Practice jazz: understanding variation in family practices using complexity science.
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Delivery of Health Care↗
Biomedical subjects
R R McDaniel
Publications and source records attributed to R R McDaniel.
Managing health care organizations: where professionalism meets complexity science.
This article examines the intersection of professionalism and complexity science as a source of new insights for improving the health care industry from both a clinical and business point of view. Viewing health care organizations as professional complex adaptive systems suggests eight leadership tasks for addressing the circumstances that engulf health care. Managers who adopt this view will be able to create new levers for positive movement in their organizations.
Commerce↗
Physicians and decisions: a simple rule for increasing connections in hospitals.
When hospitals are viewed as complex adaptive systems, simple rules can lead to behavior that emerges as complex and that enables creative, adaptive organizational responses. Based on empirical findings from a decade of research on hospital strategic decision making this article offers the simple rule of letting physicians help decide strategic issues. Seven managerial guidelines for implementing this rule are presented.
Cooperative Behavior↗
RN participation in organizational decision making and improvements in resident outcomes.
In the study on which this article is based, nursing homes with the most improvements in resident outcomes had greater registered nurse (RN) participation in decision making than did homes with the least improvements. The results suggest that nursing homes that want to improve quality can use RN participation to make improvements without significantly increasing costs. Complexity theory served as a framework for the study.
Decision Making, Organizational↗
A view from complexity science.
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Health Care Sector↗
Mergers and acquisitions in professional organizations: a complex adaptive systems approach.
Nurse managers face unique challenges as they cope with mergers and acquisitions among health care organizations. These challenges can be better understood if it is recognized that health care institutions are professional organizations and that the transformations required are extremely difficult. These difficulties are caused, in part, by the institutionalized nature of professional organizations, and this nature is explicated. Professional organizations are stubborn. They are repositories of expertise and values that are societal in origin and difficult to change. When professional organizations are understood as complex adaptive systems, complexity theory offers insight that provide strategies for managing mergers and acquisitions that may not be apparent when more traditional conceptualizations of professional organizations are used. Specific managerial techniques consistent with both the institutionalized characteristics and the complex adaptive systems characteristics of professional organizations are offered to nurse managers.
Adaptation, Psychological↗
Intensity of registered nurse participation in nursing home decision making.
In this study of data obtained from nursing home administrators and directors of nursing, we found that intensity of registered nurses' (RNs') participation in nursing home decision making varied with decision content and decision level. The primary decision activity in which RNs participated was raising the issue. The decision activity in which they participated least was choosing the alternative. The primary mechanism for RN involvement was through informal meetings. Patterns of participation varied across nursing homes and were important in explaining the extent to which RNs influence decision outcomes. RN influence over the final choice was explained by their involvement in the decision activity of raising the issue and by their involvement through informal meetings.
Analysis of Variance↗
Participation as a complicating mechanism: the effect of clinical professional and middle manager participation on hospital performance.
One way hospitals complicate themselves is by increasing the participation of clinical professionals and middle managers in making strategic decisions. Using a survey methodology this article investigates the relationships between the participation of clinical professionals (MDs and RNs) and middle managers with hospital costs, as well as the possible moderating effect of strategic complexity.
Cost-Benefit Analysis↗
Strategic leadership: a view from quantum and chaos theories.
Viewing health care from the perspective of chaos and quantum theories offers new insights into management techniques for effective and efficient delivery of health care services. This article introduces these concepts and gives specific prescriptions for managerial action.
Administrative Personnel↗
Interventions in response to chemically dependent nurses: effect of context and interpretation.
Despite state laws and professional norms, administrators intervene in different ways in response to chemically dependent nurses. The purpose of this study was to examine how context and interpretation affect these interventions. Nurse administrators from 322 hospitals participated in the study. Regression analysis revealed a relationship between interpretation (threat or nonthreat) of chemically dependent nurses and the interventions. The higher the degree of threat perceived in relation to these nurses, the higher the tendency to terminate them (p<.01), and the lower the tendency to refer them to treatment (p<.05), reintegrate them (p<.01), and hire them (p<.01). Two context variables, professionalization and communication, were related to reintegration (p<.05). Understanding the relationship between context and interpretation on decision making will allow for progress toward improved management of the health care environment.
Communication↗
Internal stakeholder group participation in hospital strategic decision-making: making structure fit the moment.
This study examines the participation of six internal stakeholder groups in hospital strategic decision-making. Results show that internal stakeholder group participation is affected by strategic decision content and by the nature of the hospital's strategy. Results show that the participation of internal stakeholdergroups is associated with lower cost per full-time employee (fte). In particular, when the low participation stakeholder groups do participate, hospitals experience lower cost per fte.
Decision Making, Organizational↗
Internal complexity and environmental sensitivity in hospitals.
Theory suggests that organizations should respond to external complexity with internal complexity. We examine whether "environmentally sensitive" hospitals are more internally complex than "environmentally insensitive" hospitals. Results show that environmentally sensitive and insensitive hospitals differed on three of the measures of internal complexity: goal complexity, strategic complexity, and relational complexity.
Chief Executive Officers, Hospital↗
Untangling healthcare competition.
Traditional approaches to competition may be inappropriate for healthcare providers. Neoclassical economics makes the implicit assumption that a single actor embodies consumption, compensation, and benefit from a transaction. In healthcare, this assumption does not hold. Instead, such actions are accomplished by three separate actors--consumers (physicians), customers (third-party payers), and clients (patients). A hospital simultaneously competes in three arenas. Hospitals compete for physicians along a technological dimension. Competition for third-party payers takes on a financial dimension. Hospitals compete for patients along a marketing dimension. Because of the complex marketplace interactions among hospital, patient, physician, and third-party payer, the role of price in controlling behavior is difficult to establish. The dynamics underlying the hospital selection decision--that is, the decision maker's expectations of services and the convenience of accessing services--must also be considered. Healthcare managers must understand the interrelationships involved in the three-pronged competitive perspective for several reasons. This perspective clarifies the multiple facets of competition a hospital faces. It also disentangles the actions previously fulfilled by the traditional single buyer. It illuminates the critical skills underlying the competition for each audience. Finally, it defines the primary criterion each audience uses in sorting among hospitals. Recognition of the multifaceted nature of competition among healthcare providers will help demystify market behavior and thereby improve internal organizational communication systems, managers' ability to focus on appropriate activities, and the hospital's ability to adapt to changing market conditions.
Catholicism↗
Developing interorganizational relationships in the health sector: a multicase study.
Because of the wide diversity among health care organizations, interorganizational relationships (IORs) among them are difficult to manage. This article describes three case studies that, taken together, suggest that IOR performance is related to IOR development processes. Specifically, IOR performance is related to the way managers process information to manage uncertainty and ambiguity.
Chief Executive Officers, Hospital↗
Rooting out organizational conflict.
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Communication↗
Physician participation in hospital strategic decision making: the effect of hospital strategy and decision content.
An exploratory study examined variation in the participation of physicians in hospital strategic decision making as a function of (1) strategic decision content or (2) hospital strategy, or both. The findings revealed that who participates is a function of decision content while how physicians participate is a function of decision content and the interaction of decision content and hospital strategy.
Decision Making, Organizational↗
Hospitals as interpretation systems.
In this study of 162 hospitals, it was found that the chief executive officer's (CEO's) interpretation of strategic issues is related to the existing hospital strategy and the hospital's information processing structure. Strategy was related to interpretation in terms of the extent to which a given strategic issue was perceived as controllable or uncontrollable. Structure was related to the extent to which an issue was defined as positive or negative, was labeled as controllable or uncontrollable, and was perceived as leading to a gain or a loss. Together, strategy and structure accounted for a significant part of the variance in CEO interpretations of strategic events. The theoretical and managerial implications of these findings are discussed.
Decision Making, Organizational↗
Demystifying the boardroom. Tips for timid trustees.
The complexity of a modern hospital can mystify and intimidate trustees; they may have difficulty understanding how the hospital works and thus may feel unable to contribute to its success. Stripping away some of the mystery may enable them to more effectively fulfill their roles to "hold in trust" and "govern." Some strategies trustees can use to gain control include hiring a chief executive officer (CEO) who can communicate, remembering who works for whom, assuming that anyone who makes more than $80,000 a year expects to earn it, and stifling the urge to seek "fairness." To clarify the relationship between board and CEO, trustees should ask the following questions: Are all subsystems contributing to the system's overall goals, or are some serving their own ends? Does the system allow interaction among subsystems to promote synergy, or does it isolate the parts? How does the CEO plan to produce the required product or service and achieve profit goals within the organizational policies? How will the trustees know whether the intended product or service has been produced within the organizational policies at the desired profit? By following a code of conduct, trustees will become more effective. The seven elements of the code include observing behaviors and reporting observations, asking questions and insisting on clear answers, establishing relationships with constituencies, making decisions and being willing to explain those decisions, making sure solutions fit problems, realizing that management is a series of approximations, and seeing that adherence to the hospital's mission dominates the criteria used in free choices.
Communication↗