This study explores how formal and informal social networks and decision making about resources in the hospital setting are related. Over the last few years, tensions between new public management of hospitals and increased demands has led to an increase in bottlenecks, stagnation of patient flow, and overcrowded emergency departments. These problems have led to an increase in access block for patients attempting to access the public hospital system. The introduction of Patient Flow Units has instigated the formalisation of a nurse manager function to coordinate patient flow. Nurses in such a pivotal position and who greatly influence hospital operations, tend to have special characteristics and use these to “get things done”. This thesis investigates interpersonal associations between professional (e.g. doctors and nurses) and functional groups (e.g. clinicians and managers), when making clinical and operational decisions when transferring a patient from the emergency department to a ward bed. By employing a mixed methodology, this thesis first sought to establish a snapshot of organisational culture in three hospitals. Drawing on Degeling et al. (1998) and Fitzgerald (2002), an organisational cultural survey was distributed to a total of 1750 participants. The response rate was 11.65% This survey particularly addressed five cultural constructs including a sense of organisational commitment, perceptions of managerial role characteristics, perceptions of currently pursued organisational goals, perceptions of orientation to work values when choosing a job, and interactions with various professional constituencies. In addition, 18 interviews were conducted and a total of 150 hours of observation of work processes, interactions between staff and environmental conditions were studied. This investigation largely confirmed earlier studies by Degeling (2002) and Fitzgerald (2002) that professional groups believed that their organisation primarily exhibited an Elite style of management, that financial viability is the most important goal their organisation is pursuing, and staff welfare was a low priority. In addition, it found significant differences in cultural footprints between the small hospital, which had a more integrated culture, and the large hospital, which was more fragmented in nature. However, the major contribution of this investigation is demonstrated in the qualitative chapter. This thesis found that the role of “who matters the most” in relation to decision making about patient flow, changes depending on the stage of the decision making process. It also found that non-managerial nursing staff with no formal power or legitimacy could affect urgency. The thesis comprises eight chapters. Following the introductory chapter, Chapter 2 considers the literature associated with the public health system in Australia with a focus on public hospitals in NSW. Chapter 3 critically examines the literature describing organisational culture, with an emphasis on subcultures. Chapter 4 contains a review of professional identity and roles, networks and alliances, social capital, deep smarts, and stakeholder theory. Description and justification of the research method selected to explore the thesis proposition follows in Chapter 5. Chapter 6 contains an outline of the findings concerning the analysis of the survey questionnaire to determine a cultural footprint of the three hospitals studied. Chapter 7 considers the different roles of professional groups (doctors, nurses, and others) and functional groups (clinicians and managers) in the operational phase of patient flow and in doing so contributes to knowledge. Finally, in Chapter 8, a discussion summarises the thesis findings, describes the implications, acknowledges limitations of the study and identifies avenues for future research. / Doctor of Philosophy (PhD)
| Identifer | oai:union.ndltd.org:ADTP/273604 |
| Date | January 2009 |
| Creators | Eljiz, Kathy, University of Western Sydney, College of Business, Centre for Industry and Innovation Studies |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
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