A systems science perspective on the capacity for change in public hospitals

J. Braithwaite*, J. Westbrook, E. Coiera, W. B. Runciman, R. Day, K. Hillman, J. Herkes

*Corresponding author for this work

Research output: Contribution to journalComment/opinion

7 Citations (Scopus)
4 Downloads (Pure)

Abstract

Many types of organisation are difficult to change, mainly due to structural, cultural and contextual barriers. Change in public hospitals is arguably even more problematic than in other types of hospitals, due to features such as structural dysfunctionalities and bureaucracy stemming from being publicly-run institutions. The main goals of this commentary are to bring into focus and highlight the "3 + 3 Decision Framework" proposed by Edwards and Saltman. This aims to help guide policymakers and managers implementing productive change in public hospitals. However, while change from the top is popular, there are powerful front-line clinicians, especially doctors, who can act to counterbalance top-down efforts. Front-line clinicians have cultural characteristics and power that allows them to influence or reject managerial decisions. Clinicians in various lower-level roles can also influence other clinicians to resist or ignore management requirements. The context is further complicated by multi-stakeholder agendas, differing goals, and accumulated inertia. The special status of clinicians, along with other system features of public hospitals, should be factored into efforts to realise major system improvements and progressive change.

Original languageEnglish
Article number16
Pages (from-to)1-4
Number of pages4
JournalIsrael Journal of Health Policy Research
Volume6
Issue number1
DOIs
Publication statusPublished - 24 Mar 2017

Bibliographical note

Copyright the Author(s) 2017. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • Complexity science
  • Health systems
  • Organisational change
  • Public health
  • Systems science

Fingerprint Dive into the research topics of 'A systems science perspective on the capacity for change in public hospitals'. Together they form a unique fingerprint.

  • Cite this