A Problem-Solving Routine for Improving Hospital Operations

J Health Organ Manag. 2015;29(2):252-70. doi: 10.1108/JHOM-09-2013-0191.


Purpose: The purpose of this paper is to examine empirically why a systematic problem-solving routine can play an important role in the process improvement efforts of hospitals.

Design/methodology/approach: Data on 18 process improvement cases were collected through semi-structured interviews, reports and other documents, and artifacts associated with the cases. The data were analyzed using a grounded theory approach.

Findings: Adherence to all the steps of the problem-solving routine correlated to greater degrees of improvement across the sample. Analysis resulted in two models. The first partially explains why hospital workers tended to enact short-term solutions when faced with process-related problems; and tended not seek longer-term solutions that prevent problems from recurring. The second model highlights a set of self-reinforcing behaviors that are more likely to address problem recurrence and result in sustained process improvement.

Research limitations/implications: The study was conducted in one hospital setting.

Practical implications: Hospital managers can improve patient care and increase operational efficiency by adopting and diffusing problem-solving routines that embody three key characteristics.

Originality/value: This paper offers new insights on why caregivers adopt short-term approaches to problem solving. Three characteristics of an effective problem-solving routine in a healthcare setting are proposed.

Keywords: A3 Process; Healthcare; Metaroutines; Operating performance; Operations management; Organizational problem solving.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Efficiency, Organizational / standards*
  • Hospital Administration / standards*
  • Humans
  • Interviews as Topic
  • Problem Solving*
  • Qualitative Research
  • Quality Improvement*