Movimientos de aducción con la prótesis de cadera

This research was conducted in four regional health authorities in the Canadian healthcare sector. In Canada’s universal publicly funded healthcare system, the responsibility of delivering health services rests, by and large, in the hands of health authorities. These organizations work at an arm’s length from provincial governments, receiving funding and broad-based policy directions, but not operational directives (See Philippon and Braithwaite, 2008). Charged with operating in the public’s best interest and providing goods and services that have ‘public characteristics’, Canadian health regions meet criteria set out by Bozeman and Bretchneider (1994, p. 199) of a public organization. Although there are many other definitions and conceptualizations of ‘publicness’ this paper does not discuss or consider different conceptualizations.

S

AMPLE

In line with the studies selected for comparison in this paper, namely Mintzberg (1973), which describes the work of five American CEOs who were shadowed for a period of 1 week each, and Tengblad (2006), which shadowed four Swedish CEOs to determine whether the nature of work had changed 30 years after Mintzberg’s study, this study focuses specifically on the work of top managers (CEOs). In total, four Canadian healthcare CEOs were examined, all of which were at the helm of a large public organization. Employing 5,000 to 20,000 employees in each organization, the CEOs examined in this study were responsible for managing the delivery of health services for a population base of more than 2.5 million Canadians, and managing a collective budget of approximately $4.7 billion (CAD). All of the managers under study operated large geographic health regions and managed multiple facilities in both urban and rural settings. These organizations were strategically selected to represent the geographical diversity of Canada, which includes highly populated urban environments and sparsely populated rural areas.

Importantly, the small sample size that was employed in this study allowed for the collection of in-depth, detailed information on executive work, but came at the expense of generalizability. As such, it should be noted that there is no attempt to compare or generalize findings to the work of middle or lower level managers. However, the aim of this study is not to generalize findings across managerial levels or sectors, but rather to generate insights as to the work patterns and behaviors of top managers in the Canadian healthcare sector, relative to their private sector

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ETHODOLOGY

When examining distinctions between the public and private sector, the vast majority of studies have relied on data and that from interviews and large-scale surveys and questionnaires (Boyne 2002; Rainey et al. 1995). While these methods have a number of known benefits, specifically with regards to generalizability and reliability, Rainey and Bozeman (2000) have suggested that widespread use of these tools has been problematic in examinations of public-private distinctions as a priori

views (widely held untested assertions and foregone conclusions about distinctions), may inadvertently affect empirical results. Specifically, that managers asked to comparatively evaluate their work behaviors relative to their private or public sector colleagues may unknowingly construct a reality based on established views that work is distinct (Dahl and Lindblom, 1953), treating widely held views as truisms rather than answering their questions with an open mind.

In an attempt to minimize the impact of construct validity this study relies on qualitative research instruments that have been commonly associated with the managerial work research (Carlson, 1951; Noordegraaf and Stewart, 2000). Tools used in this study include semi-structured observation and ethnographic interviews. The primary research method employed was semi-structured observation, which is referred to as ‘shadowing’ (Noordegraaf, 2000). This involved the researcher closely following managers throughout the working day from beginning to end, recording the frequency and duration of activities (structured activities based on Mintzberg’s categories), as well as trivial, mundane and difficult to articulate aspects of managing (unstructured activities). To support the observed work of the managers from

shadowing, ethnographic interviews were conducted on a daily basis, generally at the end of the day or after important meetings. These interviews were used to answer any unresolved questions about the work of the managers that surfaced over the day such as the identity of those at the other end of phone conversations, the purpose and objective of meetings, and any underlying information about issues discussed (to give any unknown context).

The observations and interviews for this study were conducted between September 2011 and May 2012, and were spread out throughout the year in 1-3 week chunks to represent executive work over the calendar year. In total, this study describes more than 679 hours of executive work, of which 488 hours were directly observable (72%). There were of course, some work activities that were not directly observable, either due to concerns relating to confidentiality of issues (53.8 hours or 7.9% or work hours), or because work was conducted in a location not accessible to the researcher (137.5 hours or 20.1% of work hours). For example, in-camera meetings between the CEO and board of directors, times when the CEOs engaged in disciplinary action with colleagues, and work that was conducted from home or hotels. In these instances the managers were asked to take note of their activities, and then play them back to the researcher verbally, either through a phone call or in a debriefing session.

To ensure that comparisons are as accurate as possible, the data collection and analysis procedures outlined by Mintzberg (1973, p. 231-277) and applied by Tengblad (2006) in a replication of Mintzberg’s initial investigation were closely followed. However, even so, there are some important contextual differences

between this investigation and the other two studies that impact the comparisons and are thus worth noting. First off, this study was conducted in a different country than both Mintzberg (1973) (United States) and Tengblad (2006) (Sweden). However, like earlier comparisons of managerial work this was not may seen as a significant factor as the managers in each study held the same positional title of Chief Executive Officer, a title which carries similar operational responsibilities in all of the counties under study (Doktor 1990; Tengblad 2006). Furthermore, managerial responsibilities are noted as being particularly similar in Sweden and Canada where, unlike the USA, CEOs generally do not serve as chairman of the board (Hossack, 2006). This was cited a notable difference between Tengblad’s earlier comparison with Mintzberg (1973). Therefore, boards of directors in both Canada and Sweden are responsible for monitoring and policymaking functions, but have no right to interfere with current operations, which is the chief responsibility of the CEO (Tengblad, 2006). Secondly, although Tengblad’s study of Swedish CEOs is the most recent comparative examination of managerial work at the top manager level, the fieldwork for his study was conducted more than 10 years prior to this examination (1998/1999). Nonetheless, this is similarly viewed as bearing little weight on the comparison, as evidence suggests that managerial work in the private sector has undergone few changes since Tengblad’s study. In fact only one major change had been alluded to (although not explicitly examined) in the literature: a greater reliance on technology in the workplace (Barley et al., 2011; Gratton, 2011; Stewart, 2008). Thus, without disrupting the pre-defined categories developed by Mintzberg (1973),

additional categories were added in an attempt to capture technology use in the workplace and provide grounds for future comparisons.

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