Managers today increasingly find themselves facing unexpected problems, needing to learn how to c... more Managers today increasingly find themselves facing unexpected problems, needing to learn how to cope with complex environments and to take action in an often chaotic flow of events. This article discusses how researchers can engage managers in a form of dialogical action research, capable of nurturing knowledge and change. This is achieved by creating space for collaborative dialogue between managers and researchers, and supplementing it with the integration of a reflexive writing practice. We first present methodological reflections related to the challenges of sustaining management practice through action research. Second, we explicate dialogical action research and illustrate the reflexive writing practice through two vignettes which provide opportunities to reflexively explore “how things work” in managers’ organizational contexts. This forms the basis for sustaining participation and learning at individual and collective levels. Finally, we identify and discuss the specific conditions and limits of such an approach.
In this article, we build on the results of a participatory action research project in
healthcar... more In this article, we build on the results of a participatory action research project in
healthcare to discuss a number of methods that can strengthen the link between
reflexive work and authoring in organizational contexts. We argue that, from an
organizational point of view, the challenge is to devise new ways to configure (and
consider) people as the authors of their work. This means assuming responsibility for,
and constructively contributing to, the goals of the organizations to which they belong.
Combining insights from theoretical reflection and experience from the field, the article
discusses the tools, process and material conditions for fostering practical reflexivity
and organizational authorship. We conclude that much is to be gained if we distinguish
between authorship and authoring. Authorship is the general process whereby managers
and organizational members contribute to the reproduction of organizational realities.
Authoring is constituted by the special circumstances whereby authorship is brought to
critical consciousness and becomes open to deliberate reorientation.
Patient centered care (PCC) is an essential dimension of healthcare systems' mission worldwide an... more Patient centered care (PCC) is an essential dimension of healthcare systems' mission worldwide and is
recognized as an important condition for ensuring the quality of care. Nonetheless, it is also acknowledged
that various care providers perceive patient centeredness differently and that there remain several
unanswered questions about the aspects of healthcare delivery that are linked to an actual achievement
of PCC. In the paper, we categorize the current research on PCC into two streams (“dyadic” and “organizational”)
and we discuss the strengths and weaknesses of each. Despite their important contributions
to healthcare services research, these approaches to PCC do not fully capture the network of practices
and relationships constituting patients and providers' experiences within healthcare contexts. Therefore,
we propose an alternative interpretation of PCC that integrates insights from “practice theories” and
emphasizes the negotiated and local nature of patient centeredness, which is accomplished through the
engagement of providers and patients in everyday care practices. To develop such interpretation, we
propose a research approach combining ethnographic and reflexive methods. Ethnography can help
achieve more nuanced descriptions of what PCC truly encapsulates in the care process by drawing
attention to the social and material reality of healthcare contexts. Reflexivity can help disentangle and
bring to surface the tacit knowledge spread in everyday care practices and transform it into actionable
knowledge, a type of knowledge that may support services improvement toward PCC. We anticipate that
such improvement is far from straightforward: an actual achievement of PCC may challenge the interests
of different stakeholders and unsettle consolidated habits, hierarchies and power dynamics. This unsettlement,
however, can also serve as a necessary condition for engaging in a participative process of
internal development. We discuss the outcomes, limitations and benefits of our approach through a
hospital case study.
Purpose – The aim of the paper is to investigate social sustainability by focussing on the stakeh... more Purpose – The aim of the paper is to investigate social sustainability by focussing on the stakeholder theory and by presenting specific levers and capabilities for building more socially sustainable organizations. Design/methodology/approach – The paper is based on the analysis of recent academic and managerial literature. Through comparing theoretical and methodological perspectives from multiple authors, a specific theoretical and methodological viewpoint based on the stakeholder theory is proposed. Findings – The paper discusses the idea that building socially sustainable organisations requires the management of multi-stakeholder processes that are physiologically conflicting and that often create paradoxical tensions. Participative settings of action and reflection and capabilities as reflexivity and “paradoxical thinking” are proposed as key levers for dealing with multi-stakeholders processes towards a more socially sustainable organizing. Research limitations/implications – This paper raises reflections focussed on the “social pillar” of sustainability and does not consider different types of organizations in different multi-stakeholders processes. Such a perspective does not exhaust the variety of cases and research studies that could be considered in the field and further developed. Originality/value – The value of the paper is in its construction of a framework for both research and practical purposes in the domain of management and sustainability. The work also attempts to link the concepts of reflexivity and paradox to a methodological proposal for leading the organizational journey towards social sustainability. Keywords Paradox, Reflexivity, Social sustainability, Conflict management research, Multi-stakeholder processes
Background: Computerized clinical decision support systems (CDSSs) have been shown to improve the... more Background: Computerized clinical decision support systems (CDSSs) have been shown to improve the efficiency
and quality of patient care by connecting healthcare professionals with high quality, evidence-based information at
the point-of-care. The mere provision of CDSSs, however, does not guarantee their uptake. Rather, individual and
institutional perceptions can foster or inhibit the integration of CDSSs into routine clinical workflow. Current
studies exploring health professionals’ perceptions of CDSSs focus primarily on technical and usability issues,
overlooking the social or cultural variables as well as broader administrative or organizational roles that may influence
CDSS adoption. Moreover, there is a lack of data on the evolution of perceived barriers or facilitators to CDSS uptake
across different stages of implementation.
Methods: We will conduct a qualitative, cross-sectional study in three Italian specialty hospitals involving frontline
physicians, nurses, information technology staff, and members of the hospital board of directors. We will use
semi-structured interviews following the Grounded Theory framework, progressively recruiting participants until
no new information is gained from the interviews.
Discussion: CDSSs are likely to become an integral and diffuse part of clinical practice. Various factors must be
considered when planning their introduction in healthcare settings. The findings of this study will guide the
development of strategies to facilitate the successful integration of CDSSs into the regular clinical workflow. The
evaluation of diverse health professionals across multiple hospital settings in different stages of CDSS uptake
will better capture the complexity of roles and contextual factors affecting CDSS uptake.
Purpose -This paper seeks to provoke thoughts around the possibility of using the lever of practi... more Purpose -This paper seeks to provoke thoughts around the possibility of using the lever of practices and situated knowledge to trigger organisational change and to redesign it with the involvement of the whole organisation. Design/methodology/approach -The paper presents connections between a psychosociological approach and a practice-based approach. The use of ethnomethodology is offered as a way to detect situated practice and meaning at works. Findings -This contribution underlines how change and learning in organisations can find support in investing in local knowledge and in detecting and reflecting around the living practices of daily activities. Knowing in practice requires the involvement and continuous work of connecting among individuals, groups, organisations and institutions in situated contexts. The paper shows how strategic a process this is, presenting a way to work on situated data. Practical implications -The paper represents a way to work on organisational change grounded on action research. Originality/value -The paper combines a psychological perspective within the field of practice-based studies and sustains a specific ethnographic method to create organisational areas of reflexivity.
This article explores the importance of power and dissymmetry in promoting participative knowledg... more This article explores the importance of power and dissymmetry in promoting participative knowledge and change in action research. Based on the analysis of two action research cases, the paper builds its argument by analyzing two key aspects: the construction of the action research setting and its maintenance during the process. It does so by highlighting the decisions assumed with respect to the relationship between researchers and participants and with respect to power issues. The findings indicate that promoting a functional dissymmetry in internal relationships allows distribution of the necessary types of power that make the participants use their authority and knowledge to invest in change. Thus, the distributed leadership is essential every time an organization needs to create a realistic and workable change of roles and responsibilities inside its boundaries. The article discusses some key factors in employing dissymmetry for sustained learning and knowledge-sharing.
The paper addresses the role of organizational artifacts in mediating the tacit, implicit and
inf... more The paper addresses the role of organizational artifacts in mediating the tacit, implicit and informal knowledge embedded in working practice, routines and taken-for-granted activities. Analyzing organizational artifacts offers the possibility to explore the relationship between affordance and agency in the workplace. Methods. Nowadays, healthcare contexts are forced to engage in ongoing organizational change. The plurality of actors that inhabit health care services cope with pressures for reorganization and are often challenged to update their operational systems. The paper describes an action research which took place in an (Italian public) hospital during a reorganization aimed at changing the paradigm of healthcare delivery. The contribution highlights the main phases of the intervention, focusing on the revision process of the Nursing Record as crucial artifact. Results. Participants tried to make the Record easier, clearer, closer to the patient condition and more connected to the Medical Record. The new Record needed to be effective in identifying the diagnosis, the therapeutic problems and solutions for each patient, and the correct evaluation system requested. Changing the Record, moreover, entailed a professional accountability both as social responsibility for own daily activity and as responsivity to the relational and transactive processes in which practitioners are engaged. Conclusions. Artifacts can be seen as mediating objects that spread knowledge and meanings, thus founding the cooperative actions and the possibility to share working cultures. In this direction, the paper proposes new research paths for inquiring situated experiences of transformative agency and and discusses innovative methodological options for developing training interventions.
Training of attention in patients with remitting-relapsing multiple sclerosis 59 Olga Orel ᴥ ABST... more Training of attention in patients with remitting-relapsing multiple sclerosis 59 Olga Orel ᴥ ABSTRACT. Il lavoro presenta un'esperienza di ricerca-intervento condotta per accompagnare un cambiamento organizzativo di un ospedale di medie dimensioni del Nord Italia. Il contributo sollecita una riflessione sul ruolo degli artefatti quali organizzatori delle pratiche lavorative, offrendo una prospettiva di ricognizione e analisi dei processi di costruzione e condivisione della conoscenza. Viene evidenziato il ruolo di mediatore svolto dagli artefatti e dalle inscriptions a essi relative, rispetto a conoscenze tacite e a pratiche operative circolanti all'interno di uno specifico contesto organizzativo.
Purpose – This chapter focuses on an innovative effort in the Italian context in which a complex ... more Purpose – This chapter focuses on an innovative effort in the Italian context in which a complex web of partnerships was created as the foundation of an alternative model of healthcare. More specifically, the start-up of a healthcare organization – Welfare Italia Service – is analyzed and discussed with respect to its sustainability. Design/methodology/approach – The process of organizing a sustainable healthcare is analyzed through the theoretical lenses of multi-stakeholders management and partnership perspectives. The possibility of developing dense knowledge about the Welfare Italia Service’s case has stemmed from our collaboration with the organization board with regard to a research process intended to monitor the organizational start-up and its sustainability challenges. Findings – The case provides new insights into the dynamic nature of building multi-stakeholder partnership in a complex environment; the developmental life-cycle challenge of multi-stakeholder partnership, and the meaning of sustainability. The case suggests a tapestry of issues such as how sustainability may be ‘‘paradoxical,’’ dynamic, led by different and sometimes conflicting logics, and changeable over time like a growing tree in an intricate forest. Originality/value – The case can stimulate learning and discussions both within the community of practitioners and the community of academics with respect to which promising conditions could help address the challenge of starting-up a sustainable organization in the healthcare field.
Managers today increasingly find themselves facing unexpected problems, needing to learn how to c... more Managers today increasingly find themselves facing unexpected problems, needing to learn how to cope with complex environments and to take action in an often chaotic flow of events. This article discusses how researchers can engage managers in a form of dialogical action research, capable of nurturing knowledge and change. This is achieved by creating space for collaborative dialogue between managers and researchers, and supplementing it with the integration of a reflexive writing practice. We first present methodological reflections related to the challenges of sustaining management practice through action research. Second, we explicate dialogical action research and illustrate the reflexive writing practice through two vignettes which provide opportunities to reflexively explore “how things work” in managers’ organizational contexts. This forms the basis for sustaining participation and learning at individual and collective levels. Finally, we identify and discuss the specific conditions and limits of such an approach.
In this article, we build on the results of a participatory action research project in
healthcar... more In this article, we build on the results of a participatory action research project in
healthcare to discuss a number of methods that can strengthen the link between
reflexive work and authoring in organizational contexts. We argue that, from an
organizational point of view, the challenge is to devise new ways to configure (and
consider) people as the authors of their work. This means assuming responsibility for,
and constructively contributing to, the goals of the organizations to which they belong.
Combining insights from theoretical reflection and experience from the field, the article
discusses the tools, process and material conditions for fostering practical reflexivity
and organizational authorship. We conclude that much is to be gained if we distinguish
between authorship and authoring. Authorship is the general process whereby managers
and organizational members contribute to the reproduction of organizational realities.
Authoring is constituted by the special circumstances whereby authorship is brought to
critical consciousness and becomes open to deliberate reorientation.
Patient centered care (PCC) is an essential dimension of healthcare systems' mission worldwide an... more Patient centered care (PCC) is an essential dimension of healthcare systems' mission worldwide and is
recognized as an important condition for ensuring the quality of care. Nonetheless, it is also acknowledged
that various care providers perceive patient centeredness differently and that there remain several
unanswered questions about the aspects of healthcare delivery that are linked to an actual achievement
of PCC. In the paper, we categorize the current research on PCC into two streams (“dyadic” and “organizational”)
and we discuss the strengths and weaknesses of each. Despite their important contributions
to healthcare services research, these approaches to PCC do not fully capture the network of practices
and relationships constituting patients and providers' experiences within healthcare contexts. Therefore,
we propose an alternative interpretation of PCC that integrates insights from “practice theories” and
emphasizes the negotiated and local nature of patient centeredness, which is accomplished through the
engagement of providers and patients in everyday care practices. To develop such interpretation, we
propose a research approach combining ethnographic and reflexive methods. Ethnography can help
achieve more nuanced descriptions of what PCC truly encapsulates in the care process by drawing
attention to the social and material reality of healthcare contexts. Reflexivity can help disentangle and
bring to surface the tacit knowledge spread in everyday care practices and transform it into actionable
knowledge, a type of knowledge that may support services improvement toward PCC. We anticipate that
such improvement is far from straightforward: an actual achievement of PCC may challenge the interests
of different stakeholders and unsettle consolidated habits, hierarchies and power dynamics. This unsettlement,
however, can also serve as a necessary condition for engaging in a participative process of
internal development. We discuss the outcomes, limitations and benefits of our approach through a
hospital case study.
Purpose – The aim of the paper is to investigate social sustainability by focussing on the stakeh... more Purpose – The aim of the paper is to investigate social sustainability by focussing on the stakeholder theory and by presenting specific levers and capabilities for building more socially sustainable organizations. Design/methodology/approach – The paper is based on the analysis of recent academic and managerial literature. Through comparing theoretical and methodological perspectives from multiple authors, a specific theoretical and methodological viewpoint based on the stakeholder theory is proposed. Findings – The paper discusses the idea that building socially sustainable organisations requires the management of multi-stakeholder processes that are physiologically conflicting and that often create paradoxical tensions. Participative settings of action and reflection and capabilities as reflexivity and “paradoxical thinking” are proposed as key levers for dealing with multi-stakeholders processes towards a more socially sustainable organizing. Research limitations/implications – This paper raises reflections focussed on the “social pillar” of sustainability and does not consider different types of organizations in different multi-stakeholders processes. Such a perspective does not exhaust the variety of cases and research studies that could be considered in the field and further developed. Originality/value – The value of the paper is in its construction of a framework for both research and practical purposes in the domain of management and sustainability. The work also attempts to link the concepts of reflexivity and paradox to a methodological proposal for leading the organizational journey towards social sustainability. Keywords Paradox, Reflexivity, Social sustainability, Conflict management research, Multi-stakeholder processes
Background: Computerized clinical decision support systems (CDSSs) have been shown to improve the... more Background: Computerized clinical decision support systems (CDSSs) have been shown to improve the efficiency
and quality of patient care by connecting healthcare professionals with high quality, evidence-based information at
the point-of-care. The mere provision of CDSSs, however, does not guarantee their uptake. Rather, individual and
institutional perceptions can foster or inhibit the integration of CDSSs into routine clinical workflow. Current
studies exploring health professionals’ perceptions of CDSSs focus primarily on technical and usability issues,
overlooking the social or cultural variables as well as broader administrative or organizational roles that may influence
CDSS adoption. Moreover, there is a lack of data on the evolution of perceived barriers or facilitators to CDSS uptake
across different stages of implementation.
Methods: We will conduct a qualitative, cross-sectional study in three Italian specialty hospitals involving frontline
physicians, nurses, information technology staff, and members of the hospital board of directors. We will use
semi-structured interviews following the Grounded Theory framework, progressively recruiting participants until
no new information is gained from the interviews.
Discussion: CDSSs are likely to become an integral and diffuse part of clinical practice. Various factors must be
considered when planning their introduction in healthcare settings. The findings of this study will guide the
development of strategies to facilitate the successful integration of CDSSs into the regular clinical workflow. The
evaluation of diverse health professionals across multiple hospital settings in different stages of CDSS uptake
will better capture the complexity of roles and contextual factors affecting CDSS uptake.
Purpose -This paper seeks to provoke thoughts around the possibility of using the lever of practi... more Purpose -This paper seeks to provoke thoughts around the possibility of using the lever of practices and situated knowledge to trigger organisational change and to redesign it with the involvement of the whole organisation. Design/methodology/approach -The paper presents connections between a psychosociological approach and a practice-based approach. The use of ethnomethodology is offered as a way to detect situated practice and meaning at works. Findings -This contribution underlines how change and learning in organisations can find support in investing in local knowledge and in detecting and reflecting around the living practices of daily activities. Knowing in practice requires the involvement and continuous work of connecting among individuals, groups, organisations and institutions in situated contexts. The paper shows how strategic a process this is, presenting a way to work on situated data. Practical implications -The paper represents a way to work on organisational change grounded on action research. Originality/value -The paper combines a psychological perspective within the field of practice-based studies and sustains a specific ethnographic method to create organisational areas of reflexivity.
This article explores the importance of power and dissymmetry in promoting participative knowledg... more This article explores the importance of power and dissymmetry in promoting participative knowledge and change in action research. Based on the analysis of two action research cases, the paper builds its argument by analyzing two key aspects: the construction of the action research setting and its maintenance during the process. It does so by highlighting the decisions assumed with respect to the relationship between researchers and participants and with respect to power issues. The findings indicate that promoting a functional dissymmetry in internal relationships allows distribution of the necessary types of power that make the participants use their authority and knowledge to invest in change. Thus, the distributed leadership is essential every time an organization needs to create a realistic and workable change of roles and responsibilities inside its boundaries. The article discusses some key factors in employing dissymmetry for sustained learning and knowledge-sharing.
The paper addresses the role of organizational artifacts in mediating the tacit, implicit and
inf... more The paper addresses the role of organizational artifacts in mediating the tacit, implicit and informal knowledge embedded in working practice, routines and taken-for-granted activities. Analyzing organizational artifacts offers the possibility to explore the relationship between affordance and agency in the workplace. Methods. Nowadays, healthcare contexts are forced to engage in ongoing organizational change. The plurality of actors that inhabit health care services cope with pressures for reorganization and are often challenged to update their operational systems. The paper describes an action research which took place in an (Italian public) hospital during a reorganization aimed at changing the paradigm of healthcare delivery. The contribution highlights the main phases of the intervention, focusing on the revision process of the Nursing Record as crucial artifact. Results. Participants tried to make the Record easier, clearer, closer to the patient condition and more connected to the Medical Record. The new Record needed to be effective in identifying the diagnosis, the therapeutic problems and solutions for each patient, and the correct evaluation system requested. Changing the Record, moreover, entailed a professional accountability both as social responsibility for own daily activity and as responsivity to the relational and transactive processes in which practitioners are engaged. Conclusions. Artifacts can be seen as mediating objects that spread knowledge and meanings, thus founding the cooperative actions and the possibility to share working cultures. In this direction, the paper proposes new research paths for inquiring situated experiences of transformative agency and and discusses innovative methodological options for developing training interventions.
Training of attention in patients with remitting-relapsing multiple sclerosis 59 Olga Orel ᴥ ABST... more Training of attention in patients with remitting-relapsing multiple sclerosis 59 Olga Orel ᴥ ABSTRACT. Il lavoro presenta un'esperienza di ricerca-intervento condotta per accompagnare un cambiamento organizzativo di un ospedale di medie dimensioni del Nord Italia. Il contributo sollecita una riflessione sul ruolo degli artefatti quali organizzatori delle pratiche lavorative, offrendo una prospettiva di ricognizione e analisi dei processi di costruzione e condivisione della conoscenza. Viene evidenziato il ruolo di mediatore svolto dagli artefatti e dalle inscriptions a essi relative, rispetto a conoscenze tacite e a pratiche operative circolanti all'interno di uno specifico contesto organizzativo.
Purpose – This chapter focuses on an innovative effort in the Italian context in which a complex ... more Purpose – This chapter focuses on an innovative effort in the Italian context in which a complex web of partnerships was created as the foundation of an alternative model of healthcare. More specifically, the start-up of a healthcare organization – Welfare Italia Service – is analyzed and discussed with respect to its sustainability. Design/methodology/approach – The process of organizing a sustainable healthcare is analyzed through the theoretical lenses of multi-stakeholders management and partnership perspectives. The possibility of developing dense knowledge about the Welfare Italia Service’s case has stemmed from our collaboration with the organization board with regard to a research process intended to monitor the organizational start-up and its sustainability challenges. Findings – The case provides new insights into the dynamic nature of building multi-stakeholder partnership in a complex environment; the developmental life-cycle challenge of multi-stakeholder partnership, and the meaning of sustainability. The case suggests a tapestry of issues such as how sustainability may be ‘‘paradoxical,’’ dynamic, led by different and sometimes conflicting logics, and changeable over time like a growing tree in an intricate forest. Originality/value – The case can stimulate learning and discussions both within the community of practitioners and the community of academics with respect to which promising conditions could help address the challenge of starting-up a sustainable organization in the healthcare field.
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Papers by Mara Gorli
environments and to take action in an often chaotic flow of events. This article discusses how researchers can engage
managers in a form of dialogical action research, capable of nurturing knowledge and change. This is achieved by creating
space for collaborative dialogue between managers and researchers, and supplementing it with the integration of a reflexive
writing practice. We first present methodological reflections related to the challenges of sustaining management practice
through action research. Second, we explicate dialogical action research and illustrate the reflexive writing practice through
two vignettes which provide opportunities to reflexively explore “how things work” in managers’ organizational contexts.
This forms the basis for sustaining participation and learning at individual and collective levels. Finally, we identify and discuss
the specific conditions and limits of such an approach.
healthcare to discuss a number of methods that can strengthen the link between
reflexive work and authoring in organizational contexts. We argue that, from an
organizational point of view, the challenge is to devise new ways to configure (and
consider) people as the authors of their work. This means assuming responsibility for,
and constructively contributing to, the goals of the organizations to which they belong.
Combining insights from theoretical reflection and experience from the field, the article
discusses the tools, process and material conditions for fostering practical reflexivity
and organizational authorship. We conclude that much is to be gained if we distinguish
between authorship and authoring. Authorship is the general process whereby managers
and organizational members contribute to the reproduction of organizational realities.
Authoring is constituted by the special circumstances whereby authorship is brought to
critical consciousness and becomes open to deliberate reorientation.
recognized as an important condition for ensuring the quality of care. Nonetheless, it is also acknowledged
that various care providers perceive patient centeredness differently and that there remain several
unanswered questions about the aspects of healthcare delivery that are linked to an actual achievement
of PCC. In the paper, we categorize the current research on PCC into two streams (“dyadic” and “organizational”)
and we discuss the strengths and weaknesses of each. Despite their important contributions
to healthcare services research, these approaches to PCC do not fully capture the network of practices
and relationships constituting patients and providers' experiences within healthcare contexts. Therefore,
we propose an alternative interpretation of PCC that integrates insights from “practice theories” and
emphasizes the negotiated and local nature of patient centeredness, which is accomplished through the
engagement of providers and patients in everyday care practices. To develop such interpretation, we
propose a research approach combining ethnographic and reflexive methods. Ethnography can help
achieve more nuanced descriptions of what PCC truly encapsulates in the care process by drawing
attention to the social and material reality of healthcare contexts. Reflexivity can help disentangle and
bring to surface the tacit knowledge spread in everyday care practices and transform it into actionable
knowledge, a type of knowledge that may support services improvement toward PCC. We anticipate that
such improvement is far from straightforward: an actual achievement of PCC may challenge the interests
of different stakeholders and unsettle consolidated habits, hierarchies and power dynamics. This unsettlement,
however, can also serve as a necessary condition for engaging in a participative process of
internal development. We discuss the outcomes, limitations and benefits of our approach through a
hospital case study.
theory and by presenting specific levers and capabilities for building more socially sustainable
organizations.
Design/methodology/approach – The paper is based on the analysis of recent academic and
managerial literature. Through comparing theoretical and methodological perspectives from multiple
authors, a specific theoretical and methodological viewpoint based on the stakeholder theory is
proposed.
Findings – The paper discusses the idea that building socially sustainable organisations requires the
management of multi-stakeholder processes that are physiologically conflicting and that often create
paradoxical tensions. Participative settings of action and reflection and capabilities as reflexivity and
“paradoxical thinking” are proposed as key levers for dealing with multi-stakeholders processes
towards a more socially sustainable organizing.
Research limitations/implications – This paper raises reflections focussed on the “social pillar” of
sustainability and does not consider different types of organizations in different multi-stakeholders
processes. Such a perspective does not exhaust the variety of cases and research studies that could be
considered in the field and further developed.
Originality/value – The value of the paper is in its construction of a framework for both research and
practical purposes in the domain of management and sustainability. The work also attempts to link the
concepts of reflexivity and paradox to a methodological proposal for leading the organizational journey
towards social sustainability.
Keywords Paradox, Reflexivity, Social sustainability, Conflict management research,
Multi-stakeholder processes
and quality of patient care by connecting healthcare professionals with high quality, evidence-based information at
the point-of-care. The mere provision of CDSSs, however, does not guarantee their uptake. Rather, individual and
institutional perceptions can foster or inhibit the integration of CDSSs into routine clinical workflow. Current
studies exploring health professionals’ perceptions of CDSSs focus primarily on technical and usability issues,
overlooking the social or cultural variables as well as broader administrative or organizational roles that may influence
CDSS adoption. Moreover, there is a lack of data on the evolution of perceived barriers or facilitators to CDSS uptake
across different stages of implementation.
Methods: We will conduct a qualitative, cross-sectional study in three Italian specialty hospitals involving frontline
physicians, nurses, information technology staff, and members of the hospital board of directors. We will use
semi-structured interviews following the Grounded Theory framework, progressively recruiting participants until
no new information is gained from the interviews.
Discussion: CDSSs are likely to become an integral and diffuse part of clinical practice. Various factors must be
considered when planning their introduction in healthcare settings. The findings of this study will guide the
development of strategies to facilitate the successful integration of CDSSs into the regular clinical workflow. The
evaluation of diverse health professionals across multiple hospital settings in different stages of CDSS uptake
will better capture the complexity of roles and contextual factors affecting CDSS uptake.
informal knowledge embedded in working practice, routines and taken-for-granted activities. Analyzing organizational
artifacts offers the possibility to explore the relationship between affordance and agency in the workplace. Methods.
Nowadays, healthcare contexts are forced to engage in ongoing organizational change. The plurality of actors that inhabit
health care services cope with pressures for reorganization and are often challenged to update their operational systems.
The paper describes an action research which took place in an (Italian public) hospital during a reorganization aimed at
changing the paradigm of healthcare delivery. The contribution highlights the main phases of the intervention, focusing
on the revision process of the Nursing Record as crucial artifact. Results. Participants tried to make the Record easier,
clearer, closer to the patient condition and more connected to the Medical Record. The new Record needed to be effective
in identifying the diagnosis, the therapeutic problems and solutions for each patient, and the correct evaluation system
requested. Changing the Record, moreover, entailed a professional accountability both as social responsibility for own daily
activity and as responsivity to the relational and transactive processes in which practitioners are engaged. Conclusions.
Artifacts can be seen as mediating objects that spread knowledge and meanings, thus founding the cooperative actions
and the possibility to share working cultures. In this direction, the paper proposes new research paths for inquiring situated
experiences of transformative agency and and discusses innovative methodological options for developing training
interventions.
Design/methodology/approach – The process of organizing a sustainable healthcare is analyzed through the theoretical lenses of multi-stakeholders management and partnership perspectives. The possibility of developing dense knowledge about the Welfare Italia Service’s case has stemmed from our collaboration with the organization board with regard to a research process intended to monitor the organizational start-up and its sustainability challenges.
Findings – The case provides new insights into the dynamic nature of building multi-stakeholder partnership in a complex environment; the developmental life-cycle challenge of multi-stakeholder partnership, and the meaning of sustainability. The case suggests a tapestry of issues such as how sustainability may be ‘‘paradoxical,’’ dynamic, led by different and sometimes conflicting logics, and changeable over time like a growing
tree in an intricate forest.
Originality/value – The case can stimulate learning and discussions both within the community of practitioners and the community of academics with respect to which promising conditions could help address the challenge of starting-up a sustainable organization in the healthcare field.
environments and to take action in an often chaotic flow of events. This article discusses how researchers can engage
managers in a form of dialogical action research, capable of nurturing knowledge and change. This is achieved by creating
space for collaborative dialogue between managers and researchers, and supplementing it with the integration of a reflexive
writing practice. We first present methodological reflections related to the challenges of sustaining management practice
through action research. Second, we explicate dialogical action research and illustrate the reflexive writing practice through
two vignettes which provide opportunities to reflexively explore “how things work” in managers’ organizational contexts.
This forms the basis for sustaining participation and learning at individual and collective levels. Finally, we identify and discuss
the specific conditions and limits of such an approach.
healthcare to discuss a number of methods that can strengthen the link between
reflexive work and authoring in organizational contexts. We argue that, from an
organizational point of view, the challenge is to devise new ways to configure (and
consider) people as the authors of their work. This means assuming responsibility for,
and constructively contributing to, the goals of the organizations to which they belong.
Combining insights from theoretical reflection and experience from the field, the article
discusses the tools, process and material conditions for fostering practical reflexivity
and organizational authorship. We conclude that much is to be gained if we distinguish
between authorship and authoring. Authorship is the general process whereby managers
and organizational members contribute to the reproduction of organizational realities.
Authoring is constituted by the special circumstances whereby authorship is brought to
critical consciousness and becomes open to deliberate reorientation.
recognized as an important condition for ensuring the quality of care. Nonetheless, it is also acknowledged
that various care providers perceive patient centeredness differently and that there remain several
unanswered questions about the aspects of healthcare delivery that are linked to an actual achievement
of PCC. In the paper, we categorize the current research on PCC into two streams (“dyadic” and “organizational”)
and we discuss the strengths and weaknesses of each. Despite their important contributions
to healthcare services research, these approaches to PCC do not fully capture the network of practices
and relationships constituting patients and providers' experiences within healthcare contexts. Therefore,
we propose an alternative interpretation of PCC that integrates insights from “practice theories” and
emphasizes the negotiated and local nature of patient centeredness, which is accomplished through the
engagement of providers and patients in everyday care practices. To develop such interpretation, we
propose a research approach combining ethnographic and reflexive methods. Ethnography can help
achieve more nuanced descriptions of what PCC truly encapsulates in the care process by drawing
attention to the social and material reality of healthcare contexts. Reflexivity can help disentangle and
bring to surface the tacit knowledge spread in everyday care practices and transform it into actionable
knowledge, a type of knowledge that may support services improvement toward PCC. We anticipate that
such improvement is far from straightforward: an actual achievement of PCC may challenge the interests
of different stakeholders and unsettle consolidated habits, hierarchies and power dynamics. This unsettlement,
however, can also serve as a necessary condition for engaging in a participative process of
internal development. We discuss the outcomes, limitations and benefits of our approach through a
hospital case study.
theory and by presenting specific levers and capabilities for building more socially sustainable
organizations.
Design/methodology/approach – The paper is based on the analysis of recent academic and
managerial literature. Through comparing theoretical and methodological perspectives from multiple
authors, a specific theoretical and methodological viewpoint based on the stakeholder theory is
proposed.
Findings – The paper discusses the idea that building socially sustainable organisations requires the
management of multi-stakeholder processes that are physiologically conflicting and that often create
paradoxical tensions. Participative settings of action and reflection and capabilities as reflexivity and
“paradoxical thinking” are proposed as key levers for dealing with multi-stakeholders processes
towards a more socially sustainable organizing.
Research limitations/implications – This paper raises reflections focussed on the “social pillar” of
sustainability and does not consider different types of organizations in different multi-stakeholders
processes. Such a perspective does not exhaust the variety of cases and research studies that could be
considered in the field and further developed.
Originality/value – The value of the paper is in its construction of a framework for both research and
practical purposes in the domain of management and sustainability. The work also attempts to link the
concepts of reflexivity and paradox to a methodological proposal for leading the organizational journey
towards social sustainability.
Keywords Paradox, Reflexivity, Social sustainability, Conflict management research,
Multi-stakeholder processes
and quality of patient care by connecting healthcare professionals with high quality, evidence-based information at
the point-of-care. The mere provision of CDSSs, however, does not guarantee their uptake. Rather, individual and
institutional perceptions can foster or inhibit the integration of CDSSs into routine clinical workflow. Current
studies exploring health professionals’ perceptions of CDSSs focus primarily on technical and usability issues,
overlooking the social or cultural variables as well as broader administrative or organizational roles that may influence
CDSS adoption. Moreover, there is a lack of data on the evolution of perceived barriers or facilitators to CDSS uptake
across different stages of implementation.
Methods: We will conduct a qualitative, cross-sectional study in three Italian specialty hospitals involving frontline
physicians, nurses, information technology staff, and members of the hospital board of directors. We will use
semi-structured interviews following the Grounded Theory framework, progressively recruiting participants until
no new information is gained from the interviews.
Discussion: CDSSs are likely to become an integral and diffuse part of clinical practice. Various factors must be
considered when planning their introduction in healthcare settings. The findings of this study will guide the
development of strategies to facilitate the successful integration of CDSSs into the regular clinical workflow. The
evaluation of diverse health professionals across multiple hospital settings in different stages of CDSS uptake
will better capture the complexity of roles and contextual factors affecting CDSS uptake.
informal knowledge embedded in working practice, routines and taken-for-granted activities. Analyzing organizational
artifacts offers the possibility to explore the relationship between affordance and agency in the workplace. Methods.
Nowadays, healthcare contexts are forced to engage in ongoing organizational change. The plurality of actors that inhabit
health care services cope with pressures for reorganization and are often challenged to update their operational systems.
The paper describes an action research which took place in an (Italian public) hospital during a reorganization aimed at
changing the paradigm of healthcare delivery. The contribution highlights the main phases of the intervention, focusing
on the revision process of the Nursing Record as crucial artifact. Results. Participants tried to make the Record easier,
clearer, closer to the patient condition and more connected to the Medical Record. The new Record needed to be effective
in identifying the diagnosis, the therapeutic problems and solutions for each patient, and the correct evaluation system
requested. Changing the Record, moreover, entailed a professional accountability both as social responsibility for own daily
activity and as responsivity to the relational and transactive processes in which practitioners are engaged. Conclusions.
Artifacts can be seen as mediating objects that spread knowledge and meanings, thus founding the cooperative actions
and the possibility to share working cultures. In this direction, the paper proposes new research paths for inquiring situated
experiences of transformative agency and and discusses innovative methodological options for developing training
interventions.
Design/methodology/approach – The process of organizing a sustainable healthcare is analyzed through the theoretical lenses of multi-stakeholders management and partnership perspectives. The possibility of developing dense knowledge about the Welfare Italia Service’s case has stemmed from our collaboration with the organization board with regard to a research process intended to monitor the organizational start-up and its sustainability challenges.
Findings – The case provides new insights into the dynamic nature of building multi-stakeholder partnership in a complex environment; the developmental life-cycle challenge of multi-stakeholder partnership, and the meaning of sustainability. The case suggests a tapestry of issues such as how sustainability may be ‘‘paradoxical,’’ dynamic, led by different and sometimes conflicting logics, and changeable over time like a growing
tree in an intricate forest.
Originality/value – The case can stimulate learning and discussions both within the community of practitioners and the community of academics with respect to which promising conditions could help address the challenge of starting-up a sustainable organization in the healthcare field.