Using the balanced scorecard to mobilize human resources in organizational transformation.

Traditionally, the balanced scorecard (BSC) has been an effective tool in linking measurement to strategy. However, what is least understood is how the BSC can be used to redefine organizational relationships, re-engineer fundamental processes and transform organizational culture, for superior performance in an organization with the same people, services and technology that previously delivered dismal performance. This paper highlights the process and uses York Central Hospital in Toronto, Ontario, Canada as an illustrative example.     

Analyzing the nursing organizational structure and process from a scheduling perspective

The efficient and effective management of nursing personnel is of critical importance in a hospital’s environment comprising approximately 25 % of the hospital’s operational costs. The nurse organizational structure and the organizational processes highly affect the nurses’ working conditions and the provided quality of care. In this paper, we investigate the impact of different nurse organization structures and different organizational processes for a real-life situation in a Belgian university hospital. In order to make accurate nurse staffing decisions, the employed solution methodology incorporates shift scheduling characteristics in order to overcome the deficiencies of the many phase-specific methodologies that are proposed in the academic literature.     

Creation and management of organizational knowledge

With a view to creating and establishing a sustainable position of competitive advantage, the best organizations are increasingly investing in the application of concepts such as learning, knowledge and competency. The organization's creation or acquisition of knowledge about its actions represents an intangible resource that is capable of conferring a competitive advantage upon them. This knowledge derives from interactions developed in learning processes that occur in the organizational environment. The more specific characteristics this knowledge demonstrates in relation to the organization, the more it will become the foundation of its core competencies and, consequently, an important strategic asset. This article emphasizes nurses' role in the process of knowledge management, placing them in the intersection between horizontal and vertical information levels as well as in the creation of a sustainable competitive advantage. Authors believe that this contribution may represent an opportunity for a reflection about its implications for the scenarious of health and nursing practices.     

Joint Commission International accreditation: relationship to four models of evaluation.

OBJECTIVE: To describe the components of the new Joint Commission International (JCI) accreditation program for hospitals, and compare this program with the four quality evaluation models described under the ExPeRT project (visitatie, ISO, EFQM, organizational accreditation). RESULTS: All the models have in common with the JCI program the use of explicit criteria or standards, and the use of external reviewers. The JCI program is clearly an organizational accreditation approach with evaluation of all the 'systems' of a health care organization. The JCI model evaluates the ability of an organization to assess and monitor its professional staff through internal mechanisms, in contrast with the external peer assessment used by the visitatie model. The JCI program provides a comprehensive framework for quality management in an organization, expanding the boundaries of the quality leadership and management found in the EFQM model, and beyond the quality control of the ISO model. The JCI organizational accreditation program was designed to permit international comparisons, difficult under the other models due to country specific variation. CONCLUSION: We believe that the organizational accreditation model, such as the international accreditation program, provides a framework for the convergence and integration of the strengths of all the models into a common health care quality evaluation model.     

医院客户服务绩效评价与提升策略研究

本文通过对客户服务的绩效管理流程进行论述,并对绩效管理体系改革措施的效果进行评价,以建立学习型组织和组织的绩效文化,形成具有激励作用的工作氛围为目的。本院参考国内外经验,结合自身实际,对医院员工的客户服务绩效进行考核,提升医院创新能力和管理水平,为医院在市场竞争环境下获取竞争优势提供思路。     

Information technology strategy: three misconceptions

The core intent in developing an IT strategy is to ensure that there is a strong and clear relationship between IT investment decisions and the organization's overall strategies, goals, and objectives. In the course of developing an IT strategy, an organization may fall victim to three major misconceptions about IT strategy. Those misconceptions are: The IT strategy should be solely derived from a thorough review of organizational strategies and plans. The IT strategy should be dominated by a focus on defining needed application systems. The IT strategy is better if it is developed by using a rigorous methodology. These misconceptions are dangerous. While they are right, they are not completely right. Hence, a dogmatic approach embracing these misconceptions risks an incomplete IT strategy or a strategy that is not as aligned with the organization as it should be.     

Knowledge management: An innovative risk management strategy

Knowledge management effectively lends itself to the enterprise risk process. The authors introduce the concept of knowledge management as a strategy to drive innovation and support risk management. They align this work with organizational efforts to improve patient safety and quality through the effective sharing of experience and lessons learned. The article closes with suggestions on how to develop a knowledge management initiative at an organization, who should be on the team, and how to sustain this effort and build the culture it requires to drive success.     

军队医院组织结构创新模式

本文以现代管理理论为指导,研究医院组织结构创新模式,分析探讨军队医院组织结构变革趋势与作用;阐述了现代医院组织结构呈现扁平化、弹性化、网络化、分权化、流程化和平行化等多维结构格局,指出医院组织结构创新应以提高组织的有效性为目的;以建立学习型组织为先导,以坚持“以人为本”为原则,以医院发展战略为牵引并保持与战略的动态适应。     

Organizational capacity for community development in regional health authorities: a conceptual model

The value of community development (CD) practices is well documented in the health promotion literature; it is a foundational strategy outlined in the Ottawa Charter for Health Promotion. Despite the importance of collaborative action with communities to enhance individual and community health and well-being, there exists a major gap between the evidence for CD and the actual extent to which CD is carried out by health organizations. In this paper it is argued that the gap exists because we have failed to turn the evaluative gaze inward-to examine the capacity of health organizations themselves to facilitate CD processes. This study was designed to explicate key elements that contribute to organizational capacity for community development (OC-CD). Twenty-two front-line CD workers and managers responsible for CD initiatives from five regional health authorities in Alberta, Canada, were interviewed. Based on the study findings, a multidimensional model for conceptualizing OC-CD is presented. Central to the model are four inter-related dimensions: (i) organizational commitment to CD, rooted in particular values and beliefs, leadership and shared understanding of CD; (ii) supportive structures and systems, such as job design, flexible planning processes, evaluation mechanisms and collaborative processes; (iii) allocation of resources for CD; and (iv) working relationships and processes that model CD within the health organization. These four dimensions contribute to successful CD practice in numerous ways, but perhaps most importantly by supporting the empowerment and autonomy of the pivotal organizational player in health promotion practice: the front-line worker.     

Are you ready for the computer-based patient record?

Moving to a computer-based patient record (CPR) involves much more than simply putting computers in clinical offices. To achieve success, a health care organization must rethink and revise traditional workflows and organizational structures. Diverse constituencies within an organization must be targeted to gain buy-in to the process. Other considerations include cost justification and implementation strategies. Current market dynamics suggest that organizations should be contemplating the move to a CPR in order to gain competitive advantage or even to maintain the status quo.     

Total quality management as a health care corporate strategy

Total quality management (TQM) must become a part of corporate strategy if it is to become a way of life in health care. TQM should be understood in the context of a cultural transformation. The greatest challenge for top management is to create an organization in which every employee, department and function is linked inextricably to the organization's mission and vision. One of the key benefits of TQM is the use of teams to work on and achieve organizational objectives. Health care managers must understand motivation in order to carry the workforce with them to attain those objectives.     

A total healing environment: the Yavapai Regional Medical Center story

Patient care executives are continually challenged to increase productivity without additional expense or negative effect on patient care quality. Identifying the optimal organizational set of circumstances that meets the needs of all stakeholders is a challenge for even the most dedicated and skilled executive. This article is a case study in which healthcare leaders intuitively believed in a healing environment and successfully implemented the organizational changes necessary to translate the essence of healing into their traditional organization. The experiences of seven executives within the organization provide critical information for organizations considering implementation of a healing model in traditional settings. Characteristics of a healing model, planning and implementation considerations, and the measurement of the outcomes are identified. In addition, the research methodology used to examine the relationship of healing model characteristics to selected organizational outcomes is described.     

Strategic management system in a healthcare setting--moving from strategy to results

One of the historical challenges in the healthcare system has been the identification and collection of meaningful data to measure an organization's progress towards the achievement of its strategic goals and the concurrent alignment of internal operating practices with this strategy. Over the last 18 months the Toronto East General Hospital (TEGH) has adopted a strategic management system and organizing framework that has led to a metric-based strategic plan. It has allowed for formal and measurable linkages across a full range of internal business processes, from the annual operating plan to resource allocation decisions, to the balanced scorecard and individual performance evaluations. The Strategic Management System (SMS) aligns organizational planning and performance measurement, facilitates an appropriate balance between organizational priorities and resolving "local" problems, and encourages behaviours that are consistent with the values upon which the organization is built. The TEGH Accountability Framework serves as the foundation for the entire system. A key tool of the system is the rolling three-year strategic plan for the organization that sets out specific annual improvement targets on a number of key strategic measures. Individual program/department plans with corresponding measures ensure that the entire organization is moving forward strategically. Each year, all plans are reviewed, with course adjustments made to reflect changes in the hospital's environment and with re-calibration of performance targets for the next three years to ensure continued improvement and organizational progress. This system has been used through one annual business cycle. Results from the past year show measurable success. The hospital has improved on 12 of the 15 strategic plan metrics, including achieving the targeted 1% operating surplus while operating in an environment of tremendous change and uncertainty. This article describes the strategic management system used at TEGH and demonstrates the formal integration of the plan into its operating and decision making processes. It also provides examples of the metrics, their use in decision-making and the variance reporting and improvement mechanisms. The article also demonstrates that a measurement-oriented approach to the planning and delivery of community hospital service is both achievable and valuable in terms of accountability and organizational responsiveness.     

Total quality in acute care hospitals: guidelines for hospital managers

Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements.     

Quality management of human resources. Providers should begin by focusing on education, performance management, and reward systems

For a quality management transformation to occur, a healthcare organization must focus on education and development, performance management, and recognition and reward systems during the first years of implementation. Education and development are perhaps the most important human resource management functions when implementing quality management principles and processes because behavioral changes will be required at all organizational levels. Specific programs that support an organization's quality management effort will vary but should include the conceptual, cultural, and technical aspects of quality management. The essence of quality management is to always satisfy the customer and to continuously improve the services and products the organization offers. The approach to performance management should therefore rely on customer feedback and satisfaction. An organization committed to quality management should base its performance management approach on customer orientation, process improvement, employee involvement, decision making with data, and continuous improvement. Managers and trustees are being challenged to provide innovative recognition and reward systems that reinforce the values and behaviors consistent with quality management. Such systems must also be aligned with the behaviors and outcomes that support the philosophy, mission, and values of the Catholic healthcare ministry. The following components should be considered for a recognition and reward system: base pay, incentives, benefits, and nonmonetary rewards.     

Governing board structure, business strategy, and performance of acute care hospitals: a contingency perspective.

Contingency theory suggests that for a hospital governing board to be effective in taking on a more active role in strategic management, the board needs to be structured to complement the overall strategy of the organization. A survey study was conducted to examine the strategies of acute care hospitals as related to the structural characteristics of their governing boards. After controlling for organizational size and system membership, results indicated a significant relationship between the governing board structure of 109 acute care hospitals and their overall business strategy. Strategy also accounted for more of the variance in board structure than either organization size or system membership. Finally, the greater the match between board structure and hospital strategy, the stronger the hospitals' financial performance.     

Holding on to success: A case study in mental health care reform

This article analyzes the changes experienced by a mental health care organization in response to environmental threats and fluctuating expectations. On a general, more theoretical level, the article demonstrates how processes of environmental selection as well as organizational adaptation shape organizational forms. On a concrete, applied level, those administrative practices are articulated that can help ensure that reform efforts are successful. Administrators also must be aware of the inertial forces operating upon stable organizational forms and work to ensure that the organization remains vital and open to change.     

Determinants of hospital-based substance abuse treatment programs

Experts agree that treatment is the best solution to substance abuse problems. As the societywide problem of drug and alcohol dependence increases, so does the need for treatment programs. Research has shown that many hospitals have entered into the substance abuse treatment program business because a need for quality programs exists and because an alcohol and a substance abuse treatment product line has the potential for increasing sagging revenues. This article addresses the question of what types of hospitals are likely to engage in providing inpatient and/or outpatient treatment programs. The results indicate that organizational size (measured by the number of beds) is the best predictor of treatment service provision for both inpatient and outpatient settings, with larger hospitals being more likely to provide substance abuse programs. A need for additional chemical dependency treatment programs does not appear to be the primary motivating factor for hospitals developing this service. Rather, it seems hospitals provide these programs for other reasons--as part of providing a full array of services, as an average toward achieving organizational goals, as a means of sustaining a competitive advantage, or as a strategy for maintaining the same level of service as the competition.     

Successful strategic planning: creating clarity

Most healthcare organizations have a strategic plan of some kind. Many of these organizations also have difficulty translating their strategic plan into specific actions that result in successful performance. In the worst cases, this can jeopardize the viability of the organization. The trouble lies in a lack of clarity in what a strategic plan is and what it should do for the organization. This article will answer key questions such as: What is strategy and how does it fit with other commonly used constructs such as mission, vision, and goals? What criteria can be used to determine if something is truly strategic to the organization? What are the phases of the strategy lifecycle? How do approaches for dealing with uncertainty, such as scenario planning, fit with organizational strategic planning? How can a meaningful IT strategy be developed if the organization strategy is lacking? What principles should guide a good IT planning process?     

Developing the hospital's mission to facilitate organizational change: limits and possibilities

The author begins by discussing the field of General Administration Theory vis-à-vis the defining role of "organizational goals" within an overall change process in organizations. While admitting the validity of some challenges raised by certain authors who deny the possibility of establishing a "single" direction for the organization by explicitly outlining its formal or official goals, the author presents and discusses his experience in defining the mission in the health sector as a way to implement organizational goals. This definition is meant as a strategy to improve communications among health team members and to a culture of responsibility when dealing with health service users.