Service Improvement and Context

Making Service Improvement Happen: The Importance of Social Context “by Aoife M. McDermott, Cardiff University, Wales, United Kingdom and Mary A. Keating, Trinity College Dublin, Dublin, Ireland, has just been published in the Journal of Applied Behavioral Science OnlineFirst.

Today, Professors McDermott and Keating discuss their article:

Who is the target audience for this article?

We hope to have a wide audience. The paper may be of interest to academics, while the implications may be of interest to policy-makers and practitioners.

What Inspired You To Be Interested In This Topic?

The Irish hospital sector is complex, comprised of public, private and non-profit organisations. It has recently come through major structural reform, which led to significant policy debate the benefits and downsides of each of these sectors. This sparked our interested in the impact of these different sectoral contexts on change processes and outcomes.

Were There Findings That Were Surprising To You?

The paper is built around a surprising finding – that the organisations with the seemingly most positive environments for change don’t always achieve positive outcomes. We explained this by looking at the role of social context.

How Do You See This Study Influencing Future Research And/Or Practice?

For researchers, we hope this paper illustrates the value of research that explicitly takes account of context – and that looks at the relative influence of different contextual dimensions. We also hope that it will help promote the value of qualitative methodologies in disentangling the individual and configurational influence of dimensions of context.

For managers, the paper draws attention to fact that people can achieve positive service-improvement outcomes, in spite of difficult organizational contexts. To achieve this, the paper identifies the importance of management support and reporting relationships, and draws attention to the benefits of autonomy and flexibility in job design.

For policy-makers, the study suggests a need for further reflection on, and evaluation of, structural reform to achieve change. Our findings suggest that policy makers should, in the first instance, consider how they might positively influence the social context of organizations. Indeed, given the agitating nature of structural change it may serve to further undermine the social context.

How Does This Study Fit Into Your Body Of Work/Line Of Research?

This paper is based on my PhD thesis and, as such, I hope it is the first of a line of significant and high-impact studies! We are fundamentally interested in people-management to achieve service-delivery and change, and enjoy the complexity of the health service context. Building on findings from this study, we, together with Louise Fitzgerald, are now studying the role of the HR function and clinical directorate structures in supporting service-improvement in hospitals.

How Did Your Paper Change During The Review Process?

We received very constructive feedback from the reviewers and editors. This encouraged us to make our contribution more explicit and to significantly develop the implications for research and practice. At the suggestion of one of the reviewers, we also added in a figure which serves to pull the paper together conceptually. We wish we’d initially thought to do this ourselves, but it highlighted the fact that a picture can speak a thousand words.

What, If Anything, Would You Do Differently If You Could Go Back And Do This Study Again?

Given more time and resources, it would have been interesting to also examine strategic changes, to see if the findings also hold up across second order change.

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