My second paper: "Why are healthcare services fuzzy?"

My second paper just got published in AMJ, an open access journal. Below the abstract and the link to the journal. Very excited to see this finally happen.

Why are healthcare services fuzzy?

Abstract

Background
Healthcare organisations are an enigma to many people in- and outside the service. Organisational fuzziness is a common state, characterised by a lack of clarity, lack of awareness, lack of organisational knowledge, and the reliance on practice and custom instead of transparency.
Aims
The objective of this study was to obtain a better understanding of what causes this fuzziness and provide an actionable description of fuzzy organisations. Such a description is essential to managing and preventing organisational fuzziness.
Method 
We used a longitudinal case study in an integrated health- and social care organisation to obtain a thorough understanding of how the organisation functions. These in-depth insights allowed the identification of three generators of fuzziness.
Results
We found that the three main generators of organisational fuzziness are change, informal organisation and complexity. Organisational fuzziness is thus partly due to the inherent complexities of human systems. However, also continuous change and the inability of the system to adapt its formal structures resulted in structures deteriorating or no longer being appropriate.
Conclusion
Existing approaches to explain unclear or absent structures in healthcare organisations by describing these organisations as complex adaptive systems (CAS) are too simplistic. While aspects relating to people and their interactions are indeed complex, fuzziness of structural aspects are often the result of continuous change and insufficient organisational capacity to adapt to it.

http://www.amj.net.au/index.php?journal=AMJ&page=article&op=view&path[]=1857

Applicability of Engineering Design Processes in the Design of Integrated Intellectual Disabilities Services in England

I have been quiet for an aweful long time - and a lot has happened since. Most importantly: my thesis is all done, approved and on the shelves of the Cambridge libary, so I am now a doctor (yeah). I since moved back to Germany and for the last 14 month I have been working as a consultant in Munich, with a focus on health care projects.

In case you are interested, I pasted the abstract of my thesis below. If you want to read the full thing, drop me a message (ideally with a bit of beackground on what you do and why you are interested in my work) and I can send you the pdf.

Applicability of Engineering Design Processes in the Design of Integrated Intellectual Disabilities Services in England

This dissertation investigates the applicability of engineering design processes for the design of integrated intellectual disabilities (ID) services in England. It aspires to contribute to the development of an engineering-design-style (ED) design process for a particular integrated health and social care organisation. Healthcare services in the developed world are faced with challenges arising from a growing burden of chronic disease and aging populations. In order to address these challenges, a more holistic understanding of health that also considers social factors is needed. A local integrated care service for people with intellectual disabilities constitutes an interesting case study as these intellectual disabilities services have several decades of experience in integrating health- and social care.

This study contributes to knowledge by elicitating the need to combine the engineering tradition of design as problem-solving with the tradition of design as enquiry. The applicability of engineering design processes in an indisputably complex domain, such as integrated ID services, also helps clarify of the concept of complexity within engineering design. Methodological contributions are made by developing and applying a research framework for exploratory design research and by demonstrating the utility of engineering design tools outside engineering. Furthermore, this study also provides important insights for the healthcare management literature by suggesting an approach to distinguishing complicateness from complexity, demonstrating the value of contributions of currently marginalised stakeholders and showing the applicability of a mathematical technique for pre-structuring service user involvement.

The research is guided by a framework developed specifically for exploratory design research into the care service domain. An initial exploratory study investigates design-related issues faced by the local service and to which degree engineering design is applicable. The predominantly qualitative data is analysed in diagrammatic form. It emerges that the formal, structural aspects of the organisation are complicated and suited to an engineering design approach. However, complex informal aspects, such as customs or personal relationships, surround the formal structure and are beyond the current scope of ED design processes but can be addressed by approaches in the design as enquiry tradition. Four issues are identified which will require amendments to the ED design process: organisational settings, knowledge management, the lack of a clear role, and neglected stakeholders.

The exploratory study is followed up by a detailed study which uses a Delphi approach to investigate whether the confusion about the role of specialist services is a general problem in the ID field. It further characterises key stakeholder groups in ID services in terms of their expertise and level of agreement or disagreement. The findings outline requirements for new design approaches that bridge the traditions of design as enquiry and design as problem-solving.

Submitted

I am done - last Friday I handed in my PhD thesis. As you can see from the wordle, it focused on design, services, processes and knowledge :)

I will stay in Cambridge for a bit longer to write publications (to tell the world what I found out about design, services, processes and knowledge) and hopefully implement some of my findings in the Cambridge and Peterborough Foundation Trust.

Thesis Writing

You might have seen my new posts - and perhaps wondered about my long silence. I started this blog to spread some of the ideas developed during my PhD (and hopefully obtain some feedback) until I get the chance to write them up as "proper" journal papers. The reason why I have been silent for so long was that I actually worked on writing up my PhD thesis. And indeed I now have a first draft (hurrah) and am right now waiting for the verdict from my supervisors .... To pass the time I went to the very interesting "Making health care safer" conference in Scotland. I already started to post about it - and will try to write more over the next couple of days :)

Also now all my thoughts about my PhD work are nicely ordered, I will have some more stuff to blog about in the coming weeks and I also have become really interested in the past year in the relationship between healthcare services and developmental work - so watch this space :)