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Show more“Ambidexterity: Noun: 1. ambidextrous ease, skill, or facility; 2. unusual cleverness; 3.duplicity; deceitfulness.” Retrieved March 21, 2010, from Dictionary.com website: http://dictionary.reference.com/browse/ambidexterity Despite their research and educational prowess, Academic Medical Centers are in a crisis. Public reporting of quality and patient satisfaction data, increasing costs, stiffer competition, and anticipated tightening of budgets have created new levels of urgency among medical school deans and hospital CEOs to increase the effectiveness of the clinical enterprise on multiple fronts. This study models an AMC as a loosely coupled system and examines how interdisciplinary teams—comprising administrators, physicians, and nurses—work to harmonize seemingly disparate quality improvement goals. Structural equation modeling techniques were used to rigorously test the premise that contextual ambidexterity mediates the relationships between team characteristics, the team’s organizational context and goal harmony. Several cross-product terms were modeled to isolate interaction effects. This research contributes to the field in three ways. First, it offers a novel conceptualization of contextual ambidexterity as a two-stage alignment-to-adaptability process and draws linkages to the theory of the Toyota Production System. Second, it offers preliminary guidance on key characteristics of teams that sponsors should seek, and on the nature of the context they should create. Finally, the study suggests that sponsors should be wary of charismatic leaders who achieve goal harmony through equifinal meaning construction which often does not survive post-implementation sensemaking.
Doctorate of Management Programs
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Show moreClinical quality and patient safety are important features of contemporary medical care. Health care organizations and professionals are being urged to make significant improvements in care delivery and care outcomes; including a reduction in the risk of inadvertent patient injury associated with the care process. This study describes an opportunity to observe how a health care system and its professional staff reviewed and revised current clinical quality and patient safety programs. The intent was to better understand the attributes and mental models organizational members brought to this task and to appreciate the influence organizational structure and culture had on the effort. Using observational ethnographic methods and semi-structured interviews native views concerning these subjects and the organization’s efforts to strengthen them were obtained. Structural complexity and ambiguous accountability were prominent emergent themes. Both impeded organizational improvement efforts directed at the topics of interest. The basis for the structural complexity was explored by comparing the subject organization with previously described models of organizational structure. The two organizational elements examined ( a tertiary referral and teaching hospital and an employed multi-specialty medical group ) demonstrated many professional bureaucratic features complemented by machine bureaucratic elements. Structural complexity contributed to the ambiguous accountability observed. A lack of clarity regarding the roles and responsibilities of the clinical departments where care is provided and the quality support departments also contributed to this uncertainty. Another factor, the professional culture associated with the physicians working in the organization, influenced issues of accountability and responsibility. As a group physicians have been ambivalent regarding the adoption of continuous quality improvement methods applied to the clinical care process. While there are several potential explanations for this behavior it is suggested that medical education, with its emphasis on independent decision-making and professional autonomy, may be a contributing factor.
Doctorate of Management Programs
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