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Developing Sustainable Diabetes Care Networks
Project delivered in partnership with Diabetes UK 
Supervisor: Dr Colin Pilbeam
Networks of individuals and organizations are used increasingly to provide health and social care in the UK. They provide opportunities to focus resources on particularly significant and major health conditions, for example diabetes, cancer and stroke patients, combining relevant skills to deliver care more effectively.
However, networks vary considerably in their structural form and mode of governance and it remains unclear how contextual variation influences these two key characteristics of networks. Moreover, while we know that inter-personal trust, role complementarity, shared values and leadership all significantly contribute to the initiation and establishment of a network, we know little about how these influences change as the network develops or indeed whether they stimulate network change. Uncertainty also lies in the real benefit derived from networks; individual organizational not collective performance is measured. Greater effectiveness is assumed.
A number of research questions naturally arise from this:
1. How do differences in environmental context affect the choice of governance and the structural form of a network?
2. How do any of the internal factors (trust, leadership or shared values) affect the development and evolution of a network?
3. How is network performance measured? And how does performance change with time?
4. How do networks impact the local healthcare system?
In partnership with Diabetes UK, Cranfield School of Management is seeking a PhD student on either a full-time or part-time basis to investigate any of these potential research questions. The successful candidate will draw on existing research literature on networks generally and on health-care networks specifically to establish an appropriate conceptual framework before accessing with the support of Diabetes UK appropriate diabetes care networks to gather empirical data. The project has both academic and practical impact. In addition to a doctoral thesis and a number of academic publications, the project will help Diabetes UK develop appropriate tools and guides for developing sustainable networks to deliver care to a greater number of patients.
Please contact Dr Colin Pilbeam in the first instance.
Admission requirements:
- a strong first degree (UK level 2.1 minimum)
- please see Admission Requirements for English language requirements.
Deadlines:
- applications for scholarships – mid-April
- self-funded applications – 15 July.
See website for full details
DOWNLOAD PDF POSTER:
My DBA Experience: Ian Hedges
Researcher Ian Hedges shares his experience of the Cranfield International Executive Doctorate (DBA). Ian’s research topic is around what factors influence relationships when organisations collaborate on projects and is supervised by Dr Emma Parry with Dr Jonathan Lupson and Dr Colin Pilbeam.
Safety Leadership
Davidson R, Denyer D, Pilbeam C (2014) Safety Leadership.
More posters on risk management
Denyer D (2014) Leadership and decision making in safety-critical environments.
Goffin K, Hopkin P, Szwejczewski M, Kutsch E (2014) Roads to resilience: Building dynamic approaches to risk to achieve future success.
Ferrer J, Julien D (2014) Development of a risk assessment tool for the proactive management of Supply Chain risk.
Grayson D (2014) Board oversight of social, environmental and economic impacts.
Illin T, Varga L (2014) An actionable definition of systemic risk in financial services validated using data from the Icelandic financial system failure.
Kutsch E, Hällgren M, Denyer D (2014) K2 – Against All Odds: A journey into oblivion.
Marynissen H, Pieters S, Van Achte T (2014) Crisis Communication Work Process developed for Belgian Federal Government.
Montañés J, Julien D, Tjahjono B (2014) Interactive tool to assess SC1 risk for a food network which includes the 3BL2.
Tobias J, Pavlov A (2014) Which Swan is Yours? Fostering Individuals’ Resilience and Performance Through Mindfulness.
Wilding R (2014), The evolution of transformational research in Supply Chain Risk & Resilience.
Communicating the risks to encourage safe behaviour
Hugo Marynissen
Cranfield DBA
A synopsis of his International Executive Doctorate (DBA) research, by Hugo Marynissen at Cranfield School of Management.
A constitutive view on risk communication in organisations managing high-risk processes: Towards a conceptual framework.
This study presents a conceptual framework for a constitutive view of risk communication in organisations managing high-risk processes. Over the last few decades, multiple incidents in these types of organisations indicate that the mere communication of risk information and safety procedures does not necessarily lead to risk averse attitudes. Therefore, it might suggest that the traditional transfer of information is not fulfilling its aim, namely to keep the organisation safe. This doctoral thesis proposes a form of constitutive communication that involves all organisational members in an open safety dialogue as an alternative to this informational approach of communication. As such, it offers a way of taking into account the interpretive, subjective aspects of communication and shows how they interweave with formal communication structures to create the possibility of ongoing safe operations.
An on-shore gas-receiving terminal on the European continent was the subject for two empirical research studies. Based on multiple methods, including qualitative interviews, ethnographic data analysis, repertory grid-based interviews, and social network analysis, this study indicates how a constitutive dialogue that creates a common mindset concerning safe operations among all staff can be installed and supported. Furthermore, it demonstrates how despite the fact that every individual in this organisation has different perceptions of the present risks, constitutive risk communication leads to coordinated safe behaviour. These findings offer new perspectives on the solution-oriented knowledge about the relationship between risk communication and risk savvy in organisations managing high-risk processes.
The theoretical background to this phenomenon was supported by a literature review in the field of risk communication and risk perception in organisations managing complex interactive and tightly coupled processes. These findings, together with those of the empirical research projects, were compared with insights in the theoretical fields of High-Reliability Organisations (HRO) and Communication Constitutes Organisations (CCO), and result in a conceptual framework for a constitutive view on risk communication in organisations managing high-risk processes.
This research offers a number of theoretical and practical contributions to the field of HROs, the field of CCO research. It not only confirms key insights into these theoretical fields, it is also the first study that links the use of CCO to organisations managing high-risk technologies.
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Supervisor: Prof. Donna Ladkin
Supervisory panel: Dr. Colin Pilbeam, Prof. David Denyer
Related Resources:
Safety Leadership in Service Organisations
Dr Colin Pilbeam outlines a research project which is currently looking at safety issues in service organisations. The project is sponsored by IOSH (Institution of Occupational Safety and Health).
DOWNLOAD A RELATED PROJECT POSTER HERE
Leadership on the Knowledge Interchange
Strategy Complexity and Change Management on the Knowledge Interchange
How do they manage? The realities of middle and front-line management in health care
Published: July 2013
Client or sponsors: National Institute for Health Research
Authors: Prof David Buchanan, Prof David Denyer, Dr Joe Jaina, Prof Clare Kelliher, Cíara Moore, Dr Emma Parry, Dr Colin Pilbeam
Summary:
This project addressed three questions. First, how are middle management roles in acute care settings changing, and what are the implications of these developments? Second, how are changes managed following serious incidents, when recommendations from investigations are not always acted on? Third, how are clinical and organisational outcomes influenced by management practice, and what properties should an ‘enabling environment’ possess to support those contributions?
Data were gathered from around 1200 managers in six trusts through interviews, focus groups, management briefings, a survey with 600 responses, and serious incident case studies. For this project, ‘middle management’ meant any role below board level that included managerial responsibilities. Evidence provided by trust workforce information offices revealed that the management function is widely distributed, with >30% of hospital staff holding either full-time management posts or ‘hybrid’ roles combining managerial with clinical or medical responsibilities. Hybrids outnumber full-time managers by four to one, but most have only limited management training, and some do not consider themselves to be managers. Management capabilities now at a premium include political skills, resilience, developing interprofessional collaboration, addressing ‘wicked problems’, performance management and financial skills.
Case study evidence reveals multiple barriers to the implementation of change following serious incidents. These barriers relate to the complex causes of most incidents, the difficulties in establishing and agreeing appropriate action plans and the subsequent problems of implementing ‘defensive’ change agendas. The conclusions from these case studies suggest that the management of serious incidents could potentially be strengthened by adding a change management perspective to the current organisational learning focus, by complementing root cause and timeline analysis methods with ‘mess mapping’ processes and by exploring opportunities to introduce systemic changes and high-reliability methods in addition to fixing the root causes of individual incidents.
Interview, focus group and survey evidence shows that middle managers are deeply committed but face increasing workloads with reduced resources, creating ‘extreme jobs’ with long hours, high intensity and fast pace. Such roles can be rewarding but carry implications for work–life balance and stress. Other pressures on middle management included rising patient and public expectations, financial challenges, burdensome regulation (external and internal), staffing problems, incompatible and dated information systems, resource and professional barriers to implementing change and problematic relationships with external agencies. Despite these pressures, management contributions included maintaining day-to-day performance, ‘firefighting’, ensuring a patient experience focus in decision-making, translating ideas into working initiatives, identifying and ‘selling’ new ideas, facilitating change, troubleshooting, leveraging targets to improve performance, process and pathway redesign, developing infrastructure (information technology, equipment, estate), developing others and managing external partnerships. Actions required to maintain an enabling environment to support those contributions would involve individual, divisional and organisational steps, most of which would be cost neutral.
Recommendations for future research concern the assessment of management capacity, the advantages and drawbacks of service-line organisation structures, the incidence and implications of extreme managerial jobs, evaluating alternative serious incident investigation methods, and the applicability of high-reliability organisation perspectives in acute care settings.
DOWNLOAD THE FULL REPORT HERE (www.nihr.ac.uk)
Related resources:
Associated project resources and briefings from Cranfield Healthcare Management Group (www.cranfield.ac.uk/som)
Middle managers: Front line of change (SoMResearchInsights.com)
Making the right changes after Mid Staffs | Resource centre | Health Service Journal (hsj.co.uk)
Mid Staffordshire Hospital: Making the Right Changes (SoMResearchInsights.com)
Sweat the small stuff… minor problems, rapid fixes, major gains (SoMResearchInsights.com)
Sweat the small stuff… minor problems, rapid fixes, major gains
By Cíara Moore, Operations Manager for Medicine,
Cambridge University Hospitals NHS Foundation Trust
Following interviews with Consultants, an initiative was set up to explore the potential benefits to patients, staff, and overall organizational performance, when minor problems are addressed in an acute healthcare setting. Small issues can be overlooked in a context where major change is at a premium.
This initiative, Sweat the small stuff, was implemented by a three-person team: the project lead – ‘an animateur’ who designed the initiative; a consultant – ‘champion’; and an administrative lead in the ‘who knows who knows what’ role. The aims of the five-day process were to: prove whether minor problems could be identified, explored, and resolved in such a short time; uncover why any issues had not been fixed previously; and to assess the impact that fixing the issues identified has on the staff concerned and patient care.
It is significant that the failure to have fixed these issues previously was not attributed directly either to lack of finance or staff. Only one fix involved some minor expenditure and all issues were fixed within the target five days. Teams where genuinely delighted with the process. The cluster of ‘soft’ benefits that emerged from this small-scale initiative also helped to cement the mutual inter-professional trust, respect, and collaboration on which those larger-scale challenges are likely to depend.
Next steps
One more session has been run since this initial study – again resulting in similar patterns of easy fixes, highlighting that if you Sweat the small stuff, it pays. An additional 27 people have been trained within the hospital and the medical Directorate have now commenced a series of Sweat the small stuff events in a phased manner for all 16 of their specialities.
This study was based on interviews and focus groups with middle and senior managers at six acute trusts and one primary care trust. The final stages of the project include a management survey, debriefing groups, and case studies exploring how changes are managed in the aftermath of serious incidents.
Participating trusts
Bedford Hospital NHS Trust
NHS Bedfordshire Primary Care Trust
Cambridge University Hospitals NHS Foundation Trust
Gloucestershire Hospitals NHS Foundation Trust
Northampton General Hospital NHS Trust
North Bristol NHS Trust
Whipps Cross University Hospital NHS Trust
Project team
Prof David A. Buchanan (PI)
Dr Charles Wainwright
Dr Catherine Bailey
Prof David Denyer
Prof Clare Kelliher
Ms Cíara Moore
Dr Emma Parry
Dr Colin Pilbeam
Dr Janet Price
Prof Kim Turnbull James
Acknowledgements: The associated research was funded by the National Institute for Health Research Service Delivery and Organization programme, award number SDO/08/1808/238, ‘How do they manage?: a study of the realities of middle and front line management work in healthcare’.
See associated project resources and briefings from Cranfield Healthcare Management Group
SoM Research Insights 