Section 3.5.7: Organizational Theory
Ewan Ferlie, AcSS
King's College London
Organizational Interventions
- Overview of the Chapter Structure
- Key learning points
- Supporting frameworks and theories
- Summary of evidence
- Areas for future research
Overview of Chapter Structure
- Introduction and background
- What organizational KT interventions should we consider:
- quality programs
- organizational change programs
- implementation of evidence based practice guidelines
- organizational knowledge creation and synthesis
- Future research;
- Implications for reflective practitioners
Key Learning Points
- Slow but cumulative growth of organisational research in this area;
- Social science as well as biomedical research base;
- Key findings suggest 'emergence', local processes and limits to top down control;
- Interface with management practice is problematic;
- More attention needed on how to get such research into practice;
Background
- Growth of the importance of the meso (organisational) level of analysis alongside the micro (near clinical) and macro (system wide);
- Repeated attempts to introduce change programmes in health care organisations over the last 20 years;
- Importing new organisational and managerial ideas;
Theoretical Frameworks
- (i) Literature on Quality Programmes such as evaluations of Total Quality Management; Business Process Engineering and service improvement strategies in health care organisations;
- (ii) Organisational Change programmes/management of change in health care organisations;
- Generic organisational studies literature
- (iii) implementation of evidence based practice guidelines; draws more on the perspective of clinical as well as organisational research;
- (iv) organisational knowledge creation and synthesis; still developing a literature base; draws on generic organisational studies literature on knowledge management and mobilisation;
Empirical Evidence
- A range of different forms of evidence and comment;
- Large number of evaluative studies of change programmes in health care organisations;
- E.g. R. Joss and Kogan. M (1995) 'Advancing Quality: TQM in the NHS', Buckingham: Open University Press;
- Overviews: J. Ovretveit (2005) 'Public service quality improvement', in (eds) Ferlie, E., Lynn. L. and Pollitt, C. 'Oxford Handbook of Public Management', Oxford: Oxford University Press;
- Iles, V. and Sutherland, K. (2001) 'Organisational Change - A Review' London: NIHR SDO Programme;
- Primer: Berwick, D. (1996) 'A Primer on leading the Improvement of Systems', British Medical Journal, 312, pp 619-22;
- Note the emergence of service improvement as a new research and practice related field;
- Comparative Analyses: Ferlie, E. and Shortell, S. (2001) 'Improving The Quality of Health Care in the US and UK: A Framework for Change', Milbank Quarterly, 79(2): 281-315;
- Need more well designed comparative analyses.
Future Research Needs
- Need more work on Knowledge Translation and Knowledge Management processes;
- Link to existing academic work on generic organizational change programmes;
- How do health care managers use health care management research?
- More international and comparative studies are needed.
Implications for Reflective Practitioners
- Need to identify, read and discuss the relevant implementation literature;
- Not easy in a field where reviews are scarce;
- Concepts important as well as the empirics;
- Need to consider the implications of the literature for local context.
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