Shatrov, Kosta Donislavov (2021). Major regulatory shifts as a driver of organizational change in health care: A macro and a micro perspective. (Thesis). Universität Bern, Bern

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Abstract

In this dissertation, I explore how major shifts in the regulatory environment of actors involved in the delivery of health service trigger and shape organizational change. To do so, I conceptualize different types of policy intervention as exogenous shocks and use a range of qualitative and quantitative research methods. Chapter 1 portrays the general framework of this dissertation. Adopting a macro and a micro perspective respectively, I explore two distinct types of regulatory shift: First, in Chapters 2 and 3, I focus on regulation of market entry, whereas, in Chapter 4, I focus on reimbursement regulation by analyzing how the introduction of a system based on diagnosis-related groups (DRG) affects health care provision. To do so, I analyze how two acute care hospitals that had implemented kaizen—a management technique that aims to improve business processes—in a preparatory attempt to deliver their services in a more cost-efficient way. Chapter 5 concludes and suggests an agenda for future research. In Chapter 2, I analyze how the regulatory shift induced by the new European Union Medical Device Regulation (MDR) affects the main stakeholders of the medical device industry. The theoretical framework of this review draws on the main objectives that the MDR asserts to pursue in its preamble: to facilitate free trade and enhance public health. Taking a descriptive approach based on both theoretical considerations and empirical evidence, I assess whether the new regulation is likely to achieve these two objectives. To my knowledge, this analysis represents the most comprehensive scholarly review of the MDR so far. In Chapter 3, I conceptualize the new European Union Medical Device Regulation (MDR) as an exogenous shock that elicits a major shift in the regulatory environment of the medical device industry. To make sense of this new environment, firms are forced to reorient and recreate their working practices. Using Switzerland as ground for the subject of this study, I aim to determine the preliminary economic impact of the MDR on the European medical device industry. In this study, top executives and business leaders of medical device firms based in Switzerland completed an online survey with a Likert-scale-design. I used structural equation modeling (1) to determine whether some firms are more capable of change than others when faced with a major shift in their regulatory environment, and, (2) to outline ways in which firms may seek to improve their capacity to react to such a shift. My results suggest that higher levels of organizational capacity for change (OCC) are generally positively associated with financial performance (p < 0.01) but that small and medium-sized firms show higher levels of OCC (p < 0.01) and lower levels of performance than their larger competitors (p < 0.01). Furthermore, I outlined (1) strategies business leaders may wish to consider if they were to make their organizations more capable of change, and (2) measures policy makers could take to ensure that medical devices with no close substitutes are withdrawn from the market, especially in times of a global pandemic. In Chapter 4, I examine how providers of inpatient care respond to shifts in the reimbursement regulation of their services. I move forward towards an analysis from a micro perspective by examining organizational change on the example of individual providers. Additionally, I contrast examples of positive and negative implementation of kaizen—an approach thus far missing in the literature on health management research. By examining how two acute care hospitals had recently implemented the continuous improvement technique, I aim to (1) explore and understand the experiences of nurses, and (2) identify factors affecting the implementation of the technique. By means of purposeful sampling, I selected 30 nurses from different units in two private acute care hospitals in Switzerland in May 2018. I used the Organizational Transformation Model developed by Lukas, et al. (2007) to conduct semi-structured interviews and perform qualitative content analysis. Lastly, originating from the two-factor motivation theory (Herzberg et al., 1959), I suggested two types of factor influencing the implementation of kaizen—hygiene factors that may prevent nurses from getting demotivated, and motivational factors that may boost their motivation. Overall, nurses experienced kaizen as a positive practice that enabled them to discuss work-related activities in a more comprehensive manner. In some cases, however, a lack of visible improvement in the workplace lowered nurses’ motivation to make suggestions. Nurses’ attitudes towards kaizen differed across both hospitals depending on the available managerial support, resources such as infrastructure and staffing levels. To reap the benefits of kaizen, hospital managers should promote the exchange of opinions across hierarchy levels, allocate the necessary resources in terms of personnel and infrastructure, and show nurses how the technique can help them improve their workplace.

Item Type:	Thesis
Dissertation Type:	Cumulative
Date of Defense:	16 December 2021
Subjects:	300 Social sciences, sociology & anthropology > 330 Economics 300 Social sciences, sociology & anthropology > 350 Public administration & military science
Institute / Center:	11 Centers of Competence > Center of Comptetence for Public Management (KPM) 03 Faculty of Business, Economics and Social Sciences
Depositing User:	Hammer Igor
Date Deposited:	27 Oct 2022 12:19
Last Modified:	16 Dec 2022 01:30
URI:	https://boristheses.unibe.ch/id/eprint/3859

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