The aim of this paper is to assess how these reforms have changed the INHS, to what extent they concurred to improve the system, where they failed and which issues are still in agenda. To do so we run through the recent history of the INHS and propose an interpretative framework to understand the grounds for its light and shade results.
The basis for the analysis is triple. The study draws from researches, literature review, action-researches and field investigations conducted over the last 10 years in the INHS.
]]>Substance abuse treatment programmes depend on boundary spanning to identify opportunities and threats, and represent their interests to stakeholders such as licensing entities and regulators. This study sought to identify director, client, unit and market factors associated with active director boundary spanning.
Using data from the 1995, 1999–2000 and 2005 waves of a national survey of outpatient substance abuse treatment units, generalized estimating equation regression models tested associations between predictors and five aspects of directors' self-reported boundary spanning.
Directors licensed as substance abuse treatment counsellors spent more time than average consulting with other treatment providers and making presentations in the community. Older directors spent less time consulting with other treatment providers, making community presentations and liaisoning with monitoring organizations. The few associations between client unemployment and director boundary spanning were positive; the two associations between the percentage of clients who were African-American and boundary spanning were negative. Private ownership and being based in larger organizations were negatively associated with some types of boundary spanning. Perceived competition for public support was positively associated with all measures of boundary spanning.
Directors of treatment organizations may improve treatment practices and political leverage by directly, but selectively, interacting with key external stakeholders.
In a rapidly changing health-care environment, clinicians are increasingly called upon to assume complex leadership responsibilities. The research was undertaken to develop an understanding of the limits to the conceptual and methodological basis of leadership competency modelling in health services context.
Data were collected from all of the clinicians in a Psychiatric Hospital, Bahrain using a researcher-developed questionnaire. Data were gathered to critically assess the validity of the competency-based approach to leadership on the basis of subjects' capacity to discriminate in terms of importance and accomplishment between the items featured in a research tool containing a comprehensive list of 124 leadership competencies.
The results of the analyses indicate a weak identification with the competencies in the sense of revealing low levels of discriminatory sophistication on the part of subjects.
The study design was limited to participants working in single hospital; therefore, the conclusions made cannot yet be regarded categorically as generalizable. Leadership selection, development and education activities may not achieve their ultimate outcomes due to the subject identification problem associated with the competence approach. It might be necessary to reconsider the efficiency of human resource activities that rely solely on the competency approach. The conceptual basis of leadership competence in health services has been previously neglected. This research casts doubt on competency approaches to leadership if based on subject identification with pre-defined items.
This study aimed to build on the increasing evidence of a link between good people management practice, and organizational and patient outcomes in public health care to document the important human resource management practices in our hospitals.
The design included large scale survey of hospital managers' perceptions of the use of human resource management practices. The questionnaire included Human resource management (HRM) measures and additional questions related to the Australian hospital accreditation standards. Data were collected in December 2003 until April 2004 from a total sample of 92 hospitals/hospital organizations from the State of Victoria, Australia. The participants were Chief Executive Officers, Human Resource Directors and two other senior managers of the hospital organizations were invited to complete the questionnaire. There were no interventions. The main outcome measure, one-way analysis of variance was used to determine differences in the perceptions of the three groups of managers' concerning the use of HRM practices. Frequency and descriptive statistics were used to determine use of HRM practices.
A 67% response rate enabled us to document human resource management practices in Victorian hospitals. The respondents reported limited strategic and organizational HRM.
This study found limited evidence of sophisticated HRM practices among hospitals and hospital organizations in the State of Victoria, Australia. Despite the increasing evidence of a relationship among effective HRM and health-care outcomes, these hospitals reported limited performance management, training and development, and employee empowerment and decision-making. The authors suggest that it is unlikely that attempts to improve patient safety in this sector will be successful until the deficits in HRM are addressed.