Gestão da Mudança na Implementação de Sistemas de Informação em Organizações de Saúde

O sector da saúde a nível nacional e internacional atravessa uma fase de digitalização de processos. As organizações de saúde têm por isso sido confrontadas com a realização de projectos de sistemas de informação. Sendo a sua área de actuação sensível, é essencial diminuir o impacto da mudança provocada pela implementação de sistemas de informação para a saúde, maximizando a eficiência dos sistemas de informação e minimizando o impacto negativo na prestação de cuidados de saúde. Um dos principais problemas de um processo de mudança é o impacto nos profissionais, que exercem resistência, podendo inviabilizar o projecto de sistemas de informação. Neste âmbito, surge a gestão da mudança, que pretende suportar a mudança organizacional. Tendo em conta a importância dos sistemas de informação para a actividade das organizações de saúde, pretende-se estudar o comportamento dos profissionais e da organização durante o processo, ou seja, as características dos processos da gestão de mudança em projectos de sistemas de informação de saúde. A metodologia de investigação utilizada seguiu um método qualitativo interpretativo com base num estudo de caso. A instituição escolhida foi o Centro Hospitalar de S. Francisco, Leiria. Procurou-se ainda uma confrontação dos principais resultados obtidos através da realização de um inquérito alargado a profissionais de outras organizações de saúde. Com os resultados obtidos espera-se poder auxiliar as organizações na definição de estratégias para maximizar a aceitação dos sistemas de informação e minimizar a resistência dos profissionais. Os resultados do estudo indiciam já uma tendência das organizações de saúde na aplicação de estratégias para minimizar o impacto dos processos de mudança nos projectos de sistemas de informação.

Continuity of care for people with psychotic illness: its relationship to clinical and social functioning.

Background: The relationship between continuity of care and user characteristics or outcomes has rarely been explored. The ECHO study operationalized and tested a multi-axial definition of continuity of care, producing a seven-factor model used here. Aims: To assess the relationship between user characteristics and established components of continuity of care, and the impact of continuity on clinical and social functioning. Methods: The sample comprised 180 community mental health team users with psychotic disorders who were interviewed at three annual time-points, to assess their experiences of continuity of care and clinical and social functioning. Scores on seven continuity factors were tested for association with user-level variables. Results: Improvement in quality of life was associated with better Experience & Relationship continuity scores (better user-rated continuity and therapeutic relationship) and with lower Meeting Needs continuity factor scores. Higher Meeting Needs scores were associated with a decrease in symptoms. Conclusion: Continuity is a dynamic process, influenced significantly by care structures and organizational change.

Introducing matrix management within a children's services setting - personal reflections

This article reflects on the introduction of ‘matrix management’ arrangements for an Educational Psychology Service (EPS) within a Children’s Service Directorate of a Local Authority (LA). It seeks to demonstrate critical self-awareness, consider relevant literature with a view to bringing insights to processes and outcomes, and offers recommendations regarding the use of matrix management. The report arises from an East Midland’s LA initiative: ALICSE − Advanced Leadership in an Integrated Children’s Service Environment. Through a literature review and personal reflection, the authors consider the following: possible tensions within the development of matrix management arrangements; whether matrix management is a prerequisite within complex organizational systems; and whether competing professional cultures may contribute barriers to creating complementary and collegiate working. The authors briefly consider some research paradigms, notably ethnographic approaches, soft systems methodology, activity theory and appreciative inquiry. These provide an analytic framework for the project and inform this iterative process of collaborative inquiry. Whilst these models help illuminate otherwise hidden processes, none have been implemented following full research methodologies, reflecting the messy reality of local authority working within dynamic organizational structures and shrinking budgets. Nevertheless, this article offers an honest reflection of organizational change within a children’s services environment.

The quest for quality: translation of a mythical idea in a global corporation

Purpose – The purpose of this paper is to present the model of the translation of particularly important ideas for the organization and its context, called mythical ideas. Design/methodology/approach – The study is based on ethnographic research. Findings – It is found that change processes based on mythical ideas are especially dynamic but also very vulnerable. The consequences of failure can be vital for the organization and its environment. Originality/value – The paper explores the outcomes to which the translation of a mythical idea can lead. The findings are of value for people involved in organizational change processes.

Organisationer, ojämlikhet, migration : förändringar av den etniska arbetsdelningen i svensk byggnadssektor

Organizations, Inequality, Migration – Changes of the Ethnic Division of Labour in the Swedish Construction Sector During the 1990s the number of migrants from Eastern Europe increased in the Swedish construction sector. This article examines how this change was initiated by changes in the organizational population in the construction sector. The gradual enlargement of the European Union changed the institutional framework for organizations in Sweden. This created increased opportunities for new organizational forms in the construction sector. The specific niche of the new organizations was to recruit and hire out workers from Eastern Europe that were paid lower wages than Swedish workers. The diffusion of this organizational form contributed to a change of norms and beliefs about what was legitimate and illegitimate when employing migrants. This implies that the inequalities that this organizational form introduces have gained increased legitimacy in Sweden. Or in other words, it has become increasingly socially acceptable to pay migrants lower wages than Swedish workers

The impact of work settings on organisational performance measures in built facilities

A current facilities management discourse seeks to discover how the built environment promotes or retards organisational change. However, whether or not significant change arises at all is yet to be definitively established. Hence, a contribution to the school of thought in this direction is considered important. This research investigated organisational performance relative to innovative work settings. The aim of the study was to determine whether organisational performance and, hence, change are indeed brought about by innovative work settings. A sample of 102 work settings was studied, and several null hypotheses on innovative work settings and organisational performance were tested using the Kruskal-Wallis H test. Although subtle shifts were observed in the aspects of organisational performance that seem predicated on innovative work settings, to some extent the proposition that the physical properties and design of the workplace can influence organisational performance was validated.

Abating the consequences of managerialism on the forgotten employees : the issues of support, control, coping and pay

With the widespread and continuing adoption of managerialism in the public sector, ignoring the impact of change on employees could prevent managerialism from achieving its goals. Subsequently, this study investigates the efficacy of an augmented demand-control-support (D-C-S) model in predicting three of the key employee outcomes in the context of organizational change—psychological health, job satisfaction, and organizational commitment. Analyses of a survey of 207 employees in the Australian public sector, a sector that has undergone, and continues to undergo, substantial change toward managerialism, found that the augmented D-C-S model explained a significant proportion of the employee outcomes in the public sector context. The most important variables were work-based social support and job control. Coping style and perceptions of work conditions, such as pay, were also significant. The augmented D-C-S model provides a useful, proven tool for managers operating within the contemporary public sector.

An audit of leadership styles in E-commerce

Inevitably the adoption of any new technology brings about change but e-commerce is significantly different in that it completely shifts global business into a fast-paced electronic environment. The old notions of management are totally ineffective and a new style, focused on "leadership”, is required – but what style of leadership? The findings of an audit on leadership styles indicate that organisations that have successfully integrated e-commerce have exhibited a unique approach. Using a change management matrix, which determines the impact of change versus leadership style within an organisation, 182 Australian managers were audited and positioned within this matrix. It was found that within the most successful organisations, leaders had a distinctive style that facilitated the appropriate change and established a conducive e-commerce environment.

Fresh kids: the efficacy of a health promoting schools approach to increasing consumption of fruit and water in Australia

The Fresh Kids programme utilized the Health Promoting Schools (HPSs) framework to design a whole-of-school, multifaceted intervention targeting specific behaviours to promote healthy eating and reduce the risk factors associated with childhood obesity. The aim of the programme was to evaluate the effectiveness of the HPS framework to increase fruit and water consumption among primary school-aged children over a 2-year period. The study design was an interrupted time series. Four primary schools in the inner west of Melbourne, Australia, participated in the programme intervention. Baseline data were collected using a lunch box audit to assess the frequency of children with fresh fruit, water and sweet drinks, either brought from home or selected from canteen lunch orders. The lunch box audit was repeated periodically for up to 2 years following programme implementation to assess the sustainability of dietary changes. Across all participating schools, significant increases between 25 and 50% were observed in the proportion of children bringing fresh fruit. Similarly, all schools recorded increases between 15 and 60% in the proportion of students bringing filled water bottles to school and reductions between 8 and 38% in the proportion of children bringing sweet drinks. These significant changes in dietary patterns were sustained for up to 2 years following programme implementation. Targeting key nutrition behaviours and using the HPS framework is an effective and simple approach which could be readily implemented in similar childhood settings. Effective strategies include facilitating organizational change within the school; integrating curriculum activities; formalizing school policy and establishing project partnerships with local community nutrition and dietetic services.

Integrating job stress and social exchange theories to predict employee wellbeing

This research examines the organizational characteristics that contribute to employee wellbeing in public sector agencies that have undergone substantial organizational change. Two studies were undertaken, the first involving 2,466 police officers working in a statebased law enforcement agency, whereas the second comprised 1,010 occupationally diverse employees working in a State Government authority. The research was guided by a theoretical framework that begins with a model underpinning many large-scale job stress investigations—the job strain model (JSM)—and is expanded to incorporate widely used social exchange variables (i.e., psychological contract breach and organizational fairness). The results of hierarchical regression analyses from both studies confirm the value of the JSM. There was also strong support for extending the JSM to include the breach and fairness variables; however, proposed interactions between job demands and organizational fairness failed to add to the explanatory value of the model. The implications of these results particularly for public sector organizations that have undergone extensive reforms consistent with New Public Management are discussed.

Changes in museum management : a custodial or marketing emphasis

In recent years museums have changed from being predominantly custodial institutions to becoming increasingly focussed on audience attraction. New emphasis is placed on museum-audience interactions and relationships. This change in the purpose and priorities of museums has impacted upon the nature of museum management. The recognition of new roles for museum directors and the need to appeal to differentiated audiences has created new challenges for previously traditional, custodial directors. This paper presents a conceptual framework for managing museums, taking account of the museum service context and the delivery of the museum service product. It then examines two museums, one in Ireland and one in Australia, both of which have a similar cultural history. The paper considers the different management styles for museum directors and how these different styles illustrate the changes in professional perspective from the traditional (a focus on custodial preservation) to the more current (a focus on educating and entertaining the public).

Managing professionals : the emerging leadership role of Victorian Maternal and Child Health coordinators

Drawing on research into cultural and organizational change in the Victorian Maternal and Child Health Service during the 1990s, this paper examines implications for the nursing leadership provided by service coordinators. The project included a quantitative survey of nurses and semistructured interviews with managers and coordinators. Under a strongly neoliberal state government in Victoria, Australia, services were fundamentally restructured through tendering processes. A competitive, productivist culture was introduced that challenged the professional ethos of nurses and a primary health orientation to the care of mothers and infants. This paper focuses on the pressures that the entrepreneurial environment presented to maternal and child health nurses' identity and collegial relations and to the coordination role. It argues that coordinators emerged as a Significant nursing management group at the interface of administrative change and the management of professional practice. Although many nurses skilfully negotiated tensions with peers and management, their leadership role needs further clarification and support.

Integrating job stress and social exchange theories to predict employee strain in reformed public sector contexts

This research examines the organizational characteristics that contribute to employee wellbeing in public sector agencies that have undergone substantial organizational change. Two studies were undertaken, the first involving 2,466 police officers working in a state-based law enforcement agency, whereas the second comprised 1,010 occupationally diverse employees working in a State Government authority. The research was guided by a theoretical framework that begins with a model underpinning many large-scale job stress investigations—the job strain model (JSM)—and is expanded to incorporate widely used social exchange variables (i.e., psychological contract breach and organizational fairness). The results of hierarchical regression analyses from both studies confirm the value of the JSM. There was also strong support for extending the JSM to include the breach and fairness variables; however, proposed interactions between job demands and organizational fairness failed to add to the explanatory value of the model. The implications of these results particularly for public sector organizations that have undergone extensive reforms consistent with New Public Management are discussed.

Power and politics in a system implementation

The central concern of this study is to identify the role of power and politics in systems implementation. The current literature on systems implementation is typically divided into two areas, process modelling and factor based studies. Process modelling classifies the implementation into a linear process, whereas factor based studies have argued that in order to ‘successfully’ implement a system, particular critical factors are required. This literature misses the complexities involved in systems implementation through the human factors and political nature of systems implementation and is simplistic in its nature and essentially de-contextualises the implementation process. Literature has investigated some aspects of human factors in systems implementation. However, it is believed that these studies have taken a simplistic view of power and politics. It is argued in this thesis that human factors in systems implementation are constantly changing and essentially operating in a dynamic relationship affecting the implementation process. The concept of power relations, as proposed by Foucault (1976, 1977, 1978, 1980, 1982), have been utilised in order to identify the dynamic nature of power and politics. Foucault (1978) argued that power is a dynamic set of relationships constantly changing from one point in time to the next. It is this recognition that is lacking from information systems. Furthermore, these power relations are created through the use of discourse. Discourse represents meaning and social relationships, forming both subjectivity and power relations. Discourses are also the practices of talk, text and argument that continuously form that which actors speak. A post-structuralist view of power as both an obvious and hidden concept has provided the researcher a lens through which the selection and implementation of an enterprise-wide learning management system can be observed. The framework aimed to identify the obvious process of system selection implementation, and then deconstruct that process to expose the hegemonic nature of policy, the reproduction of organisational culture, the emancipation within discourse, and the nature of resistance and power relations. A critical case study of the selection and implementation of an enterprise-wide learning management system at the University of Australia was presented providing an in-depth investigation of the implementation of an enterprise-wide learning management system, spanning five years. This critical case study was analysed using social dramas to distinguish between the front stage issues of power and the hidden discourses underpinning the front stage dramas. The enterprise-wide learning management system implemented in the University of Australia in 2003 is a system which enables academic staff to manage learners, the students, by keeping track of their progress and performance across all types of training activities. Through telling the story of the selection and implementation of an enterprise-wide learning management system at the University of Australia discourses emerged. The key findings from this study have indicated that the system selection and implementation works at two levels. The low level is the selection and implementation process, which operates for the period of the project. The high level is the arena of power and politics, which runs simultaneously to the selection and implementation process. Challenges for power are acted out in the front stage, or public forums between various actors. The social dramas, as they have been described here, are superfluous to the discourse underpinning the front stage. It is the discourse that remains the same throughout the system selection and implementation process, but it is through various social dramas that reflect those discourses. Furthermore, the enactment of policy legitimises power and establishes the discourse, limiting resistance. Additionally, this research has identified the role of the ‘State’ and its influence at the organisational level, which had been previously suggested in education literature (Ball, 1990).

Relationship between workplace reform and workforce participation

This thesis sought to advance understanding of the politics of workplace reform, explaining the respective roles of management and employees and how they relate. The literature on workplace reform usually argues that reform is predicated on greater workforce participation in managerial decisions. More specifically, different approaches to workplace reform can be aligned to different forms of participation. Thus quality management can be associated with direct forms of participation, institutional workplace reform may depend on representative forms, and best practice may require a combination of both. This thesis uses empirical evidence to explore this alignment between the different approaches to workplace reform and forms of participation. The period chosen for empirical study is approximately 1985-1992 - an era of rapid innovation in workplace reform for Australian manufacturing. Three workplaces were chosen for intensive study from automotive component manufacturers because that industry was itself a laboratory for workplace reform and also because these firms exemplified different approaches to competitiveness and reform. Three approaches to workplace reform - quality management, institutional workplace reform, and best practice - were distinguished to capture the range of Australian practice at that time. Similarly two approaches to workplace participation were distinguished - direct and representative - to reflect the range of observable practices at that time and to represent competing philosophies. Direct participation illustrated an approach founded in managerial context of the political status quo, whilst representative forms were considered to permit a pluralist shift of power to enable employees to manage in place of management. The three case studies depict companies sharing the competitive crisis of their industry. From this stems the impetus for workplace reform. At this point the firms diverged in their choice of competitive strategies for workplace reform. The case studies reveal, at the superficial level, a match between the chosen approaches to workplace reform and forms of participation. Basically, quality management is associated with direct employee participation, institutional workplace reform with collective bargaining and representative consultative committees, and best practice with both. However when the implementation of reform and participation are examined this match becomes less significant. One firm, Auto Air, achieved highly effective outcomes in both reform and participation. Another firm, Auto Electrical, failed in both. The thesis concluded that the relationship between forms of participation and reform is less significant than the effective implementation of policy. Unitarist or pluralist approaches to power distribution count less than managerial capacity to integrate successive reform initiatives and their commitment to workforce participation hi change.