Prelims

Half Title Page

Research and Theory to Foster Change in the Face of Grand Health Care Challenges

Series Title Page

Advances in Health Care Management

Series Editor: Jennifer Hefner

Associate Editors: Dori A. Cross and Patrick D. Shay

Recent Volumes:

Volume 11: Biennial Review of Health Care Management – Edited by John D. Blair and Myron D. Fottler, with assistance from Grant T. Savage

Volume 12: Health Information Technology in the International Context – Edited by Nir Menachemi and Sanjay Singh, with assistance from Valerie A. Yeager and Grant T. Savage

Volume 13: Annual Review of Health Care Management: Strategy and Policy Perspectives on Reforming Health Systems – Edited by Leonard H. Friedman, Grant T. Savage and Jim Goes

Volume 14: Leading in Health Care Organizations: Improving Safety, Satisfaction and Financial Performance – Edited by Tony Simons, Hannes Leroy and Grant T. Savage

Volume 15: Annual Review of Health Care Management: Revisiting the Evolution of Health Systems Organization – Edited by Jim Goes, Grant T. Savage and Leonard H. Friedman

Volume 16: Population Health Management in Health Care Organizations – Edited by Jennifer L. Hefner, Timothy R. Huerta and Ann Scheck McAlearney

Volume 17: International Best Practices in Health Care Management – Edited by Sandra C. Buttigieg, Cheryl Rathert and Wilfried Von Eiff

Volume 18: Structural Approaches to Address Issues in Patient Safety – Edited by Susan D. Moffatt-Bruce

Volume 19: Transforming Health Care: A Focus on Consumerism and Profitability – Edited by Jennifer L. Hefner, Mona Al-Amin and Timothy R. Huerta, with Alison M. Aldrich and Tyler E. Griesenbrock

Volume 20: The Contributions of Health Care Management to Grand Health Care Challenges – Edited by Jennifer L. Hefner and Ingrid Nembhard

Volume 21: Responding to the Grand Challenges in Healthcare Via Organizational Innovation: Needed Advances in Management Research – Edited by Stephen M. Shortell, Lawton Robert Burns and Jennifer L. Hefner

Title Page

Advances in Health Care Management Volume 22

Research and Theory to Foster Change in the Face of Grand Health Care Challenges

Edited by

Jennifer L. Hefner

Ohio State University, USA

Dori A. Cross

University of Minnesota, USA

And

Patrick D. Shay

Trinity University, USA

United Kingdom – North America – Japan – India – Malaysia – China

Copyright Page

Emerald Publishing Limited

Emerald Publishing, Floor 5, Northspring, 21-23 Wellington Street, Leeds LS1 4DL

First edition 2024

Editorial matter and selection © 2024 Jennifer L. Hefner, Dori A. Cross and Patrick D. Shay.

Individual chapters © 2024 The authors.

Published under exclusive licence by Emerald Publishing Limited.

Chapter 5, Innovation Diffusion Across 13 Specialties and Associated Clinician Characteristics, copyright © 2024 Zhanna Novikov, Sara J. Singer and Arnold Milstein, is Open Access with copyright assigned to respective chapter authors. Published by Emerald Publishing Limited.

This work is published under the Creative Commons Attribution (CC BY 4.0) licence.

Anyone may reproduce, distribute, translate and create derivative works of this work (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

The ebook edition of this title is Open Access and is freely available to read online

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

ISBN: 978-1-83797-656-0 (Print)

ISBN: 978-1-83797-655-3 (Online)

ISBN: 978-1-83797-657-7 (Epub)

ISSN: 1474-8231 (Series)

About the Editors

Jennifer L. Hefner is an Associate Professor in the Division of Health Management and Policy, The College of Public Health, Ohio State University, USA.

Dori A. Cross is an Assistant Professor in the Division of Health Policy and Management, School of Public Health, University of Minnesota, USA.

Patrick D. Shay is an Associate Professor in the Department of Health Care Administration at Trinity University, USA.

About the Contributors

Casey Canfield is Assistant Professor in Engineering Management and Systems Engineering at Missouri S&T. She has an Engineering & Public Policy PhD from Carnegie Mellon University and Engineering: Systems BS from Olin College. Her research quantifies the human part of complex systems to improve decision-making in infrastructure transitions.

Nathan W. Carroll is Associate Professor of Healthcare Administration at Virginia Commonwealth University. His research focuses on understanding the financial incentives healthcare organizations face, and how organizations are responding to those incentives.

Ganisher Davlyatov, The University of Oklahoma Health Sciences Center, Department of Health Administration and Policy.

Akbar Ghiasi, University of the Incarnate Word, H-E-B School of Business and Administration.

Rachel Gifford is Assistant Professor of Healthcare Management and Organization Studies at Maastricht University. She holds a PhD in Organizational Behavior from University of Groningen. Her research interests include the organization of care delivery and healthcare professionals, organizational adaptation and the evolution of professional work in health care.

Mark Govers is Associate Professor in Organisation and Management at Maastricht University's Care and Public Health Research Institute (CAPHRI). He holds a PhD on the intersection between business information technology and organization development. His interests include socio-technical systems thinking, and digital developments and entrepreneurial behavior.

Jyotsna Gutta is Policy Analyst in the Center for Health Policy in the Department of Health Policy & Management at the Indiana University Richard M. Fairbanks School of Public Health in Indianapolis.

Larry R. Hearld, The University of Alabama at Birmingham, School of Health Professions, Department of Health Services Administration.

Anne M. Hewitt is Professor and Chair for the Department of Interprofessional Health Sciences and Health Administration and a Professor at Seton Hall University. She is primary editor of Population Health Management: Strategies, Tools, Applications and Outcomes and author of the upcoming text, Population Health: Practical Skills for Future Health Professionals.

Tory H. Hogan, The Ohio State University, College of Public Health, Division of Health Services Management and Policy.

Saleema A. Karim, Associate Professor of Healthcare Administration at Virginia Commonwealth University. Her research focuses on hospital financial sustainability, disparities, geographic variation, and HVBP and HRRP reimbursement.

Clair Reynolds Kueny, Associate Professor at Missouri S&T, received her MS and PhD in Industrial-Organizational Psychology from Saint Louis University. Her research related to applying organizational theory to healthcare delivery has been published in outlets including Occupational Health Science, Journal of Clinical Oncology, and Journal of Interprofessional Education & Practice.

Lisa Kutschera is rotation coordinator for the Medical Residency Program for the IU School of Medicine located on the Indianapolis Campus. Lisa is also the parent of a son with Autism.

Shoou-Yih D. Lee is the inaugural Martha and Wickliffe Lyne Professor of Health Administration at Virginia Commonwealth University. He is an organizational sociologist and health services researcher whose research seeks to improve health care delivery through critical examination of factors that drive organizational as well as individual decisions and behaviors.

Robert Wheech Maldonado, The University of Alabama at Birmingham, School of Health Professions, Department of Health Services Administration.

Arnold Milstein, Stanford University School of Medicine, is the Director of the Clinical Excellence Research Center at Stanford University. The Center discovers and disseminates innovations in clinical process and bedside applications of machine intelligence that lower the cost of high-quality health care.

Ingrid Mur-Veeman was Associate Professor in Organisation and Management at Maastricht University in Maastricht, the Netherlands. She played an initiating role in conceptualizing the RPB concept within the organizational DNA theory. She passed away in 2016.

Zhanna Novikov, UTHealth Houston, School of Public Health and Stanford University School of Medicine, is interdisciplinary researcher who applies organizational theory and behavior models to explore how individuals and teams in health care can innovate and improve care-safety. She's an affiliate of Stanford University's Clinical Excellence Research Center.

Alex Price is Assistant Professor in Radiation Oncology at Case Western Reserve SoM. He is currently pursuing his PhD in Systems Engineering from Missouri S&T. He has an MS in Medical Physics from Duke University. His research interests are healthcare systems modeling and novel approaches to radiation oncology.

Minakshi Raj is Assistant Professor at the University of Illinois Urbana Champaign. Her research focuses on identifying organizational and policy approaches to integrating family caregivers of older adults into the health care system with an emphasis on culturally diverse caregivers.

Shu-Fang Shih is Assistant Professor of Healthcare Administration at Virginia Commonwealth University. Her research provides empirical evidence that supports the design and implementation of human-centered, technology-driven, and integrated health and social care models to improve population health and promote health equity.

Sara J. Singer, Stanford University School of Medicine and Graduate School of Business, is Associate Director of the Clinical Excellence Research Center at Stanford university. Her research in health care management and policy focuses on how organizational leadership and culture impact efforts to implement health delivery innovations, integrate patient care, improve safety and reliability of health care organizations, and promote a culture of health.

Elveta D. Smith is Associate Professor in the Master of Healthcare Administration program at the University of North Carolina at Wilmington. After 20 years in hospital administration, she now teaches future healthcare leaders.

Sarah M. Stelzner focuses on developing programs in Community Pediatrics (e.g., the Anne E. Dyson Community Pediatrics Training Initiative, and the Our Kids Our Community Advanced Training) to improve the skills and competencies of primary care pediatricians. She provides team-based care including care conferencing to underserved populations.

Jeff Szychowski, The University of Alabama at Birmingham, School of Public Health Department of Biostatistics.

Arno van Raak is a Sociologist. He has worked at Maastricht University as an Associate Professor until 2023. His research particularly concerns integrated care, care supply chains, and interorganizational networks of care providers. Among his publications is the book entitled “Integrated Care in Europe” (2003).

Daan Westra is Assistant Professor of Healthcare Management at Maastricht University's Care and Public Health Research Institute (CAPHRI). His research focuses on the structures of and collaborative processes within interorganizational networks in the healthcare sector and across the healthcare and social services sectors.

Valerie A. Yeager is Professor and MPH Concentration Lead for the Department of Health Policy & Management at the Indiana University Richard M. Fairbanks School of Public Health in Indianapolis. Her research broadly examines the intersection and interaction of public health and health care.

List of Reviewers

Preface

We are pleased to share Volume 22 of Advances in Health Care Management (AHCM): Research and Theory to Foster Change in the Face of Grand Health Care Challenges. The past few volumes have focused on identifying and setting a research agenda for grand health care challenges (see Preface, Vol. 20, Hefner & Nembhard 2021). Through informed commentaries from prominent scholars in health care management, Volume 21 (Shortell et al., 2022) highlighted the current opportunities and challenges of: health system digitization; diversity, equity, and inclusion; COVID-19; performance improvement; network governance; inter-sector alliances; alterative payment models; and social determinants of health. A common theme across the chapters in Volume 21 was discussion of the organizational change needed to address these challenges.

Many have recognized that healthcare organizations today face the certainty of change as they confront varied grand challenges, all occurring in a broader landscape that scholars describe as radically and rapidly transforming at an unprecedented and accelerating pace (Amis & Greenwood, 2021; Dempsey et al., 2022). Such an environment is characterized by “exacerbated levels of uncertainty,” with people seeing and valuing their work differently as a result (Amis & Greenwood, 2021, p. 585; Wright et al., 2023). As healthcare leaders work to navigate the continual questions surrounding radical change and heightened uncertainty, they require an understanding of effective approaches to organizational change, yet what scholars know about change management continues to evolve.

Management models designed to understand and respond to organizational change have proliferated in the past several decades, with some of the most widely recognized models of change management now common elements in business administration and health administration education, such as Lewin's (1947) three-step model, Kotter's (1996) eight-step approach to change, or the ADKAR model for change (Hiatt, 2006). However, scholars are increasingly questioning commonly held views within the change management literature and the models they have shaped, finding empirically that no single model is a universally supported or clearly preferred approach to change management (Phillips & Klein, 2023). For example, they challenge the belief that the vast majority of changes result in failure, instead suggesting that change can yield both successes and failures simultaneously while also calling for a deeper examination and clarification of what we mean when we talk about change success or failure (By, 2020; Hughes, 2022; Suddaby & Foster, 2017). Numerous works have pushed against the assumption that successful organizational change results primarily from the behaviors, characteristics, or strategies of an individual acting as a change agent in a position of authority, instead highlighting that change leadership can be provided from numerous sources, with intentional collaboration and effective configuration of coordinated change efforts mattering more than the specific sources of leadership functions (Cummings et al., 2016; Ford et al., 2021; Karasvirta & Teerikangas, 2022).

These and other developments in change management scholarship increasingly point to the value of approaches to change management that embrace complex adaptive systems thinking. The rational, standardized, and reductionist approaches to change management that were commonly employed throughout the 20th century are increasingly recognized as inadequate to address the emergent, complex, and wicked problems faced by today's health care delivery system. Transformational change is required and, as systems themselves, organizations must embrace systems thinking in order to realize effective transformation (Beer, 2021; Bryson et al., 2021; Waddock, 2020). A systems view challenges us to focus beyond a single variable or fragment of the system within change; instead, it recognizes the system's interconnected elements and purposes, making sense of it in ways that develop a new understanding of potential transformations, and promoting collective engagement among change agents to identify key leverage points producing sizable effects and long-term solutions (Gersick, 2020; Uhl-Bien, 2021; Waddock, 2020). However, the adoption of systems thinking in and of itself presents a significant challenge to organizations today, particularly among those subject to “short-term pressures for performance” and a general “reluctance to confront inconvenient and complicated truths that might expose deeper systemic barriers” (Beer, 2021, p. 16). In light of this, some may ask: Are today's healthcare organizations up for the challenge? To that question, we find the chapters collected for this volume provide reason for optimism.

In an environment characterized by ambiguity and uncertainty, effective change management can also be seen in the collaboration, coordination, and complementarity practiced among distributed sources of change leadership (Dempsey et al., 2022; Errida & Lotfi, 2021; Ford et al., 2021; Phillips & Klein, 2023). Scholars call for approaches to change management that emphasize the power of empathy, that recognize the importance of taken-for-granted social factors underlying processes of change, that promote the involvement of varied participants, and that foster an openness to engage deeply beyond surface-level changes, such as design thinking (Hvidsten et al., 2023) and leadership-as-practice (Raelin, 2022). Such approaches encourage levels of adaptation, improvisation, and creative problem solving that are commonly aligned with both systems thinking and design thinking (Shay, 2023), leading to more effective navigation of change in the midst of complexity (Hvidsten et al., 2023). Furthermore, the mindsets that connects systems thinking and human-centered approaches to problem solving such as design thinking – including collaboration, curiosity, mindfulness, resilience, recognition of interconnections, and an appreciation for diverse perspectives (Mugadza & Marcus, 2019; Shay, 2023; Shrier et al., 2020) – not only serve as drivers of effective change management, but they also emerge consistently in this volume's chapters as critical approaches to addressing health care's grand challenges.

Therefore, this year's volume examines how health care organizations position for, and pursue, successful sustained change. We organize the chapters into four complementary sections, each a mix of theoretical and empirical contributions to guide organizations in an environment of ever-evolving challenges.

Our first section focuses on persistent drivers of environmental uncertainty to which health care organizations must be responsive. Chapter 1, by Gifford and colleagues, offers a theory-building reflection on the changing ways in which health care organizations must understand and build capacity to thrive in a state of persistent, deep uncertainty. Using a framework that contrasts approaches to buffer against environmental change with efforts to actually incite and be on the leading edge of evolving expectations, authors propose the need for organizations to remain adaptive and – where possible – create potential futures rather than engaging in avoidant, controlling approaches to change. This chapter concludes with advice to organizations on how to move toward an “Adapt and Create” approach using systems thinking and the notion of temporal work – that is, encouraging individuals and teams to break the inertia of path dependency by challenging the linkages between “what was/is done” with what could or should be done.

The subsequent two chapters offer additional tools to organizations seeking to build resilience in the face of persistent environmental uncertainty. Chapter 2, by Reynolds, Price, and Canfield, focuses on the challenge of health care organizations needing to provide timely and accessible services in rural communities. Authors detail a simulation-based approach to model the feasibility and impact of proposed organizational changes as one way to assess readiness and guide subsequent change management efforts. They illustrate via case study how this approach was used to help guide design and implementation considerations for a mobile radiation oncology unit in a rural community. In Chapter 3, authors Hogan et al. detail a theory-driven empirical analysis focused on culture change in nursing homes – that is, highly regulated health care environments plagued by chronic under-resourcing. With the uncertainties caused by such persistent financial constraint, authors seek to identify the types of change management activity that are feasible in this environment and associated with these organizations moving toward a culture of more person-centered care. They find that knowledge management (i.e., the seeking and use of information relevant to guiding organizational functioning) is associated with culture change, and that this relationship is moderated by leadership and measures of staffing ability. These findings offer insights to health care leaders looking to build adaptive systems that support organizational readiness for change despite chronic resource limitations.

The second section of this volume focuses on the mechanisms of change – how leaders within organizations frame and execute change. Chapter 4, by Govers et al., offer a theoretical consideration of why organizational change often fails, using a framework that suggests that leaders too often attempt to change routines without first modifying the underlying principles and beliefs of organizational work. Using an analogy of organizational DNA to detail how principles, beliefs, and routines bind together an organization's core technical capabilities and social capital, they use an exemplar case to showcase specific aspects of leadership intentionality and action that foster deep successful change. However, successful change also depends on characteristics of the innovation itself, and of the individuals leading the effort. In Chapter 5, Novikov, Singer, and Milstein, use a national survey of clinicians to assess how these characteristics are associated with use of artificial intelligence and other forms of innovation diffusion. Authors investigate how individuals' job aspects associated with connectivity (i.e., professional purview, supervisory responsibility, tenure with an organization) increase knowledge and awareness of innovation such that they are more likely to use and spread care delivery innovations. A key part of this knowledge and awareness building is its association with higher perception of value of new innovations, which may build personal interest in engagement as well as these individuals' ability to facilitate diffusion within their network. Chapter 6, by Tietschert et al., explores the association between management practices and safety culture after implementation of the Safe Surgery Checklist. They use longitudinal survey data from the checklist implementation at 42 general acute care hospitals in a leading hospital network. Their findings suggest that the changes in safety culture encouraged by implementation of the Safe Surgery Checklist are significantly related to changes in management practices, highlighting structured checklist implementation as an avenue for hospital administrators to enhance safety culture in their organizations.

The third section of this volume investigates organizational preparedness and response in the face of acute crisis. In Chapter 7, Carroll et al. investigate the extent to which hospital finances were impacted in Washington state due to the Covid-19 pandemic. They find a significant hit to operating margins across all hospitals for 2020 and 2021, with hospitals that treat vulnerable patients being most affected (i.e., safety-net and critical access hospitals). Both revenues and expenses were adversely impacted by the pandemic. This analysis calls into question what organizations can be doing now to buffer against the financial vulnerability caused by such extended acute disruption. A detailed commentary by Dr Smith in Chapter 8 highlights the cyclical nature of organizational attention to preparedness over the past 20 years, and the threat of complacency that sets in between spikes of large-scale crises. This chapter describes post-event recommendations issued after each recent global epidemic, and finds a lack of depth or substance in the guidance given to organizations to support sustained preparedness alongside normal operations.

The fourth and final section of the volume highlights key ways in which sociopolitical and demographic shifts are encouraging organizations to reconsider what preparedness means outside of acute crisis. In Chapter 9, Hewitt interrogates limitations of outdated paradigms we hold about health systems and health care delivery. The author details an updated “co-production of health” framework that better reflects the boundary-spanning interorganizational and inter-sector ways that health and value are created for patients and communities. This chapter offers important suggestions for future research that refines and tests this model as a useful way to design and execute transformative organizational change. Chapter 10, by Yeager and colleagues, offers a thoughtful examination of one way in which a large health system embraced a community-partnered approach to care delivery. This study qualitatively explores efforts to enhance case conferencing for children with complex needs by using parent liaisons to facilitate connection with community resources and social support. Indeed, having these boundary-spanning agents helped organizations offer patients more holistic services that reduced stress for clinicians as well as family members. Authors offer insights into the necessary coordination structures and policy-based payment changes that would help sustain this model of care. Finally, in Chapter 11, Dr Minakshi Raj offers a commentary piece that draws attention to family caregivers as a critical but under-recognized partner in the co-production of health. She details the problems of a fragmented policy landscape and a lack of enabling factors (e.g., time, awareness, connectivity) that allow for meaningful engagement of caregivers. Using a coproduction of health paradigm, organizational leaders should be thinking strategically about how to proactively integrate caregivers as boundary-spanning and value-generating members of the care team.

Jennifer L. Hefner, PhD, MPH, Ohio State University

Dori A. Cross, PhD, University of Minnesota

Patrick D. Shay, PhD, MS, Trinity University