Masters in Health Service Management Honours dissertation in the School of Public Health, Griffith University
Title: Soft systems methodology for casemix innovations in India: a case of the public hospital sector in Jaipur health service district, Rajasthan
Supervisors: Associate Professor Peter F Howard (Griffith University) and Mr Stephen Cole (Queensland Health)
During the past three decades, hospital management in economically-developed countries has been transformed by the adoption of a hospital management innovation know n as ‘casem ix ’. A s w ith any such novel advance, casemix has undergone multiple developm ents and ‘rebirths’, but these have not always factored in prior experiences and evaluations. The processes involved in the development of casemix reflect the necessity to understand and investigate casemix innovations in distinctive ways, particularly when the site for such innovations is a developing country such as India. This study utilises soft systems methodology to develop an original approach to casemix innovations in India.
The specific location selected for this study was the public hospital sector of Jaipur health service district, State of Rajasthan. The study employed a constructivist logic towards the case, whereby a quasi-experimental research design was constructed with the utilisation of soft systems concepts. The process began by effectively exploring prior literature and developing an orchestrated ‘human activity system’ amongst the actors involved in the study. The stage for this orchestration assimilated the underlying concepts of the ‘sev en-step’ soft systems model and integrated th e objectives of the study into three analysis modes: exploratory, diagnostic and design. Roles were designated for the 28 actors involved in the study and 19 inquiry questions were developed to concentrate their focus. The actors w ere classified as ‘problem ow ners’, ‘decision takers’ and a ‘problem solver’, and their involvement was expected to provide meaningful solutions to the process of introducing casemix innovations in Jaipur.
The exploratory mode of analysis involved the 25 problem owners and the problem solver in a dialogue, supported by inquiry questions 1 to 16. This inquiry process led to an appreciation of the underlying problem situation and resulted in the problem-solving system , which took into account the ‘worldviews’ of the problem owners as well as constructing explanations for purposeful casemix innovations in Jaipur. Thirty-four
worldviews were identified, which were grouped into 12 change elements. In the diagnostic mode, the problem solver developed specific ‘lines of thou ght’ based on his perceptions of the problem situation. This led to the identification of 25 barriers, and 26 perceived advantages and disadvantages of casemix innovation in Jaipur. During the design mode, the two decision takers and the problem solver were involved in a
dialogue to interpret the implications of these research findings in order develop appropriate policies to facilitate casemix innovations in Jaipur. This led to a three-point policy formula and a conceptual model at this policy level.
This study concludes by clarifying how the use of soft systems methodology for an examination of the potential diffusion of casemix innovations constitutes a novel approach to the study of innovation diffusions. In addition, the methodology encourages potential casemix researchers in India to vigorously evaluate the constructs of this study.
Key words: hospital management, innovation, casemix, soft systems methodology, Jaipur, India, human activity system, analysis modes, roles, worldviews, conceptual model, lines of thought.