Management Innovations for Healthcare Organizations

Adopt, Abandon or Adapt?

Anders Örtenblad, Carina Abrahamson Löfström, Rod Sheaff

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317578024
• Edition: 1
• Topic: Business
• Subtopic: Management
• Index: Business

Innovations in management are becoming more numerous and diverse, and are appearing in organizations providing many different kinds of products and services. The purpose of this book is to examine whether some widely-promoted examples of these management innovations – ranging from techniques such as Kaizen to styles of leadership and the management of learning – can usefully be applied to organizations which provide healthcare, and applied in different kinds of health systems. Management Innovations for Healthcare Organizations is distinctive in selecting a wide and diverse range and selection of managerial innovations to examine. No less distinctively, it makes an adaptive, critical scrutiny of these innovations. Neither evangelist nor nihilist, the book instead considers how these innovations might be adapted for the specific task of providing healthcare. Where evidence on these points is available, the book outlines that too. Consequently the book takes an international approach, with contributions from Europe, the Middle East, Australia and North America. Each contributor is an expert in the management innovation which they present. This combination of features makes the book unique.

Part I

Background and Introduction

Now organizations in health

Keep management books on the shelf

The next panacea

Or verbal diarrhoea?

Read on and decide for yourself

Chris Blantern

1 The Relevance of Management Innovations for Healthcare Organizations

Anders Örtenblad, Carina Abrahamson Löfström and Rod Sheaff

Most people would think twice before wearing shorts at the Nobel Prize dinner. Wearing shorts, you would probably not be let in, unless, of course, you were the Swedish king or queen, or one of the Nobel Prize winners. On the other hand, such behavior would certainly be innovative and—who knows—something good might come out of it. Perhaps the arrangements for these dinners would loosen up and become more fruitful for the participants. What do you think, should the shorts-wearer reconsider, or do the Nobel Prize dinner arrangements need to learn how to loosen up a bit?

While this book is definitely not about the Nobel Prize event, it connects to the above reasoning. Every innovation fights a battle against the existing way of thinking and doing things. This is also true for the kind of innovations that we like to call “management innovations”. Their relevance for healthcare organizations (see Chapter 2 of this volume for an extensive definition of “healthcare organization”) will be examined in the present book. Healthcare is a sector struggling to find a balance between values such as cost minimizing and patient safety, and management innovations could possibly help in these efforts. Healthcare is also a sector that is known for quite far-reaching conflicts, both between the various professions that are involved in healthcare and between the professionals and the administration (see, e.g., Mintzberg, 1979). “Management” is a concept that lately has become something that is said to be relevant not only for private corporations, but also for organizations in the public sector, including healthcare organizations, although this idea has its critics (see, e.g., Beardwood et al., 1999). One sign of this increased space that “management” has received is the frequent occurrence of narratives on organizations that have succeeded through practicing certain management innovations and also the quite large market where more or less decontextualized versions of management innovations are bought and sold. Thus, this book examines whether the management innovations that have often been developed for managing private corporations better and that people working in the healthcare sector may be exposed to—or even actively search for—are also valid for healthcare organizations. Do these management innovations bring ideas on how to better manage healthcare organizations that are valuable enough for healthcare organizations to change in accordance with what the management innovations prescribe, or do these innovations not deserve to be “let in” into the world of healthcare? Is there reason for people working in the healthcare sector to start to practice any of these management innovations unchanged (cf. adoption), should they simply dismiss them (cf. abandonment), or should they take a closer look at them to see if there might be elements that could be useful (cf. adaptation)? Additionally, questions such as the following will be discussed: Is it a good idea to decentralize decision-making in healthcare organizations, as some of the management innovations taken up in the book prescribe? Is it a good idea to strive for increased quality in healthcare organizations in the same way as some of the management innovations suggest? How should leadership within healthcare organizations be performed? Should those management innovations that are quite business oriented be adopted by healthcare organizations, which take care of people rather than producing sellable products or services? Etcetera. Thus, the aim of this book is to test the relevance of quite an extensive set of management innovations for healthcare organizations and, should these tests show that any of these management innovations is partly relevant but not fully so, to suggest an adapted version of the management innovation, a version that fits healthcare organizations.

This book is a bit different from the existing literature where management innovations are put into the healthcare context. First, while major parts of the existing literature often tend to focus on one single management innovation (but see Hanson, 1995; Hanson & Finkler, 1995), in this book, quite a large number of various management innovations are put into the healthcare context. Second, the fact that so many management innovations are examined in the same book has offered the opportunity for all of the contributors to relate to the same definition of healthcare organization (see Chapter 2, this volume) when relevance testing and adapting management innovations in relation to healthcare organizations. Third, while much of the existing literature tends to suggest that ready-made versions of certain management innovations fit the healthcare sector simply as they are, without considering which elements of those management innovations are less relevant, or even totally irrelevant, in this book, each management innovation is first given a general definition and thereafter the contributor(s) discusses its relevance for healthcare organizations and how it may have to be adapted to fit these organizations. Such transparency gives the reader insight into the reasoning that lies behind the conclusions drawn, and, thus, an option to consider the reasoning itself instead of merely being presented with conclusions.

In the remainder of this chapter—which focuses on management innovations, while Chapter 2 focuses on healthcare organizations—the area and concept of “management innovation” will be discussed in more depth, and its relevance for healthcare organizations will be generally discussed. More specifically, the concept of “management innovation” will be defined, and some debates within the area of management innovations and their spread will be referred to, debates such as whether management innovations actually bring something useful or if they are to be regarded as useless frauds. All this is done in order to offer a more solid background for and an introduction to the book. At the end of the chapter, the remainder of the book is outlined.

On Management Innovations and Healthcare Organizations

Management innovation can be defined as “the invention and implementation of a management practice, process, structure, or technique that is new to the state of the art and is intended to further organizational goals” (Birkinshaw et al., 2008, p. 825; see also Bort, forthcoming). Thus, management innovations represent some kind of ideal or normatively characterized prescription regarding how to better lead, structure, govern, control and organize organizations. They are “new” either in the sense that they are new to society in general or, at the least, to the organization that is implementing it (or is about to implement it). Examples of management innovations are Business Process Reengineering, Knowledge Management, Servant Leadership and Total Quality Management. These and quite a number of other management innovations will be examined in this book.

The image that is given of these management innovations in the literature about any certain management innovation (that is, literature presenting any certain management innovation in general, not specifically connected to healthcare organizations), as well as at business schools and by management gurus and consultants—and even by at least some scholars—is often one-sided. They are presented as quick-fix panaceas that bring various advantages to the organizations that adopt them, such as profitability, competitiveness and survival (Huczynski, 1993 [1996]; Kieser, 1997; Røvik, 2002). This supportive discourse rarely or never takes up any downsides that the management innovations might have. Occasionally, at the opposite pole, the management innovations are severely criticized. This discourse rarely or never mentions any gains that might occur from using the management innovations. For instance, the idea of the Learning Organization, which is one of the management innovations considered in this book, tends to be described either as “utopian sunshine” or as “Foucauldian gloom” (Driver, 2002), that is, either in terms of a one-sided recommendation to adopt the idea as is or, alternatively and much less often, a one-sided recommendation to all organizations to reject the idea.

The one-sidedness of this literature, and especially the dominating positive discourse, has, within the meta-literature on management innovations, given rise to an interpretation of organizational actors’ approach to and use of management innovations as if it was controlled by fashion mechanisms (e.g., Abrahamson, 1991, 1996a,b; Abrahamson & Fairchild, 1999). “Fashion” implies, in our case, that a certain management innovation at a given point of time rapidly gains lots of attention and interest, but then, after a certain period of time,¹ its popularity vanishes as quickly as it emerged. The one-sided positive discourse that dominates during the major part of the management innovation’s lifecycle tends to lead many organizational actors to “jump on the bandwagon” in a herd-like way (Sorge & van Witteloostuijn, 2004). But just as none of the many diets continuously appearing in the popular press, which those of us who need to lose some weight pin our hopes upon,² are probably capable of actually helping every single individual to lose weight, it cannot simply be assumed that management innovations are universally applicable panaceas. Thus, there is a risk that management innovations that appear attractive and are adopted by many other organizations but are fully or partly irrelevant are adopted (cf. Abrahamson, 1991). The reverse is, of course, also true. There is clearly a risk that management innovations that would be relevant and helpful for healthcare organizations are ignored because they are not fashionable enough or because they may not, from a quick glance, seem to fit healthcare organizations and their specific characteristics. Likewise, there is a risk that essential and even vital elements of a particular idea are not adopted or that elements that would be fatal for the organization are adopted (cf. Eccles & Nohria, 1992, p. 94). Thus, there is reason for researchers to “intervene” (Abrahamson, 1996a; Abrahamson & Eisenman, 2001; see also Birkinshaw et al., 2008) and engage in “researcher-assisted adaptation” (Örtenblad, 2013a, p. 9) of management innovations, to help organizational actors avoiding “maladaptive responses” such as dissociation or evangelicism (Whittle, forthcoming).

Even if it is impossible to escape the forces of fashion (e.g., Parker, forthcoming), and while...

Table of contents

• Cover Page
• Half-Title Page
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• List of Tables and Figures
• Contributor Presentations
• Foreword
• Foreword
• Preface
• Part I Background and Introduction
• Part II Examining Management Innovations
• Part III Conclusions and Future Research
• Index