All together now: The circular organization in a University Hospital. Part I. Planning and design

During a period of significant change in health care, hospitals are being transformed. This article—part I—reports on one university hospital's experience with a project funded by a Robert Wood Johnson Foundation and Pew Charitable Trusts initiative. The article presents the history and conditions that led to a planning year during which participants defined external and internal conditions contributing to the needs for change. Along with the driving pressures, the article addresses the planning process and the basic design for organization change, Ackoff's idealized design and circular organization. This model had been used in industry, but not in a hospital. Key themes related to the design and start-up are offered. Part II addresses the implementation of the model, the process of change, supports and barriers, and progress to date.     

Structure Underlies Other Organizational Determinants of Mental Health: Recent Results Confirm Early Sociotechnical Systems Research

Workplaces are implicated in the current global epidemic of mental illness. This paper presents early results from an action research project designed to investigate and prevent mental illness at work. It treats the organization as an open sociotechnical system where mental health is measured by self report and the affects experienced at work. Sick days are also measured. The study finds that the second genotypical, organizational design principle creates enabling conditions for mental health, many of which enablers such as trust and equality have previously been hypothesized as determinants of mental health. But the enablers are themselves consequent to a design principle. The results show how the second design principle creates the jointly optimized sociotechnical system that leads to enablers and positive outcomes, for people and the bottom line. This research reinforces the conclusion from the first study of sociotechnical systems that structure is a determinant of mental health.     

Implementing Cost Control in Health Care: Strategies Driven by an Organizational Systems Approach

In this paper, we offer a systems approach to assist health care organizations in their cost-containment efforts. A general model of the organization which specifies the various components of this approach is offered. Each system—technology, structure, psychosocial, managerial, and cultural—is linked to illustrative selected actions designed to improve cost performance. In our view, the key to successful interventions to contain costs lies in careful consideration of both the direct and interactive impacts on all systems of the health care organization. A case example of an Academic Medical Center's effort to curtail costs illustrates both the model and the sample actions.     

Consumer Participation in Designing Community Based Consumer-Directed Disability Care: Lessons from a Participatory Action Research-Inspired Project

User participation has been embraced worldwide as a means to provide better consumer outcomes in health and community care. However, methodologies to achieve effective consumer engagement at the programme design level have remained under-explored. The purpose of this study was to evaluate the impact of a Participatory Action Research (PAR)-inspired methodology used to develop a consumer-directed community care/individualised funding service model for people with disabilities. A retrospective analysis of case notes and internal reports for the first 6 years of an ongoing project were examined. The findings suggest that PAR methodologies need to take into account community development, group support, and capacity building as well as succession planning and risk management issues in order to facilitate the often lengthy policy and project development process. Drawing on these findings, this article discusses five lessons and their methodological implications for PAR in a health or social policy/programme design context.

基于Agent的项目组织和流程模型

为预测并行或复杂项目中大量涌现出的返工、协调和等待等"隐性工作", 基于Agent仿真和计算组织相关理论, 实现了经理论和实践验证有效的可计算项目组织和流程(CPOP) 模型. 该模型能对任务、流程、人员和组织进行建模, 模拟隐性工作的涌现, 输出工期、成本、质量、隐性工作和工作积压等定量结果, 评估项目组织与流程的匹配度. 这一模型有助于促进项目组织和流程设计的定量化研究.     

Bridging Worlds: Information Systems Development Through Cross-Cultural Comparison

This paper reports a case study where soft systems methodology (SSM) was used to help automate a largely manual administrative (examination) information system in a Pakistani university. Various design suggestions for information system improvements, both administrative and IT-supported were made (and implemented) through comparison with another university in Denmark which is well supported by computer systems. An action design research approach with an interpretative epistemology/ontology was adopted. Though the single comparison experience is difficult to generalise, we conclude that SSM (with some adaptations) can enable a socio-technical comparison and design effort and offer a prototype process. The comparison stimulates forward-looking design, but great care must be taken to accommodate cultural differences, and further research is necessary to integrate more sophisticated cultural analysis tools into the design process. The research extends SSM in information system development??from a single situational analysis to a comparative process and can be adapted as a pattern for practitioners with similar automation needs.     

Electronic Medical Records (EMR) and Nurses in Turkish Hospitals

Electronic medical records (EMR) are generally used by nurses in hospitals. However, studies investigating views on and evaluations of EMR by nurses are limited in Turkey and in other countries around the world. In this study, nurses’ views on EMR systems were investigated in terms of “Nursing care management”, “Order entry”, “Information Management”, “Information quality”, “Service quality”, “Impact of EMR system on clinical care”. The purpose of this study was to investigate the views/perceptions on EMR used by nurses working at hospital clinics in Turkey. The research questions were: (a) What are nurses’ perceptions on EMR? (b) Were there relationships among nurses’ perceptions on EMR? (c) Were there differences among nurses’ perceptions on EMR according to hospitals in Turkey. This study is composed of field research conducted using questionnaires. To prepare the data-measuring instrument, the literature on EMR was reviewed. A Likert scale type was used in this questionnaire. The study was planned and conducted on nurses working at inpatient care units at four Turkish hospitals. At the end of this study, the questionnaire had been conducted on 517 nurses. Total response rate is 66.70 %. We found that the Information quality of EMR, impact of EMR system on clinical care and service quality were high level. Information quality has the highest mean score. EMR system is an important system for nurses’ hospital has the highest mean score in this study. Nurses feel about impact of EMR system on clinical care that generally ‘EMR system’s usefulness’, ‘improving quality of information due to EMR system’, ‘improving quality of nurses’ work’, ‘improving quality of information due to EMR system’. All of the six subscales of EMR were positively correlated with each other. This study revealed that there are significant differences among the mean scores for six subscales according to the ownership of hospitals. EMR systems were not well integrated into their workflow. In addition, half of all respondents had not been trained in using EMR systems. This study will added to evaluation views and assessments of nurses about EMR literature. The results will assist in determining “Information quality”, “Service quality”, of EMR, and “Impact of EMR system on clinical for nurses in Turkish health system”. This survey suggests that nurses favor the use of an EMR and suggests opportunities for EMR enhancement.     

基于Agent的项目交易治理计算模型研究

项目交易治理模式选择是关系到项目成功交付的核心问题,但鲜有研究从可计算角度分析不同项目交易治理模式对项目的微观过程及最终绩效的影响.本研究基于Agent仿真技术和交易治理相关理论,构造了项目交易治理计算模型.模型通过构造集成交易、项目任务与流程、项目组织和Agent的四元子模型,利用Agent技术实现了不同交易治理模式下Agent与任务、Agent之间行为交互的治理计算模型,可以输出项目成本、项目工期、质量风险、工作积压等实施绩效进行预测和评估.研究发现该模型不仅促进了项目交易治理的量化预测分析研究,还为项目交易治理提供了有效的决策支持.     

Constancy and change: Flexible organization structures

Management organization structure is the most sensitive characteristic displayed by a business organization in the process of its adaptation to the changing environment. It is well-known, however, that excessive changeability of the structure makes the management system unstable and leads to less effective organizational behavior. The author believes that the reason lies in the fact that the structural changes almost always involve the management system's composition too. This shortcoming is rarely found in matrix management of goal-oriented programs. However, application of this type of management structure is limited as complexity of management increases disproportionately. Systems analysis of the problem situation leads to two new conclusions: (a) the variety of management organization structures required by business organizations to adapt to the changing environment can be extended if the organizational relations are regarded as part of organizational/economic symbiosis and their interrelated change; and (b) enhancement of the program component in the matrix structure makes it possible to design stable manage-management structures with a dynamic composition. Implementation of this concept in large-scale business systems brought about essentially new forms of production units' self-organization that became known as state production associations. It makes the large-scale business organizations' structures far less complex and increase their flexibility without disturbing the management systems' resilience. The newly developed principles of organizational design are universal.     

Practical Contributions of the Systems-Based Evolutionary Learning Laboratory to Knowledge and Stakeholder Management

This paper reports on a case study on improving the quality of life for women smallholder farmers in Vietnam, using the systems-based Evolutionary Learning Laboratory (ELLab) approach. The study aims to provide evidence of practical contributions of the ELLab to project stakeholder and knowledge management through the case study. A transformative learning framework was developed to provide initial reflections on the planning phase of the project. Practical contributions of the ELLab process to stakeholder identification and management, and knowledge creation during project planning and implementation are discussed. Strong evidence was found of transformations in awareness and perspectives amongst project actors that subsequently led to systemic and executable action plans. This clearly proved the value of the ELLab approach in informal transformative learning.     

Coproduction in Practice: Participatory Action Research to Develop a Model of Community Aged Care

Coproduction has become synonymous with innovative approaches to public service delivery in European Union countries as well as in Australia. Coproduction has the potential to bring together individuals, communities, and organisations in a process to collaboratively develop new models and services which improve public services. Yet, Australian policy makers and practitioners who would like to deploy coproduction within the context of older adult social care can only draw on a handful of papers and reports that could guide implementation. This paper fills this gap by reporting on the implementation of a multi-stakeholder coproduction approach to the development of a consumer directed care model for older people with complex health issues. The paper describes and critically highlights methodological challenges encountered during the 12 month-long participatory action research phase of a larger project involving older people with complex care needs, their carers, and government and non-government stakeholders. The paper outlines key considerations regarding (1) the involvement of older people with complex needs, (2) collaboration with industry partners, (3) engagement of government representatives, and (4) reflects on implementing participatory research projects within a context of outsourcing and interlinked supply chains. While not all challenges encountered could be resolved, the coproduction approach was successful in bringing together a wide range of stakeholders with competing agendas in an iterative process geared to resolve a plethora of concerns raised by older people, carers and services providers. This paper provides an example for others seeking to use coproduction and participatory methods to provide person-centred care services for older people.     

Using the Viable Systems Model to Structure a System Dynamics Mapping and Modeling Project for the Australian Taxation Office

This paper is a case study of a major System Dynamics (SD) intervention in policy design in the Australian Taxation Office. The project, which lasted two years, tested a number of hypotheses regarding the application of Stafford Beer's Viable Systems Model (VSM) to the structure and process of the project. The paper reports that the success of the VSM within the ATO was qualified by political changes in the external environment.     

基于元网络的项目组织学习能力对任务完成影响评价仿真方法

组织能力是影响项目任务完成的决定性因素,而学习能力是组织能力形成的关键基础.基于元网络理论和动态仿真方法,将组织(人)、知识和任务视为多智能体复杂交互系统,提出知识扩散度和任务完成水平两项关键指标,研究项目组织学习能力对任务完成水平影响的内在机理.以通用品牌别克汽车4S店建设项目群管理为例,验证评价指标的合理性,并进一步通过仿真实验,识别项目组织的关键知识、关键组织以及关键学习阶段,进行组织学习能力提升和任务分配的优化.为项目组织设计、任务分配及组织学习的研究探索了一种有效的方法.     

Application of Scenario-based Approaches in Leadership Research: An Action Research Intervention as Three Sets of Interlinked Practices

This article illustrates how scenario planning (SP) and scenario analysis as can be conceptualised as practices contributing to an action research (AR) investigation of leadership development. The project described in this article was intended to strengthen leadership capacity in Australia’s rapidly changing aged care and community care sector. A research team comprising academics from three universities and managers from two faith-based not-for-profit organisations providing aged and community care participated in this study. As part of the research, two sets of scenario-based workshops were held: the first, to identify possible futures using SP; and the second, to deal with plausible scenarios these organisations are likely to face with the changes happening in the aged care environment in Australia by using scenario analysis. Although the researchers did not consider a link between practice theory and AR during the SP phase, practice theory became useful during the scenario analysis phase. The article includes a brief literature review followed by a discussion on the relationship between AR and practice theory. The processes used in the two sets of scenario workshops are then described in detail along with the data collected and analysed. The article concludes with some reflections on the use of scenarios in practice as well as an acknowledgment that practice theory would be useful in investigating leadership capability development.     

基于信息熵的大型工程项目管理组织结构选择模型

针对大型工程项目管理组织结构选择问题,基于信息熵理论,引入质量与时效的概念,分别从信息传递的准确性与时效性两个维度描述组织结构的有序度,并综合上述两个维度,给出工程项目管理组织结构有序度的定义;在此基础上,结合最优化理论方法,建立大型工程项目管理组织结构选择模型;最后,辅以实例来介绍该模型的实际应用。     

Patient Safety Culture,Evidence-Based Practice and Performance in Nursing

Evidence-based practice is a problem-solving approach in which the best available and useful evidence is used by integrating research evidence, clinical expertise, and patient values and preferences to improve health outcomes, service quality, patient safety and clinical effectiveness, and employee performance. This study aimed to identify the effects of nurses’ patient safety culture perceptions and their evidence-based nursing attitudes on the hospital’s patient safety level and employee performance. A cross-sectional design was employed in this study. Participants included nurses working in a state hospital in Burdur, Turkey, and 218 nurses responded to the research instrument (participation rate: 55.7%). Data were collected through face to face interviews that were conducted from February 20–May 20, 2016. The results of the analyses revealed that evidence-based nursing attitudes and hospital safety culture dimensions explained 29.2% of the total variance in the hospital patient safety level, while evidence-based nursing attitudes and hospital safety culture dimensions explained 15.5% of the total variance in nurse performance. The “evidence-based nursing related beliefs and expectations” aspect of the evidence-based nursing attitude dimension, and the “management support for patient safety” aspect of the patient safety culture dimension were significant predictors of nurses’ performance. The present findings add to the increasing interest in improving evidence-based practice and service quality in order to achieve better patient outcomes.     

Learning by Action Research: A Policy for School Development

In this article I define a project organization as action research. Thus defined, the approach presents a method for experiential learning among educators who develop as learners in an educational setting. Second, the approach describes a method for focusing on research related to change in classroom didactics brought about by the mediating instruments educators discover and use so as to overcome their own learning anxiety. Third, action research and academic investigation are described as a method for integrating theory with practice. Finally, action research is outlined as an effort for social justice—the way knowledge usually develops by social construction.     

复杂作用关系过程的区域显著性实验设计及全局建模方法

针对参数与质量特性之间作用关系复杂过程的参数优化,提出一种基于质量特性变化显著程度的序贯设计及全局建模方法. 首先以均匀设计为基础, 将其拆分形成一系列的设计点集和添加点集; 其次利用初始设计点集建立过程的支持向量回归(SVR)模型, 并对建模样本点进行Ward聚类, 由此将可行域划分成若干子区域, 并以各子区域支持向量的比率反映该子区域质量特性变化的显著程度; 而后以欧氏距离为判别依据, 将添加点集中的实验点划分至合适的子区域, 根据"子区域间区别对待, 子区域内均匀分散"的原则, 调整各子区域内添加实验点的数目, 在支持向量率较高的子区域添加较多实验点; 上述步骤迭代进行直至满足终止准则, 再拟合过程最终的SVR模型. 仿真与实证研究表明, 与基于"均匀分散"原则的传统均匀设计和超拉丁方抽样相比, 所提方法的实验设计效率与模型性能均有较大提高: 实验点可以有针对性地集中分布于质量特性变化较为显著的子区域, 模型预测误差降低了29.8%以上, 而且能够以较小的样本量发现过程的多个极值, 得到更优的参数优化结果.     

Examining Conditions that Influence Evaluation use within a Humanitarian Non-Governmental Organization in Burkina Faso (West Africa)

Program evaluation can support capacity building and inform practice and policy. Yet long-term efforts to ensure evaluation use (EU) in the humanitarian sector are seldom documented, leaving much uncertainty about EU conditions. This study examined conditions that influenced EU by stakeholders of a humanitarian non-governmental organization (NGO) in Burkina Faso striving to base its health care program on solid evidence. It used 36 qualitative semi-structured interviews and a single case study design to document stakeholders’ (n?=?26) perception of EU conditions. Analyses focussed on characteristics of five broad conditions of research use previously documented. Results demonstrate that EU was facilitated by intended users with proactive attitudes, research experience, and willingness to participate in program evaluations. Also helpful was an organizational culture that valued learning, feedback, and accountability, wherein leaders collaborated toward common goals. Evaluation-based knowledge that met information needs and that was actionable, contextualized, and quickly accessible enhanced EU. Knowledge transfer strategies promoting EU were diverse, participatory, adapted to needs, and regularly followed up. Evaluators who were trusted, experienced, credible, and adaptable, promoted EU most effectively. Conversely, EU was compromised when intended users felt distrusting, uninformed, or unable to engage in program evaluations. Knowledge contradicting expectations or deemed inapplicable impeded EU. Adapting knowledge transfer strategies required time and interactions. Initially, evaluations were not sufficiently adapted and put into plain language, which hampered EU. EU conditions are numerous and intricately interrelated, but interpersonal relationships, trust, and effective communication are key conditions for evaluators and stakeholders wishing to promote EU.

     

多阶段医疗系统下病人滞留分析与应用

连续治疗(continuity of care)逐渐成为评价医疗系统质量的一个重要指标,而现实中由于下一阶段无可用资源导致已完成当前阶段服务的病人滞留现象频繁发生.现有文献通常假定病人在滞留期间处于等待状态,实地研究却表明病人滞留期间会继续接受下一阶段治疗服务,且上下阶段的服务时长存在相关性.基于此,建立考虑病人连续治疗的排队模型,设计滞留可能性估计算法.与仿真结果及其它相关算法比较,新建算法具有更高准确性与稳定性.此外,对新建算法的扩展应用证明其在评价医疗系统性能与优化医疗资源配置上效果显著.