Environmental and personal factors affecting innovation in health care amongst general and nurse managers.

Australia's public health field has developed a decentralised management structure that consists of multi-disciplinary workplace teams. Within this structure, Nurse Managers endeavour to not only participate in innovative workplace practice but also strive to work in a positive organizational climate (Swansburg, 1996). This thesis provides a unified review, which consolidates the findings from three published, multi-method research studies that addressed innovative practices of nurse managers in the public health care sector. An extensive literature review underlies the three publications and was carried out in two stages. The first phase examined innovation theories searching to identify and develop a definition appropriate to the public health care sector. Next, the innovation process and the factors that associated with innovative practice were reviewed. The results of the literature search provided the framework for three multi¬-method studies surveying 360 public health care sector Nurse Managers. The surveys were undertaken in rural and metropolitan NSW and Victoria. The first of the three studies was the anchor study for this thesis and examined the dual notions of work experience and innovation and work climate and innovation. The results for the first notion revealed a strong relationship between experience and innovation supporting the research literature, indicating Nurse Managers can be visionary and creative because they have knowledge of organizational structures and experience. The second area of results showed metropolitan and rural Nurse Managers desired an organizational climate of fairness that developed trust and confidence in the innovative process in the organisational team and in a positive innovative organizational climate. The publications from this study concluded that there was a need for Nurse Managers to review their style and communication skills with experience to effectively relate at all levels of the organizational structure in a positive organisational climate. These results lead to the second study and publication which examined in more depth, the differences between the innovative climate of metropolitan and rural health organisations for Nurse Managers. The results in this study revealed a significant relationship between support and innovation and a relationship between fairness and innovation implying that when supported and working in a positive environment innovative managerial practice is attainable. Metropolitan and rural regional scores indicated a significant difference existed between the two groups on scores of innovation. However, there was no significant difference found between regional and metropolitan samples on organisational climate. The reason for the differences in innovative approaches was not evident. The factors that w(luld potentially affect the organisational climate required for innovative practice were identified as fairness, trust, support, recognition and reward for efforts. The third study and publication was developed to investigate more thoroughly the results from Study I and 2 and was done with the co-operation of a large rural health service area in NSW, Australia. The results of this study indicated a correlation between individual and team innovation revealing innovation perception was part of the work practice and that there was little difference between general and nurse managers and their perceptions of innovation. Overwhelmingly, the majority of managers indicated they were expected to be innovative in their current position with recognition and rewards attached. Collectively, the unified results of the three studies and publications revealed that innovative practice was only approached by Nurse Managers from a clinical not a managerial perspective in that most nurse managers were addressed as being managers of patient related areas. Formal education and experience were also noted as a requirement for supporting innovative practice. The findings across all three studies showed a correlation between effective communication and the development of new ideas that involved management styles, organisational structure and experience in the position with effective and supportive organizational structures. An analysis of the overall findings provides a coherent view, which indicated nurse managers in both the rural and metropolitan public health care sector preferred an innovative workplace environment. However, in the rural sector, managers believed they were supported but required fairness in an innovative environment. In contrast, metropolitan nurse managers said they required support from organizational administrators. In addition, managers indicated that they were autonomous, experienced and were innovative in a supportive organizational climate. The conclusion of the three papers provided in this thesis is that there is a need for health care managers in the public sector to have the required education and be innovative in conjunction with experience in the team environment. In most circumstances innovation was perceived as being part of everyday management. However, to gain experience managers are required to stay in their managerial positions for more than two years to consolidate their knowledge. Post-graduate education was also a factor that managers perceived as growth in their experience in the public health care organization. Autonomy of the roles of Nurse Managers with the public health care sector is paramount to their success with the bureaucracy of the health care organizational structure. Finally, the process of workplace innovation and nurse managers employed in the Australian health care sector is complex as many variables impact on this process and this is discussed in terms of implications for today's health care sector.