The determination of organization stakeholder salience in public health.

Because interorganizational arrangements are encouraged as necessary to meet public health goals, it is critical for the managers of public health services at any level to consider stakeholder theory from an organizational perspective. Public health managers are responsible for the stakeholders in public health as well as public health as a stakeholder in other organizations. This article presents an innovative tool for the determination of organization stakeholder salience that assists managers in establishing priorities for interorganizational relationships during strategic planning and day-to-day decision making.     

Developing an assessment tool for evaluating community involvement

BACKGROUND: Current UK policy has resulted in greater requirements for public and patient participation in health service planning and decision making. Organizations and services need to be able to monitor and evaluate the effectiveness and quality of their community involvement processes, but there are few appropriate evaluation tools or sets of indicators available. This paper reports on work within Bradford Health Action Zone to develop a self-assessment tool for organizations on community involvement. METHODS: A multi-agency working group developed the tool. A literature search was undertaken and evaluation resources were reviewed. A set of benchmarks for community involvement in regeneration was utilized in developing the assessment areas. A range of individuals with expertise on community involvement practice and performance management was consulted. The tool was then piloted in two primary care trusts prior to final modifications. RESULTS: The process resulted in the production of Well Connected--a self-assessment tool on community involvement designed for organizations to assess their progress and identify areas for improvement. A scoring system assesses evidence of a strategic approach to community involvement, good practice throughout the organization, and a range of opportunities and support. Feedback from the pilots revealed that the tool had facilitated assessment of the strengths and weaknesses of organizational practices. CONCLUSION: The paper discusses some of the methodological challenges pertaining to the measurement of community involvement. Notwithstanding those challenges, it is argued that Well Connected provides a robust and practical framework that health organizations and their partners can use to assess practice.     

Electronic commerce: beyond the euphoria

As the center of considerable media attention, case study articles, vendor research, and development efforts, electronic commerce technology is entering healthcare and having a profound effect. The simple truth, however, is that after the drama and excitement begins to wear off, completing a successful e-commerce implementation remains good old-fashioned hard, sometimes monotonous work. To be successful, e-commerce technologies must be planned and implemented with rigorous project standards, and incorporated with significant process and workflow reengineering to actually return significant value to the organization. This article briefs readers on the organizational issues they must consider in evaluating e-commerce readiness--cultural, executive and technological factors that either support or inhibit project and technology success. Readers will be left with the tools to conduct an electronic commerce "readiness assessment" to evaluate the immediate, mid- and long-term potential of electronic commerce; practical remediation strategies for better preparing the organization for the changes inherent in moving to an e-commerce-enabled business model; and comments from the field--advice from organizations that have successfully implemented e-commerce technologies into their ongoing operations.     

Applying total quality management concepts to public health organizations.

Total quality management (TQM) is a participative, systematic approach to planning and implementing a continuous organizational improvement process. Its approach is focused on satisfying customers' expectations, identifying problems, building commitment, and promoting open decision-making among workers. TQM applies analytical tools, such as flow and statistical charts and check sheets, to gather data about activities within an organization. TQM uses process techniques, such as nominal groups, brainstorming, and consensus forming to facilitate communication and decision making. TQM applications in the public sector and particularly in public health agencies have been limited. The process of integrating TQM into public health agencies complements and enhances the Model Standards Program and assessment methodologies, such as the Assessment Protocol for Excellence in Public Health (APEX-PH), which are mechanisms for establishing strategic directions for public health. The authors examine the potential for using TQM as a method to achieve and exceed standards quickly and efficiently. They discuss the relationship of performance standards and assessment methodologies with TQM and provide guidelines for achieving the full potential of TQM in public health organizations. The guidelines include redefining the role of management, defining a common corporate culture, refining the role of citizen oversight functions, and setting realistic estimates of the time needed to complete a task or project.     

Western organizational change capacity theory and its application to public health organizations in China: A multiple case analysis

As health reform becomes a crucial task for both Chinese and United States government, public health organizations are required to adopt changes based on reform policy. Organizational Change Capacity theory is a Western theory that indicates the capacities that organizations should possess when pursuing successful organizational change. This study seeks to understand the applicability of this theory to Chinese public health organizations by contrasting organizations that have achieved success or remained challenged in implementing organizational change to optimize health reform. The research questions are: Is the Organizational Change Capacity theory applicable in Chinese public health organizations? How should it be modified to best fit Chinese public health organizations? Seventy‐two participants from 12 public health organizations in Beijing and Xi'an were recruited for interviews and follow‐up questionnaires that asked for experiences during their organizational changes. During the analysis, a new Chinese Organizational Change Capacity theory with nine main themes emerged. This new framework provides a guideline for Chinese public health organizations to evaluate their change capacity, and offers a theoretical foundation for researchers to design interventions that increase these organizations' capacity in achieving successful change.     

Waiting lists in Dutch health care: an analysis from an organization theoretical perspective

PURPOSE: To develop propositions on why public policies towards decreasing waiting list in health care can be expected to be unsuccessful. DESIGN/METHODOLOGY/APPROACH: On the basis of a case study of public policies directed towards the reduction of the waiting lists in health care a number of propositions are formulated explaining why this policy has turned out to be ineffective. The propositions are based on theoretical insights form the field of organizations studies about the behavior of organizations and professionals. FINDINGS: It is demonstrated that public policies on reducing waiting lists in the Dutch health care system are likely to be ineffective because the policy-making strategies used are based on unrealistic assumptions about the behavior of organizations and professionals who are expected to reduce the waiting lists. RESEARCH LIMITATIONS/IMPLICATIONS: Although the propositions are based on established organization literature, empirically they are only based on one case study. PRACTICAL IMPLICATIONS: In order to develop effective policy interventions it is important to be realistic about the behavior and strategies of the actors towards which the policy is directed. Moreover, rather than directing exclusive attention to those waiting, it is important for policy makers to address the interdependencies of the organizational field in which waiting lists occur. ORIGINALITY/VALUE: This paper gives directions to policy makers who need to deal with complex and interdependent problems.     

Concepts and theory of health impact assessment

Health effects are often overlooked in the planning of policies, programmes or projects, which has led to international and national pressure for evaluation of potential influence. For this reason, Health Impact Assessment (HIA) has been emphasized by many national governments and international organizations such as the European Union and WHO. HIA is a helpful decision-making tool with methodology that was defined as "a combination of procedures, methods, and tools by which a policy, a program or a project may be judged as to its potential effects on health of a population and the distribution of effects within the population" in the WHO Gothenburg paper. In recent decades, many HIAs have been implemented for proposals including building new airports, dams, employment strategy, and housing policy. However, there is very little information on HIA in Japan, even among public health professionals and policy makers. In this review, we introduce basic concepts and theory, and discuss how to improve HIA activities in Japan.     

Individuals and changes in health organizations: a psychosociological approach

The Brazilian health sector has undergone a severe crisis, affecting the case-resolving capacity, efficiency and governability of the health system as a whole and health organizations in particular. Although innovative management systems and tools have been encouraged, such innovations are limited in their ability to spawn organizational change, especially with regard to the challenge of enabling individual adherence to institutional projects and relations involving individuals and organizations. This paper focuses on the French psychosociological approach for analyzing and intervening in organizations, one of whose main thinkers is Eugène Enriquez. In its view of contemporary organizations, this approach focuses on the conflict between reproduction and creation as the main problem to be solved by management processes. While an organization is essentially seen as a place of order and repetition, organizational change implies the challenge of bringing creative individuals into the organization's project, avoiding the trap of controlling their minds and behavior.     

Examining the role of context in the implementation of a deliberative public participation experiment: results from a Canadian comparative study

To resolve tensions among competing sources of evidence and public expectations, health-care managers and policy makers are turning more than ever to involve the public in a wide range of decisions. Yet efforts to use research evidence to inform public involvement decisions are hampered by an absence of rigorous public participation evaluation research. In particular, greater rigour in exploring the roles played by different contextual variables--such as characteristics of the issue of interest, the culture of the sponsoring organization and attributes of the decision being made--is needed. Using a comparative quasi-experimental design, we assessed the performance of a generic public participation method implemented in 5 Canadian regionalized health settings between 2001 and 2004. Participant and decision-maker perspectives were assessed and, through direct observation, the roles exerted by contextual variables over the public involvement processes were documented and analysed. Our findings demonstrate that a generic public participation method can be implemented in a variety of contexts and with considerable success. Context exerts fostering and inhibiting influences that contribute to more (or less) successful implementation. Public participation practitioners are encouraged to pay careful attention to the types of issues and decisions for which they are seeking public input. Sufficient organizational resources and commitment to the goals of the public participation process are also required. Attention to these contextual attributes and their influence on the design and outcomes of public participation processes is as important as choosing the "right" public participation mechanism.