Organisational health in healthcare organisations: an extended exploration of application across a range of settings
File(s)
Author(s)
Williams, Stephen
Type
Thesis
Abstract
For us to comprehend fully the drivers of high performance in healthcare, we must shift our focus, from existing down-stream markers of quality, up-stream to the elements within an organisation that allow high performance to be both established and maintained in the long term. These elements are best conceptualised under the heading of organisational health, a term coined in the management literature in the 1950s, where organisations with a strong complement of these elements are perceived as ‘healthy’ organisations. In this thesis, organisational health is considered across a range of different healthcare settings.
The thesis itself is divided into three sections. In the first of these, an existing measure of organisational health, the Healthcare-OH questionnaire, was utilised in a nationwide survey of acute NHS trusts. Analysis of results, in concert with other existing contemporaneous datasets, allowed for extended testing of both the validity and reliability of this measure. Confirmatory factor analysis revealed an eight factor model, with each domain of organisational health denoted as a separate factor, demonstrated good fit. The sum scores of each domain were subjected to external validity testing and were seen to correlate with a variety of different performance metrics including existing measures of both staff satisfaction and trust finance.
The second section considered organisational health in previously unconsidered healthcare contexts. This involved the use of the Healthcare-OH questionnaire in the setting of independent healthcare organisations, with the resulting data subjected to measurement invariance analysis prior to comparison with data from the nationwide survey in the first section. Two further studies presented in this section considered organisational health in the context of primary care, beginning with a qualitative study to re-define the construct within this setting. Organisational health in primary care was thus considered as a theoretical framework, consisting of the elements of Strategy, Leadership, Resources, Staff wellbeing, Ways of working and Capacity for change. The output of this work was then used as the basis for the generation of a context specific measure, the GP-OH survey, which was tested across staff from 191 GP practices to permit an examination of validity and reliability.
The third and final section considered organisational health as a dynamic entity and aimed to identify events and interventions which might confer improvements in organisational health. It consists of a cross-sectional repeated-measure study considering organisational health across a twelve-month period within a single acute NHS trust. Differences in organisational health over time were examined and compared to events occurring both within and around the trust during the same time period. This study noted a fluctuation in the trust’s Resilience during the year and considered the reasons behind this with note to the complex web of internal and external drivers exerting influence ranging from organisational restructuring through to ‘never’ events and junior doctor strikes.
There follows a concluding chapter reflecting on the successes and failures of the thesis. This body of work has attempted to address limitations found within the current literature on organisational health in healthcare organisations, providing a series of empirical studies including work in a variety of unconsidered healthcare contexts. However, it has raised theoretical questions as to the relative importance of the consistent elements of organisational health. Further work, with both qualitative studies, to re-examine the theoretical framework of organisational health for hierarchy and confounders, and quantitative studies, to extend organisational health measurement into the mental health sector and to healthcare organisations outside of the UK, is proposed.
The thesis itself is divided into three sections. In the first of these, an existing measure of organisational health, the Healthcare-OH questionnaire, was utilised in a nationwide survey of acute NHS trusts. Analysis of results, in concert with other existing contemporaneous datasets, allowed for extended testing of both the validity and reliability of this measure. Confirmatory factor analysis revealed an eight factor model, with each domain of organisational health denoted as a separate factor, demonstrated good fit. The sum scores of each domain were subjected to external validity testing and were seen to correlate with a variety of different performance metrics including existing measures of both staff satisfaction and trust finance.
The second section considered organisational health in previously unconsidered healthcare contexts. This involved the use of the Healthcare-OH questionnaire in the setting of independent healthcare organisations, with the resulting data subjected to measurement invariance analysis prior to comparison with data from the nationwide survey in the first section. Two further studies presented in this section considered organisational health in the context of primary care, beginning with a qualitative study to re-define the construct within this setting. Organisational health in primary care was thus considered as a theoretical framework, consisting of the elements of Strategy, Leadership, Resources, Staff wellbeing, Ways of working and Capacity for change. The output of this work was then used as the basis for the generation of a context specific measure, the GP-OH survey, which was tested across staff from 191 GP practices to permit an examination of validity and reliability.
The third and final section considered organisational health as a dynamic entity and aimed to identify events and interventions which might confer improvements in organisational health. It consists of a cross-sectional repeated-measure study considering organisational health across a twelve-month period within a single acute NHS trust. Differences in organisational health over time were examined and compared to events occurring both within and around the trust during the same time period. This study noted a fluctuation in the trust’s Resilience during the year and considered the reasons behind this with note to the complex web of internal and external drivers exerting influence ranging from organisational restructuring through to ‘never’ events and junior doctor strikes.
There follows a concluding chapter reflecting on the successes and failures of the thesis. This body of work has attempted to address limitations found within the current literature on organisational health in healthcare organisations, providing a series of empirical studies including work in a variety of unconsidered healthcare contexts. However, it has raised theoretical questions as to the relative importance of the consistent elements of organisational health. Further work, with both qualitative studies, to re-examine the theoretical framework of organisational health for hierarchy and confounders, and quantitative studies, to extend organisational health measurement into the mental health sector and to healthcare organisations outside of the UK, is proposed.
Version
Open Access
Date Issued
2019-10
Date Awarded
2020-07
Copyright Statement
Creative Commons Attribution NonCommercial NoDerivatives Licence
Advisor
Darzi, Ara
Purkayastha, Sanjay
Chaturvedi, Sankalp
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)