How do you define and structure the core of social and health management? You also have to justify your point of view

Introduction

Social and health management involves various practices and strategies to address the wellbeing of individuals and communities within healthcare and social service settings (Simha and Lemak 2010, p. 221). Developing a comprehensive understanding of this interdisciplinary field’s core components and structure is pivotal in formulating effective interventions and policies that serve the various stakeholders’ diverse needs. This essay will define and structure the core of social and health management by synthesizing insights from multiple perspectives.

Navigating Institutional Dynamics and Evolving Organizational Landscapes in Health Care

The highly institutionalized nature of healthcare systems perpetuates the status quo, as the mechanisms constituting these systems tend to resist externally imposed change (Ferlie et al. 2016, p. 34). Concurrently, the professionalized character of these systems grants professionals a considerable degree of power to maintain stability and control over their work domains. Understanding the power dynamics associated with these institutional and professional structures is instrumental in comprehending the dynamics of stability or change within healthcare organizations. While early literature on institutionalization focused on how organizations respond to normative and regulative forces, leading to isomorphic pressures and homogeneity, subsequent studies unveiled that organizations can accommodate institutional pressures even when dissociated from performance improvement (Ferlie et al. 2016, pp. 27–29). Simultaneously, the sociology of professions literature illuminates how professions exert control over their work, acquire monopolistic positions, and engage in jurisdictional claims over task domains, culminating in occupational closure and power dynamics across professional groups (Ferlie et al. 2016, p. 30). Recent research has integrated the concepts of institutionalization and professionalization by examining competing institutional logics, such as professionalism, managerialism, and market forces, demonstrating how change initiatives must navigate the power dynamics associated with professionalism (Ferlie et al. 2016, p. 33). Recognizing the interplay between institutionalization and professionalization, recent studies have also examined competing institutional logics, such as professionalism, managerialism, and market forces, demonstrating that change initiatives must navigate the power dynamics associated with professionalism (Ferlie et al. 2016, p. 34). This intricate landscape is further complicated by the emergence of new organizational forms and arrangements in response to the healthcare sector’s pressing challenges, including the need to control costs, improve quality, and incorporate new biomedical advances. New organizational structures are also being developed to address the twin challenges of differentiation and integration in healthcare delivery (Ferlie et al. 2016, p. 46). Contrary to the traditional belief that form follows function, the author suggests that in the face of significant environmental changes, alterations in organizational form often precede changes in functions (Chapter 2, p. 40-41). Various factors, including economic pressures, legislative reforms, and the need for greater accountability and integrated service delivery, drive the development of these new organizational forms. However, the governance structure and accountability mechanisms within these new organizational forms are crucial for supporting transformation and addressing the interdependent relationships involved.

Managerial Paradigms and Organizational Cultures in Health Care Transformation

As healthcare systems struggle with the complexities of institutional dynamics and the evolving organizational landscapes, management and organizational culture are critical considerations. Management has assumed an increasingly pivotal role in healthcare systems, transcending the mere translation of policy intent (Ferlie et al. 2016, p. 78). This shift has been accompanied by a transitioning from traditional bureaucratic management to proactive, private sector-style management under New Public Management (NPM) reforms (Ferlie et al. 2016, p. 80). However, the transposition of private sector management models and practices to healthcare settings necessitates contextual nuance and adaptation to account for the unique characteristics of the healthcare sector. Policymakers have imposed culture management and leadership interventions to drive integration and collaboration. However, their effectiveness has been limited due to the top-down imposition and failure to account for entrenched professional cultures (Ferlie et al. 2016, p. 76). Effective knowledge mobilization is paramount in addressing complex “wicked issues” through evidence-based practices like evidence-based medicine (EBM) (Ferlie et al. 2016, p. 77). Concomitantly, workforce development and the introduction of new or changed professional roles can impact existing professional jurisdictions, often encountering resistance from professional associations. To navigate these complexities, hybrid clinical managers who blend managerial and clinical roles can enable professional governance from a distance. Organizational culture, an integral aspect of understanding the nature of healthcare organizations and the forces that shape them, relates to the shared social aspects of organizations, including values, beliefs, and norms that guide behaviour (Ferlie et al. 2016, p. 93). Healthcare organizations are likely to have multiple sub-cultures based on professional groups, specialties, and departments, complicating the assessment and measurement of organizational culture despite the availability of various instruments and approaches. While there is a belief that organizational culture is linked to healthcare performance, this relationship is intricate, contingent, and potentially recursive. Cultural change in healthcare organizations can be classified as first-order (evolutionary) or second-order (radical) change, with models of cultural change often focusing on crises as triggers, leadership, success consolidation, and relearning/re-education (Furrer et al. 2008, p. 2; Ferlie et al. 2016, p. 104). Navigating these intricate managerial paradigms and organizational cultures is essential for driving transformation in health care systems.

Fostering Employee Wellbeing and Collaborative Leadership for Integrated Health and Social Care

Given the issues and the changes ongoing in the health and social care systems, fostering employee wellness and producing good leaders are necessary. Researchers advocate for increased employee wellness within Human Resource Management (HRM) theory and practice, whereby they define wellness as encompassing the psychological, physical, and social components (Guest 2017, p. 26; Bahreini et al. 2021, p. 534). Several factors that contribute to employee wellbeing were subsequently identified. These include job design, balance between job demands and resources, safe working environments, development opportunities, fair compensation, and employment security (Guest 2017, p. 27). HR practices are essential to promote employee wellbeing. Such practices include investing in employees, providing engaging work, creating a positive social and physical environment, allowing employee voice, and providing organizational support (Guest 2017, p. 31). Promoting employee wellbeing through various HR practices and fostering a positive employment relationship could form a core social and health management component. Effective leadership is crucial in interprofessional health and social care teams to support innovation and improvement that can complement the focus on employee wellbeing (Barker 1997, p. 358; Yawson 2016, pp. 262–263; Smith et al. 2018, p. 452). Key themes emerged from the evidence on interprofessional team leadership, including facilitating shared leadership, transformation and change, personal qualities, goal alignment, creativity and innovation, communication, team-building, leadership clarity, direction setting, external liaison, skill mix and diversity, and clinical and contextual expertise (Smith et al. 2018, pp. 458-462). Interprofessional team leadership requires a unique blend of knowledge and skills to support collaboration, shared decision-making, and integrated practices among professionals (Smith et al., 2018, p. 463). Interprofessional team leaders need to find ways to persuade team members from different professions to give up some professional autonomy and integrate their practices. Edmonstone (2020) argues the need to move beyond focusing on leadership development confined to healthcare and instead develop leadership within health and social care systems (p. 351). Systems leadership involves leading across organizational and geographical boundaries, addressing complex issues through inter-organizational networks and non-linear approaches.

Leveraging Strategic Management Theories and Multidisciplinary Research Approaches for Social and Health Management

As social and health management aims to navigate the complexities of institutional dynamics, organizational landscapes, managerial paradigms, organizational cultures, employee wellbeing, and collaborative leadership, it becomes imperative to draw upon strategic management theories and multidisciplinary research approaches (Sagsan 2019, pp. 628–631). Rosenberg Hansen and Ferlie (2016) discuss the applicability of strategic management theories like Porter’s strategic positioning model and the resource-based view (RBV) in public sector organizations, including those in the social and health sectors (p. 1). The usefulness of these strategic management theories depends on three key dimensions: the degree of administrative autonomy, the degree of performance-based budgeting, and the degree of market-like competition (p. 5). For traditional public organizations with low levels of these three dimensions, strategic positioning models like Porter’s may not be as applicable due to the lack of freedom to choose markets, customers, and strategies (p. 8). However, strategic positioning models may be more relevant for more autonomized and market-like service-delivery organizations influenced by New Public Management (NPM) reforms. Regarding the RBV, the focus on value creation and efficient use of resources can be applicable in traditional public organizations, but the emphasis on isolating resources for competitive advantage may not be compatible (p. 11-12). For NPM-influenced organizations with higher levels of the three dimensions, the RBV’s focus on developing dynamic capabilities to adapt to changing environments may be more relevant (p. 12). Examples are provided of English academic health sciences centres and a Danish university hospital where aspects of the RBV could be applied (p. 13-14). A robust evidence-informed approach is crucial to complement the insights from strategic management theories. Evidence discusses the need for an evidence-informed approach in management research, similar to the evidence-based approach used in medical sciences (Tranfield et al. 2003, p. 207; Thorpe and Beasley 2004, p. 335). Systematic reviews can help synthesize research evidence to inform policy and practice in healthcare and other disciplines like education, criminal justice, and social care (p. 209-210). Applying the principles of systematic review from medical sciences to management research can help counteract bias, enhance the knowledge base, and inform policymaking and practice.

Conclusion

The core of social and health management emerges as a multifaceted domain that requires a holistic understanding of institutional dynamics, organizational structures, managerial practices, cultural considerations, employee wellbeing, collaborative leadership, strategic management theories, and multidisciplinary research approaches. Addressing the highly institutionalized and professionalized nature of healthcare systems and understanding the power dynamics associated with these structures is crucial for initiating and sustaining transformative change. As the healthcare sector struggles with pressing challenges, such as cost control and quality improvement, new organizational forms and arrangements become a pivotal consideration. By integrating diverse perspectives and leveraging evidence-informed practices, social and health management can navigate the complexities of this field and drive transformative change within health and social care systems.

References

Bahreini, R., Gholizadeh, M., Gedik, F. G., Yousefi, M. and Janati, A., 2021. Components of contributing conditions to strengthen health system management and leadership capacity building: a systematic review and decision making framework. Leadership in Health Services [online], 34 (4), 527–545. Available from: https://www.proquest.com/docview/2575224107/abstract/7FD1C13379E34FB4PQ/1 [Accessed 7 Mar 2024].
Barker, R. A., 1997. How can we train leaders if we do not know what leadership is? Human Relations [online], 50 (4), 343–362. Available from: https://www.proquest.com/docview/231429531/abstract/572E77564070431EPQ/1 [Accessed 7 Mar 2024].
Edmonstone, J. D., 2020. Beyond healthcare leadership? The imperative for health and social care systems. Leadership in Health Services [online], 33 (4), 351–363. Available from: https://www.proquest.com/docview/2467523539/abstract/6925843F37B24701PQ/1 [Accessed 7 Mar 2024].
Ferlie, E. by E., Montgomery, K. and Pedersen, and A. R., eds. 2016. The Oxford Handbook of Health Care Management. Oxford, New York: Oxford University Press.
Furrer, O., Thomas, H. and Goussevskaia, A., 2008. The structure and evolution of the strategic management field: A content analysis of 26 years of strategic management research. International Journal of Management Reviews [online], 10 (1), 1–23. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1468-2370.2007.00217.x [Accessed 7 Mar 2024].
Guest, D. E., 2017. Human resource management and employee wellbeing: towards a new analytic framework. Human Resource Management Journal [online], 27 (1), 22–38. Available from: https://onlinelibrary.wiley.com/doi/10.1111/1748-8583.12139 [Accessed 7 Mar 2024].
Rosenberg-Hansen, J. and Ferlie, E., 2016. Applying Strategic Management Theories in Public Sector Organizations: Developing a typology. Public management review, 18 (1), 1–19.
Sagsan, M., 2019. Knowledge Management Discipline: Test for an Undergraduate Program in Turkey. [online]. Available from: https://www.academia.edu/1474634/Knowledge_Management_Discipline_Test_for_an_Undergraduate_Program_in_Turkey [Accessed 7 Mar 2024].
Simha, A. and Lemak, D. J., 2010. The value of original source readings in management education: The case of Frederick Winslow Taylor. Journal of Management History, 16 (2), 233–252.
Smith, T., Fowler-Davis, S., Nancarrow, S., Ariss, S. M. B. and Enderby, P., 2018. Leadership in interprofessional health and social care teams: a literature review. International journal of health care quality assurance incorporating Leadership in health services, 31 (4), 452–467.
Thorpe, R. and Beasley, T., 2004. The characteristics of performance management research: Implications and challenges. International Journal of Productivity and Performance Management [online], 53 (3/4), 334–344. Available from: https://www.proquest.com/docview/218423369/abstract/CC613D1DC79B4C90PQ/1 [Accessed 7 Mar 2024].
Tranfield, D., Denyer, D. and Smart, P., 2003. Towards a Methodology for Developing Evidence-Informed Management Knowledge by Means of Systematic Review. British Journal of Management [online], 14 (3), 207–222. Available from: https://molloy.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=buh&AN=10833059&site=ehost-live [Accessed 7 Mar 2024].
Yawson, R., 2016. The importance of multimethods and mixed methods research in understanding complexity in leadership. International Journal of Complexity in Leadership and Management, 3, 261.