Keeping the blood flowing - Hindrances to systemic viability in a Norwegian hospital
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Purpose: The purpose of this thesis is to identify what hindrances to systemic viability that exist in a Norwegian hospital. Background: Norwegian hospitals experience a substantial increase in the number of patients, the complexity in diagnoses, and chronic health problems due to an ageing population, lifestyle-induced diseases, and longer life expectancy. However, resources are not correspondingly inexhaustible, which creates a gap between demand and the resources needed to fulfil it. This again call for efficiency improvements. However, research shows that there exist little knowledge about why Norwegian hospitals are performing differently and seeing a slower increase in productiveness than could be expected and that is required. Approach: As the Norwegian hospitals are highly affected by its environment, in addition to being complex and in need of a holistic approach to management, the theoretical foundation for this thesis is systems theory. Furthermore, the Viable System Model (VSM) is applied to answer the problem statement. The empirical foundation for the thesis is a case study of the Department of Orthopaedic Surgery at St. Olav s Hospital in Trondheim; one of the largest hospitals in Norway. The VSM is applied to create a diagnosis of the case department, which in turn points to hindrances to systemic viability. Findings: The VSM diagnosis revealed six main hindrances for systemic viability in the department. First, interdisciplinary management functions are not clearly defined in some of the units and the border between operations and management is not clear. Second, the systems for obtaining knowledge about the environment (i.e. future activity load) are weak. Third, the VSM reveals an unsteady information flow across the department and the fourth finding is that the department s co-ordination function is not fully implemented and supported. The fifth finding claim that there are few and unstable interdisciplinary meeting points in the department. Finally, the diagnosis points to the need for systemic thinking because it serves as a prerequisite for viability. In addition, the two Fast Track pathways are described as guiding stars for implementing the VSM principles into the organization. Conclusion: I believe that the VSM diagnosis serves as a good starting point for addressing hindrances to systemic viability. Additionally, the thesis contributes to the current debate about management in Norwegian hospital as well as the need for knowledge about and tools to help increase efficiency and effectiveness to meet the increasing need for the hospitals services.