Weick’s small wins approach to problem solving to show how an especially individualistic embodiment of liberalism contributes to the construction of a social and institutional reality that discourages firms from behaving integratively towards former prisoners. In so doing, we produce a conceptual framework that points to ways by which the scarcity of integrative firms within individualist liberal societies might be addressed.
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