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Why do some hospitals perform better than others? A realist evaluation of the role of health workforce management in well-performing health care organisations

Tuesday, 20 September, 2011 - 15:00
Campus: Brussels Health Campus
Faculty: Medicine and Pharmacy
auditorium P. Brouwer
Bruno Marchal
phd defence

Despite the general acknowledgement of the role
of health workforce management in good
performance of health services and programmes,
little research has been carried out on this issue
in low- and middle-income countries. Aiming to
contribute to this body of research, a
comparative case study based on realist
evaluation was carried out in 4 hospitals in
Ghana. It intertwined a substantive with a
methodological thread. The initial case studies
found proof of concept of the high commitment
management approach. Subsequent cases
identified configurations of management practices
and conditions that explain high performance.
The well-performing hospitals were found to be
run by strong teams that shared and
communicated a strong vision with the mid-level
managers and the operational staff. Effectively
supporting the latter led to a positive
organisational climate by triggering reciprocating
behaviour on the basis of social and economic
exchange. This in turn increased organisational
commitment, a known intermediate step towards
organisational performance. Methodologically,
there is little published guidance on how to carry
out realist evaluations in the health sector. This
dissertation presents the methodological
challenges and shows how we dealt with them,
framed against the published guidance. In the
realist inquiry tradition, this study is a first step
to ‘organise’ existing knowledge and new
empirical findings. It may inspire other
researchers to continue this line of research and
health service managers to look at their
organisation and their management practices
through other glasses.