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Subject: search.filters.subject.420306 Health care administration

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    Strategic and operational management principles on integrated coordinated healthcare in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Business Studies (Management), Massey University, New Zealand
    (Massey University, 2024) McCullough, Ailsa
    Background - Globally the health system burden has been rising due to increasing populations and complexity of health status, as well as resource and infrastructure pressures. To address this, the World Health Organisation Strategy has encouraged health economies worldwide to embed Integrated Coordinated Healthcare (ICH) services. Aligned with this, New Zealand (NZ) has progressively introduced system-wide initiatives supporting ICH design and implementation at each tier of the health system. Aims and objectives – This research explored management principles involved with ICH service delivery at each tier of the NZ health system, to understand how organisations have applied theories in practice, to improve efficiency and effectiveness of service delivery and support sustainability. Methodology – This research took an interpretivist position and followed inductive methodology to investigate how management principles for ICH have evolved with the contributions of stakeholders. This research obtained qualitative data via purposive and snowball sampling, to request participants take part in semi-structured interviews and complied with ethics by gaining participants informed consent and ensuring their privacy. The findings reflected common themes across interviewees and were categorised using an iterative coding process for each participants’ responses. Their themes were compared to literature. Bias is an inherent limitation for this type of study, though mitigations were taken to reduce this. Key findings and conclusions – The findings added to the body of knowledge for ICH management principles. As the strategic level, they indicated that ICH is beneficial for the sustainability of the NZ health system, if service objectives are aligned with strategic government initiatives. At the sector level the findings outlined that partnering shares risk and benefit between the funder and suppliers to incentivise goal congruence in achieving social good objectives. In contrast, conditional contracts enable the funder to manage competition objectively, to equitably reward suppliers. The findings contrast ICH operational management approaches to achieve efficiency and effectiveness. They pose the view that for complex patient groups and ICH service pathways, integration should be implemented with coordination of assessments, policies, and information systems across multiple suppliers. They posit that ICH designs for patient groups whose service use is largely unaffected by complexity other than their health condition, can feasibly achieve integration within clinics delivering multi-disciplinary services. The findings further indicated ICH designs must incorporate meaningful monitoring supported by collaborative processes to ensure stakeholders embed continuous improvements. The findings also demonstrated that building trust is key for engaging with suppliers, particularly for Māori and ICH services. Contribution - The key management principles for ICH are themed around connectivity and contextual factors, governance and equity, and collaboration and trust. ICH designs should include realistic measures to monitor performance and quality, and categorise complexity, enabling organisations and funders to assess the relative impact of improvements on health outcomes. Incorporating these management principles into designs should support the efficiency and effectiveness of ICH services in practice.
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    Advancing environmental sustainability in German hospitals : challenges and practices : a thesis presented in partial fulfilment of the requirements for the degree of Master of Business Studies in Management at Massey University, Manawatū, New Zealand
    (Massey University, 2024) Suessenguth, Nora Johanna
    This study focuses on the German healthcare sector, more specifically on German hospitals. In Germany, the healthcare sector is responsible for 5.2% of the national greenhouse gas (GHG) emissions and therefore has a substantial impact on environmental sustainability. Despite growing awareness about the importance of minimising their environmental impact, this aspect is still often neglected. Limited pressure and support, limited financial means, the difference of priorities in the healthcare sector, such as high quality patient care, and lack of knowledge about environmental management in hospitals are known reasons for this. Despite these barriers, a few hospitals in Germany have been able to dedicate resources to address environmental sustainability. This study aims to provide practical insights for hospital management and enhance understanding of how hospitals in Germany can advance in environmental sustainability despite the multiple barriers they face. Three research questions are addressed: (1) What actions are hospitals taking to improve their environmental sustainability? (2) What challenges do hospitals face in implementing these actions? (3) What practices enable hospitals to overcome these challenges and advance in environmental sustainability? This study draws on three theoretical frameworks regarding governance, development, and organisational change. To analyse how hospitals can advance in environmental sustainability based on these frameworks, the adaptive capacity needs to be examined, which determines how well an organisation is able to respond to changes and implement change initiatives to progress towards sustainability. Therefore, change initiatives of hospitals are examined, as well as four dimensions shaping the implementation of these initiatives: strategy making, organising processes, management capabilities and relational assets, thereby highlighting the challenges of implementation. For this study, a multiple explanatory case study design was adopted. Data were collected via semi structured interviews with people in four German hospitals whose task is to address sustainability, and with one managing director of an overarching organisation, linking the healthcare sector to sustainability. Findings were identified via thematic analysis. Three domains, with eight themes and various subthemes, categories, and codes were identified. Domain 1 (sustainability actions) includes theme 1: change initiatives, domain 2 (challenges in implementation) includes themes 2–5: strategy making, organising processes, management capabilities, and relational assets, and domain 3 (enabling practices) includes themes 6–8: establishing structures, collaboration and knowledge sharing, and openness to alternative approaches. First, sustainability actions were identified. They include initiatives to reduce environmental impact, change behaviour, increase resilience, and assess the environmental impact. Then, several challenges in implementing initiatives were identified within the dimensions of strategy making, organising processes, management capabilities, and relational assets. They include lack of external pressure and support, lack of knowledge, time, and personnel, organisational complexity, lack of funding, difficulty to change behaviour, and the competition of environmental sustainability with hygiene and patient safety. Finally, enabling practices to overcome these challenges were also identified. They include establishing structures within hospitals, engaging in collaboration and knowledge sharing with external and internal stakeholders, and openness to alternative approaches. These practices were found to improve implementation of change initiatives, which could impact the adaptive capacity of a hospital, leading to them being able to advance in environmental sustainability.
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    Quality improvement interpreted as a complex adaptive system : implications and opportunities : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy at Massey University, Palmerston North, New Zealand
    (Massey University, 2024-11-01) Wilson, William
    The effectiveness of quality improvement (QI) methods in healthcare has been challenged, especially under circumstances of high complexity. This thesis examines the implications for quality improvement if complex socio-technical systems such as healthcare are interpreted as complex adaptive systems (CAS). The research followed a mixed-method design. Informed by the complex systems and quality management literature, a conceptual model for quality improvement within CAS was developed — the complex quality improvement network (CQIN). An agent-based simulation model was then used to establish the plausibility and face validity of the model constructs and their interaction. Thematic analysis and crisp-set qualitative comparative analysis (QCA) were then used to examine the evidence for CQIN constructs within published quality improvement case studies. One applied case study was also conducted for deeper insight into the practical difficulties of interpreting a real-world quality improvement project as a CAS. Finally, the findings of the simulation modelling and the secondary data analysis were integrated into a Bayesian network model. Empirical evidence, in the form of consistency across cases and coverage within cases, was found for eleven of the twelve CQIN constructs. Multiple sets of sufficient conditions for reported improvement success were identified across cases. These sets were minimised to four strategies for successful quality improvement; i) strengthening agent network communication paths; ii) building shared understanding of problem and context amongst networked agents; iii) increasing problem-solving effectiveness; and iv) improved system signal integration. If the evolutionary foundations for CAS are in some way inhibited, the likelihood of quality improvement success is reduced. Healthcare quality improvement can be plausibly simulated using fundamental CAS principles. The first contribution to quality improvement discourse is the CQIN model, a CAS model of change applied specifically to quality improvement. A second contribution of this research is a complex quality improvement risk assessment model, the CQIN Bayesian Network. Practitioners can use this model to examine and test identified CAS-informed improvement strategies. The individual CQIN constructs make a third contribution by providing new categories of causal factors for the comparison of disparate quality improvement case studies.
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    Exploring the impact of telehealth videoconferencing services on work systems for key stakeholders in New Zealand : a sociotechnical systems approach : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Management at Massey University, Albany, New Zealand
    (Massey University, 2020) Green, Nicola Jane
    This thesis explores how the impacts of telehealth videoconferencing services (THVCS) on work systems are perceived by key stakeholders in New Zealand. Telehealth - the use of information and communications technologies to deliver healthcare when patients and providers are not in the same physical location - exemplifies how technological developments are changing the ways in which healthcare is provided and experienced. With the objectives of improving access, quality, and efficiencies of financial and human resources, THVCS use real time videoconferencing to provide healthcare services to replace travel to a common location. Despite the benefits of telehealth reported in the extant literature, there continues to be difficulties with developing and sustaining services. The aim of this inquiry is to understand how THVCS impact key stakeholders in the work system. Specifically, it seeks to examine the characteristics of THVCS in the New Zealand context, identify the facilitators and barriers to THVCS, and understand how the work system can adapt for THVCS to be sustained practice. The research design is framed by a post-positivist approach and underpinned by sociotechnical systems (STS) theory. STS theory and a human factors/ergonomics design approach inform the methodology, including the use of the SEIPS 2.0 model. Forty semi-structured qualitative interviews and contextual observations in a two-phase methodology explore the perceptions of an expert telehealth group, and providers, receivers, and decliners of THVCS. These data are analysed using the framework method of thematic analysis. The key findings suggest that to enable sustained THVCS in New Zealand, factors such as new ways of working; change; human connection; what is best for patient; and equity need to be recognised and managed in a way that balances costs and consequence and ensures fit across the work system. Theoretical contributions to knowledge are made through the development of a conceptual model from the literature, exploring THVCS with an STS theory lens and developing SEIPS 2.0. Methodologically, this inquiry contributes a theory-based, qualitative approach to THVCS research and draws on the perceptions of unique groups of participants. Significantly, the findings make practical contributions to the design of the THVCS in the New Zealand context.