Maximizing value in healthcare partnerships: A case examining an inter-organizational relationship in the public and non-profit sectors

Healthcare organizations around the world are striving to find the right balance between using their resources effectively and providing personalized care to patients. Health care is shifting from a reactive, towards a more person-centric approach to improve health outcomes. To achieve quality improvements and efficiencies, health care organizations are forming inter-organizational relationships. Despite the benefits, little is known about how organizations capture value from strategic partnership. In this context, this paper aims to examine the processes that occur as part of a public and non-profit sector relationship within health care that directly relate to how the partnering organization acts to capture value. Using a qualitative case study of an Australian public-sector health service partnership, the study employs a value mapping framework to distinguish between different types of value (captured, missed, destroyed, and opportunity), and presents an integrated model consisting of three process phases: (1) inter-organizational cooperation effort, (2) organizational effect, and (3) social value. The study highlights the potential for negative and unintended consequences and discusses implications for management.     

Rethinking the policy of contracting out Social Services to non-governmental organizations

The article describes, analyzes and evaluates the lessons and dilemmas resulting from the Government's policy of contracting out with non-governmental organizations for the provision of three types of services: foster care, adoption and home care services for the elderly. The dilemmas are: structural tension between governmental control and autonomy of provider organizations; power?–?dependence relations between the Government and the providers, the choice option available to clients; the ethical, moral and professional aspects of contractualism; the myth of innovative programs initiated by provider organizations; service quality versus price of services; and accountability of provider organizations to their stakeholders. Based on the lessons learned, the article highlights the need to rethink the strategy of contracting out and reassess the role of the Government in providing social services.     

Strategic giving and the nursing shortage

• Health care organizations in the United States face a significant nursing shortage, which seriously impacts the quality and availability of health care. Confronting this challenge requires involvement from organizations beyond the public sector. This paper explores an initiative by Blue Cross and Blue Shield of Florida, exemplifying the concept of ‘strategic philanthropy,’ to contribute their financial resources and strong institutional ties to respond to the current and future shortage of nurses in Florida. Through this intervention, the company and partnering organizations hope to benefit the health care sector, the public, and themselves from the outcomes associated with the generation of a greater supply of nurses.

Copyright © 2006 John Wiley & Sons, Ltd.     

Why do some hospital leaders “speak no evil” about their organizations' medical errors?

Sentinel events, preventable medical errors resulting in serious disability or death, are a significant problem for hospital leaders. Accreditation agencies, such as the Joint Commission, urge hospitals to voluntarily disclose information about medical errors. However, some healthcare leaders “speak no evil” by choosing not to release sentinel‐event data. In an effort to increase the reporting of medical errors, several states passed laws mandating disclosure of sentinel events to the government. The state‐reported medical error rates of Indiana hospitals were compared with their leaders' perceptions of quality of care. Regardless of the number of sentinel events occurring at their hospitals, leaders consistently claimed their organizations provided high‐quality care. Two theories, rationalization and gaming, are presented to explain why leaders do not acknowledge the presence of serious quality‐management problems in their organizations.     

ISO 9000: a guide to world-class quality standards

World standards for determining companies' commitment to continuous quality improvement (CQI) have been established. These standards are collectively known as ISO-9000. Prudent buyers of goods and services for health care organizations that are also committed to CQI should understand these standards and use them to facilitate supplier certification.     

Job autonomy, trust in leadership, and continuous improvement: An empirical study in health care

This research examines the influence of autonomy in day-to-day work on commitment of frontline employees to continuous improvement. Our hypothesized model links the job characteristics theory of work design that associates job autonomy with responsibility for outcomes, and the total quality management perspective that advocates empowering employees in order to generate commitment to continuous improvement. Further, as leadership is known to have a role in shaping job behaviors, and is considered important for the success of total quality management, the influence of trust in leadership on the relationship between job autonomy and commitment to continuous improvement is also examined. We test our hypotheses on data collected from individual employees working for an outpatient health care organization that is applying lean principles for managing and improving work processes. Based on our results, we present implications for organizations implementing continuous improvement initiatives such as lean, particularly in service environments such as health care.     

A labor relations research agenda for health care settings

Inadequate attention has been given to labor-management relations in health care organizations. Bacause of the labor-intensive nature of health care and the great dependence on human resources, health services researchers should place greater emphasis on labor-management issues. This article develops a framework and suggests methodologies for examining labor relations in health care organizations. Specifically, six cirtical issues are suggested for attention by researchers: (1) the quality of the union-management relationship; (2) union organizing drives; (3) collective bargaining and contract negotiations; (4) impasse resolution; (5) contract administration and grievance handling; and (6) labor-management cooperation. These areas of research have been dominated by industrial relations researchers who have focused primarily on the manufacturing sector. Given cost containment and competitive pressures, it is timely to bridge the gap between the health services research community and the accumulating body of knowledge in industrial relations.     

The impact of buyer-supplier relationship quality and information management on industrial vending machine benefits in the healthcare industry

Despite the calls for a deeper understanding of SCM in the healthcare industry, theoretical research focused on healthcare buyer-supplier collaboration, specifically inventory management issues, remains nascent and fragmented. Although slow to change, healthcare organizations have begun to consider alternative inventory management systems to improve inventory control and patient care. Industrial vending machines (IVM) can help healthcare organizations address inventory management issues. Grounded in transaction cost economics and contingency theory, this research develops and empirically tests a model that highlights the critical role of information management in the link between buyer-supplier relationship quality and performance outcomes within the context of IVM implementation and use in the healthcare industry. Based on survey data from healthcare managers, results indicate that both information management and relationship quality are tied to a series of benefits in the context of collaborative buyer-supplier IVM agreements.     

Drawing from a bottomless well? Exploring the resilience of value-based psychological contracts in voluntary organizations

In an era of increased involvement by the third sector in the delivery of social services due to public sector outsourcing, this paper explores the resilience of employee psychological contracts in voluntary organizations in the context of their close relationship with state funding bodies. The results suggest that value-laden psychological contracts exhibit some resilience when state funding bodies interfere with the organizational mission of voluntary organizations. However, there are clear limits as to how far value-based aspects of the psychological contract compensate for unfulfilled obligations on the economic and socio-emotional dimensions caused by externally driven cost pressures. The paper suggests serious implications for HR practitioners and wider concerns relating to the quality of care delivered to the vulnerable.     

Local government reform between ‘exogenous’ and ‘endogenous’ driving forces

Abstract

Configuration is an appealing concept to help understanding the complex arrangements that guide organizations' actions and contribute to their coherence. Although health care organizations are often described as professional bureaucracy a deep understanding of their structure and systems is still lacking. In this article, we draw on empirical data gathered in a Canadian teaching hospital to expose the nature of interdependencies and themes that drive some of its configurations at health care unit level. Five clinical activities were investigated (ocular surgery, brachytherapy, vascular surgery, rheumatology and geriatrics) using direct systematic observation. Four sub-orchestrating themes emerged. Based on the findings it is argued that the operating core of health care organizations is not homogeneous but rather heterogeneous. Therefore it is our contention that hospitals and other public organizations where professionals control the activities at operating level might be better regarded as ‘diversified professional federation’ than as professional bureaucracy.     

Developing collaborative professionalism: an investigation of status differentiation in academic organizations in knowledge transfer partnerships

In recent years, there has been a significant growth in knowledge transfer partnerships to improve the quality and timeliness of health care. These activities require an increasing level of interdependence between academic and health care professionals, with important implications for human resource management. To understand these knowledge transfer partnerships, we conducted an in-depth longitudinal study based on 99 interviews and 5 focus group workshops across academic and health care professionals in nine university-based knowledge transfer partnerships in England. We explore how academic professionals of lower and higher status organizations develop a new form of professional work, based on the principles of collaborative professionalism, during their involvement in partnerships with health care professionals. We illuminate how the interdependent work between academic professionals and health care professionals in the development of a new academic specialization is shaped by the status of their organizations.     

Multiple Institutional Logics in Health Care: ‘Productive Ward: Releasing Time to Care’

Health care organizations are often confronted with multiple institutional logics. In this study, a longitudinal case study method was used to gain insights into the adoption decision-making and implementation process of an apparently hybrid innovative practice when multiple logics are present. The case study focuses on the adoption and implementation of ‘Productive Ward: Releasing Time to Care’ in a Dutch hospital. This is a quality improvement programme developed by the National Health Service (NHS) in the United Kingdom. The results show that institutional logics complicate the adoption and implementation process.     

Organizational learning and the learning organization in health care

Learning is seen as a systems-level phenomenon that stays within the organization regardless of the "players" involved. However, this article reviews some of the history of organizational learning and the learning organization and makes a proposal for how health care organizations are becoming learning organizations.     

The state of total quality management: a review

As quality is seen as becoming a competitive mandate, many organizations are said to be embracing the practice of total quality management (TQM) as an improvement strategy. In this paper, we will be examining the extent to which quality management (QM) - TQM in particular-has been adopted by organizations. Just as there are companies that claim that QM is benefiting them, the concept is also increasingly being criticized for not bringing about the promised results, and in the following review, studies that have highlighted this disparity in opinions will be reviewed. Increasingly, doubts have been raised as to whether partial quality management - and not TQM - is being practised in organizations. This paper will also examine the difficulties companies may be faced with in their attempts to embrace TQM.     

Intrapreneurship and firm entrepreneurial orientation: insights from the health care service industry

Intrapreneurship affects our daily lives and is a research topic of great importance. Given the current economic climate, its relevance to firm performance has increased considerably both among academics and practitioners. Specifically, our approach has focused on the identification, analysis and explanation of the determinants/variables that influence the intrapreneurship process in the health care service industry, including the private, public and social sectors. The methodology employed consisted of collecting primary data via a questionnaire survey. The questionnaire was sent by e-mail to health care employees and middle managers from the northern and center regions of Portugal, and the study covered 202 professionals from 45 organizations. The results show that the participating health care team members present intrapreneurial behavior, and health care organizations create favorable internal conditions that support the theoretical concepts of intrapreneurship and firm entrepreneurial orientation (FEO).     

Integration and Task Allocation: Evidence from Patient Care

Using the universe of patient transitions from inpatient hospital care to skilled nursing facilities and home health care in 2005, we show how integration eliminates task misallocation problems between organizations. We find that vertical integration allows hospitals to shift patient recovery tasks downstream to lower‐cost organizations by discharging patients earlier (and in poorer health) and increasing post‐hospitalization service intensity. Although integration facilitates a shift in the allocation of tasks and resources, health outcomes either improved or were unaffected by integration on average. The evidence suggests that integration solves coordination problems that arise in market exchange through improvements in the allocation of tasks across care settings.     

Coordination Networks Within and Across Organizations: A Multi‐level Framework*

ABSTRACT There are important organizational phenomena that cannot be fruitfully examined without crossing levels of analysis, as others have shown. We argue that coordination of patient care in the current institutional environment is one such phenomenon. As organizations vertically disintegrate and outsource services that were once produced internally, coordination with external organizations becomes increasingly important for achieving desired performance outcomes. We describe the efforts of one hospital to extend the intra‐organizational coordination of patient care to encompass coordination with its external partners. The organization design and network perspectives are both conducive to spanning multiple levels of analysis. We show that the two perspectives together serve as a useful vehicle for developing a framework that links intra‐ and inter‐organizational coordination.     

A health maintenance organization design for long term care under medicaid

The rapid increase in public expenditures for long term care under Medicaid is discussed. The major cause of this increase is identified as the high and often excessive utilization of nursing home care. Health maintenance organizations (HMOs) are considered in terms of their ability to reduce health care costs by curbing unnecessary hospitalization. The HMO structure is extended to long term care, where it is argued that unnecessary nursing home care can be reduced. A health maintenance organization targeted to the Medicaid long term care population is proposed and a detail flow analysis of the HMO is presented.     

Getting to go in managed care

The challenge for leadership and the required changes are great. Our personal limitations include a limited view of the world and the threat of an overwhelming risk if one gets too far out on the limb. "Getting to go" will open up new and strange territories that will provide opportunity and failure for leaders. Capable leaders will pursue the opportunity. Threatened leaders will resist the change. For those leaders who feel that the managed care existing today provides the most cost-effective, quality outcome for the individual, his or her sponsor in the community, they will go no further. Unfortunately for many of us, managed care means a third party trying to micromanage patients (deductions, authorizations, and so on), employers (claims, incentives, and so forth), and providers (approvals, forums, payment, tricks, and the like). Providers need to go ahead and master efficient care. We owe that to the community and the third party nightmare of administrative overkill must be laid to rest. For those healthcare leaders who believe that managed care as a system focused on improving the health status of our communities is superior to our existing system, their individual goals and leadership focus must be changed accordingly. We cannot sit by idly and wait for the system to change us. Instead our obligation is to lead our organizations toward a new era in health care.