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An Exploratory Case Study of
Nursing Intellectual Capital and Hospital Performance
Alexandra Harris, RN, MN/MHSc, CHE, PhD (c) Lawrence S. Bloomberg Faculty of Nursing University of Toronto Canadian Health Workforce Conference Wednesday, October 5th 2016
Presentation Overview
1. Background 2. Study Aims 3. Theoretical Underpinnings 4. Methods 5. Preliminary Results 6. Significance of Research
Background
• Paradigm shift: knowledge economy • Emergence of ‘Intellectual Capital’ (IC)
• In healthcare …
• Knowledge-intensive industry • Nursing as a knowledge-based profession
(Nursing) Intellectual Capital
Human
Social Structural
IC NIC?
(N)IC and Performance
?
Intellectual Capital (IC)
Nursing Intellectual Capital (NIC)
Organizational Performance
Study Aims
To explore what encompasses NIC, as well as whether and how NIC influences hospital performance. To explore whether there are conditions that help develop or grow NIC.
Definitions
Nursing Intellectual Capital
• All human and non-human nursing knowledge resources that are sources of organizational value
Hospital Performance
• Defined by Kaplan & Norton’s (1992) Balanced Scorecard approach
Theoretical Underpinnings
• Knowledge-Based View of the Firm Grant (1996) & Spender (1996)
• Premise: knowledge is the critical input in production
Methods
Design • Exploratory, embedded case study (Yin, 2014)
• 2 units of analysis: organization & program
Setting • Large, academic hospital in Toronto, ON
• 2 embedded clinical programs: 1 ‘high’ performer; 1 ‘low’ performer
Methods
Sources of Data Administrative documents (2011-2014)
• Organization’s strategic/performance management activities
Archival records (2011-2014)
• Nurse, patient and financial activity
Key informant interviews • Organization & program; nursing & non-nursing;
administrators & clinicians
Data Analysis
For case description and context • Administrative documents - Content analysis • Archival records – BSC methodology, descriptive
To explore research questions • Key informant interviews - Framework method
(Gale, Heath, Cameron, Rashid & Redwood, 2013)
Results
Participant Characteristics
N=
(Nsg., Non-Nsg.)
Avg. Yrs.
Experience in Org.
Organization Level 7 (3,4) 16.3
Clinical Program One 7 (5,2) 11.4
-Program Administrators 3 (2,1) 18.7
-Clinical Staff 4 (3,1) 6.0
Clinical Program Two 7 (5,2) 15.9
-Program Administrators 3 (2,1) 28.3
-Clinical Staff 4 (3,1) 6.5
TOTAL 21 14.5
Preliminary Results – RQ #1 What are the elements that comprise NIC in an
academic hospital?
Implicit
vs.
Explicit
Individual
vs.
Social
Preliminary Results – RQ #2 Are there organizational conditions that facilitate and
impede the development of NIC in an academic hospital?
Preliminary Results – RQ #3
Does NIC have an influence on an academic hospital’s ability to perform, and if so, how?
Staff Patients Financial
Research Education
Study Site’s BSC Domains
Significance of Research
• Re-conceptualizes nursing inputs or resources through a knowledge-based lens
• Explores NIC beyond traditional human capital perspective
• Informs future approaches to measuring and managing nursing knowledge resources as it relates to organizational performance
Acknowledgements
Thesis Supervisor: Dr. Linda McGillis Hall Committee: Dr. Whitney Berta Dr. Adalsteinn Brown
Doctoral funding provided by:
References
Gale, N. K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi- disciplinary health research. BMC Medical Research Methodology, 13(1), 117.
Grant, R.B. (1996). Toward a knowledge-based theory of the firm. Strategic Management Journal, 17, 109-122.
Kaplan, R. S., & Norton, D. (1992). The balanced scorecard - measures that drive performance. Harvard Business Review, 70, 71–79.
Spender, J. C. (1996). Making knowledge the basis of a dynamic theory of the firm. Strategic Management Journal, 17, 45–62.
Yin, R.K. (2014). Case study research (5th ed., pp. 1-282). Thousand Oaks, California: Sage Publications Inc.
