1
|
Debets M, Jansen I, Lombarts K, Kuijer-Siebelink W, Kruijthof K, Steinert Y, Daams J, Silkens M. Linking leadership development programs for physicians with organization-level outcomes: a realist review. BMC Health Serv Res 2023; 23:783. [PMID: 37480101 PMCID: PMC10362722 DOI: 10.1186/s12913-023-09811-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Hospitals invest in Leadership Development Programs (LDPs) for physicians, assuming they benefit the organization's performance. Researchers have listed the advantages of LDPs, but knowledge of how and why organization-level outcomes are achieved is missing. OBJECTIVE To investigate how, why and under which circumstances LDPs for physicians can impact organization-level outcomes. METHODS We conducted a realist review, following the RAMESES guidelines. Scientific articles and grey literature published between January 2010 and March 2021 evaluating a leadership intervention for physicians in the hospital setting were considered for inclusion. The following databases were searched: Medline, PsycInfo, ERIC, Web of Science, and Academic Search Premier. Based on the included documents, we developed a LDP middle-range program theory (MRPT) consisting of Context-Mechanism-Outcome configurations (CMOs) describing how specific contexts (C) trigger certain mechanisms (M) to generate organization-level outcomes (O). RESULTS In total, 3904 titles and abstracts and, subsequently, 100 full-text documents were inspected; 38 documents with LDPs from multiple countries informed our MRPT. The MRPT includes five CMOs that describe how LDPs can impact the organization-level outcomes categories 'culture', 'quality improvement', and 'the leadership pipeline': 'Acquiring self-insight and people skills (CMO1)', 'Intentionally building professional networks (CMO2)', 'Supporting quality improvement projects (CMO3)', 'Tailored LDP content prepares physicians (CMO4)', and 'Valuing physician leaders and organizational commitment (CMO5)'. Culture was the outcome of CMO1 and CMO2, quality improvement of CMO2 and CMO3, and the leadership pipeline of CMO2, CMO4, and CMO5. These CMOs operated within an overarching context, the leadership ecosystem, that determined realizing and sustaining organization-level outcomes. CONCLUSIONS LDPs benefit organization-level outcomes through multiple mechanisms. Creating the contexts to trigger these mechanisms depends on the resources invested in LDPs and adequately supporting physicians. LDP providers can use the presented MRPT to guide the development of LDPs when aiming for specific organization-level outcomes.
Collapse
Affiliation(s)
- Maarten Debets
- Amsterdam UMC, Medical Psychology, Univ of Amsterdam, Amsterdam Public Health, AMC, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Iris Jansen
- Amsterdam UMC, Medical Psychology, Univ of Amsterdam, Amsterdam Public Health, AMC, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands
| | - Kiki Lombarts
- Amsterdam UMC, Medical Psychology, Univ of Amsterdam, Amsterdam Public Health, AMC, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands
| | - Wietske Kuijer-Siebelink
- School of Education, Research On Responsive Vocational and Professional Education, HAN University of Applied Sciences, Nijmegen, Netherlands
- Research On Learning and Education, Radboud University Medical Centre, Radboudumc Health Academy, Nijmegen, Netherlands
| | - Karen Kruijthof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, De Boelelaan 1117, Amsterdam, Netherlands
| | - Yvonne Steinert
- Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, Montreal, Canada
| | - Joost Daams
- Medical Library, Amsterdam University Medical Centers, Amsterdam, Noord-Holland, Netherlands
| | - Milou Silkens
- Department of Health Services Research & Management, City University of London, London, UK
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, Netherlands
| |
Collapse
|
2
|
Clouder L, Bluteau P, Jackson JA, Adefila A, Furlong J. Education for integrated working: A qualitative research study exploring and contextualizing how practitioners learn in practice. J Interprof Care 2021; 36:24-33. [PMID: 34402733 DOI: 10.1080/13561820.2021.1889485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Integrated working can be a means of providing efficient and cost-effective care, which benefits both service users and health professionals. However, it does require readiness of practitioners to work in new and innovative ways to achieve integration. This paper describes the findings of a qualitative study exploring the nature of practice-based education and training underpinning successful integrated care teams using an ecological systems theory lens. Nine teams in the West Midlands region of the United Kingdom (UK) participated in this study. A total of 27 participants were involved in semi-structured interviews during which they shared their views and experiences of learning in practice. Thematic analysis of interview transcripts highlighted the shifting context of working in integrated teams impacting on learning, the influence of leadership on education and training, the nature of in-service training, and the knowledge-sharing culture. The findings highlight that the learning climate is highly dependent on the leadership ethos in the practice context, which influences the allocation of time and resources for training and clinical supervision. Whilst formal education and training has an important role to play in fostering integrated working, informal learning is pivotal to successful integration and potentially has greater impact making it worthy of further study.
Collapse
Affiliation(s)
- Lynn Clouder
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Patricia Bluteau
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | | | - Arinola Adefila
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Jan Furlong
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| |
Collapse
|
3
|
Flaig J, Alam A, Huynh J, Reid-Hector J, Heuer A. Examining How Formal Leadership Development Programs Positively Influence Hospital Leaders' Individual Competencies and Organizational Outcomes - An Evidence-Based Literature Review. J Healthc Leadersh 2020; 12:69-83. [PMID: 32821187 PMCID: PMC7423345 DOI: 10.2147/jhl.s239676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background Leadership development programs (LDPs) are known to be educational and valuable, yet time consuming and costly for a healthcare organization and participants alike. This study is aimed to determine the impact that participation in a formal LDP has on hospital managers and leaders’ competencies, as well as to identify the positive organizational outcomes that can be achieved. Materials and Methods We conducted a literature review focusing on hospital managers and leaders who participated in formal LDPs. From there, we extracted data to determine the outcomes achieved by participating in LDPs. Results The search yielded 7420 articles, of which 23 articles were used for this literature review. Overall, there were a wide range of positive outcomes for participants of LDPs and some outcomes appeared more frequently than others. The beneficial outcome that appeared most frequently was that participants were able to gain knowledge of management and leadership roles and responsibilities which appeared 13 times. An increase in participant’s confidence and communication skills appeared 10 times, respectively. The ability to network with others within the organization and an increase in job positivity and satisfaction appeared 7 times each. Discussion LDPs provided an array of positive outcomes for hospital leaders who had participated. However, there was a lack of studies on the topic and more research is needed in order to have a better understanding of the correlation between LDPs and beneficial organizational outcomes.
Collapse
Affiliation(s)
- John Flaig
- Rutgers School of Health Professions, Department of Interdisciplinary Studies Newark, NJ 07950, USA
| | - Arzina Alam
- Rutgers School of Health Professions, Department of Interdisciplinary Studies Newark, NJ 07950, USA
| | - Jimmy Huynh
- Rutgers School of Health Professions, Department of Interdisciplinary Studies Newark, NJ 07950, USA
| | - Janet Reid-Hector
- Rutgers School of Health Professions, Department of Interdisciplinary Studies Newark, NJ 07950, USA
| | - Albert Heuer
- Rutgers School of Health Professions, Department of Interdisciplinary Studies Newark, NJ 07950, USA
| |
Collapse
|
4
|
Braithwaite J, Ludlow K, Testa L, Herkes J, Augustsson H, Lamprell G, McPherson E, Zurynski Y. Built to last? The sustainability of healthcare system improvements, programmes and interventions: a systematic integrative review. BMJ Open 2020; 10:e036453. [PMID: 32487579 PMCID: PMC7265014 DOI: 10.1136/bmjopen-2019-036453] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The sustainability of healthcare delivery systems is challenged by ageing populations, complex systems, increasing rates of chronic disease, increasing costs associated with new medical technologies and growing expectations by healthcare consumers. Healthcare programmes, innovations and interventions are increasingly implemented at the front lines of care to increase effectiveness and efficiency; however, little is known about how sustainability is conceptualised and measured in programme evaluations. OBJECTIVES We aimed to describe theoretical frameworks, definitions and measures of sustainability, as applied in published evaluations of healthcare improvement programmes and interventions. DESIGN Systematic integrative review. METHODS We searched six academic databases, CINAHL, Embase, Ovid MEDLINE, Emerald Management, Scopus and Web of Science, for peer-reviewed English journal articles (July 2011-March 2018). Articles were included if they assessed programme sustainability or sustained outcomes of a programme at the healthcare system level. Six reviewers conducted the abstract and full-text review. Data were extracted on study characteristics, definitions, terminology, theoretical frameworks, methods and tools. Hawker's Quality Assessment Tool was applied to included studies. RESULTS Of the 92 included studies, 75.0% were classified as high quality. Twenty-seven (29.3%) studies provided 32 different definitions of sustainability. Terms used interchangeably for sustainability included continuation, maintenance, follow-up or long term. Eighty studies (87.0%) clearly reported the timepoints at which sustainability was evaluated: 43.0% at 1-2 years and 11.3% at <12 months. Eighteen studies (19.6%) used a theoretical framework to conceptualise or assess programme sustainability, including frameworks that were not specifically designed to assess sustainability. CONCLUSIONS The body of literature is limited by the use of inconsistent definitions and measures of programme sustainability. Evaluations of service improvement programmes and interventions seldom used theoretical frameworks. Embedding implementation science and healthcare service researchers into the healthcare system is a promising strategy to improve the rigour of programme sustainability evaluations.
Collapse
Affiliation(s)
- Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kristiana Ludlow
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Luke Testa
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jessica Herkes
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hanna Augustsson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gina Lamprell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elise McPherson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
5
|
Bartman T, Heiser K, Bethune A, Crandall W, McClead R, Davis JT, Brilli RJ. Interprofessional QI Training Enhances Competency and QI Productivity Among Graduates: Findings From Nationwide Children's Hospital. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:292-298. [PMID: 28817428 DOI: 10.1097/acm.0000000000001862] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Significant resources are expended on quality improvement (QI) training courses. The authors sought to determine whether education provided in QI course training improves self-assessed QI content competence and QI-related productivity among course graduates. METHOD "Quality Improvement Essentials" is a four-month didactic and experiential course designed to prepare multidisciplinary professionals to participate in and lead QI efforts at Nationwide Children's Hospital (NCH). This study used a milestone-based self-assessment survey of graduates from 2012 to 2014 to gauge change in participants' self-assessed QI competency after course completion. Four competency domains were evaluated: QI knowledge; testing and implementing change using teams; data management and analysis; and spreading and sustaining science. Metrics for assessing individual QI productivity were presentation or publication of QI work outside NCH; local, regional, or national QI teaching; serving on a local, regional, or national QI committee; appointment as a QI leader; involvement in an internal or external QI collaborative; and leading a maintenance of certification Part IV project approved by NCH. RESULTS Course participation more than doubled participants' self-assessed QI competence across all four domains. Gains continued after the course, increasing with time rather than degrading. Self-assessed competency increase was significantly associated with increased QI productivity. CONCLUSIONS Self-assessed QI competence dramatically improved after participation in an educational course and continued to increase over time. Increased self-assessed QI competency correlated with increased individual QI productivity. Further studies are necessary to fully evaluate "return on investment" for this type of course.
Collapse
Affiliation(s)
- Thomas Bartman
- T. Bartman is associate professor, Department of Pediatrics, Division of Neonatology, Ohio State University College of Medicine, director of quality improvement for neonatal services, and associate medical director for quality, Nationwide Children's Hospital, Columbus, Ohio. K. Heiser is vice president for education and designated institutional official, Nationwide Children's Hospital, Columbus, Ohio. A. Bethune is quality improvement services education coordinator, Department of Education, Nationwide Children's Hospital, Columbus, Ohio. W. Crandall is professor, Department of Pediatrics, Ohio State University College of Medicine, Division of Gastroenterology, and medical director for quality, Nationwide Children's Hospital, Columbus, Ohio. R. McClead is emeritus professor, Department of Pediatrics, Division of Neonatology, Ohio State University College of Medicine, and associate chief medical officer, Nationwide Children's Hospital, Columbus, Ohio. J.T. Davis is emeritus professor of clinical surgery, Ohio State University College of Medicine, and assistant to the chief medical officer, Nationwide Children's Hospital, Columbus, Ohio. R.J. Brilli is professor, Department of Pediatrics, Division of Critical Care Medicine at Ohio State University College of Medicine, and chief medical officer, Nationwide Children's Hospital, Columbus, Ohio
| | | | | | | | | | | | | |
Collapse
|
6
|
Abstract
PURPOSE Leading health systems have invested in substantial quality improvement (QI) capacity building, but little is known about the aggregate effect of these investments at the health system level. We conducted a systematic review to identify key steps and elements that should be considered for system-level evaluations of investment in QI capacity building. METHODS We searched for evaluations of QI capacity building and evaluations of QI training programmes. We included the most relevant indexed databases in the field and a strategic search of the grey literature. The latter included direct electronic scanning of 85 relevant government and institutional websites internationally. Data were extracted regarding evaluation design and common assessment themes and components. RESULTS 48 articles met the inclusion criteria. 46 articles described initiative-level non-economic evaluations of QI capacity building/training, while 2 studies included economic evaluations of QI capacity building/training, also at the initiative level. No system-level QI capacity building/training evaluations were found. We identified 17 evaluation components that fit within 5 overarching dimensions (characteristics of QI training; characteristics of QI activity; individual capacity; organisational capacity and impact) that should be considered in evaluations of QI capacity building. 8 key steps in return-on-investment (ROI) assessments in QI capacity building were identified: (1) planning-stakeholder perspective; (2) planning-temporal perspective; (3) identifying costs; (4) identifying benefits; (5) identifying intangible benefits that will not be included in the ROI estimation; (6) discerning attribution; (7) ROI calculations; (8) sensitivity analysis. CONCLUSIONS The literature on QI capacity building evaluation is limited in the number and scope of studies. Our findings, summarised in a Framework to Guide Evaluations of QI Capacity Building, can be used to start closing this knowledge gap.
Collapse
Affiliation(s)
- Gustavo Mery
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark J Dobrow
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Im
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Adalsteinn Brown
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Larson DB, Mickelsen LJ, Garcia K. Realizing Improvement through Team Empowerment (RITE): A Team-based, Project-based Multidisciplinary Improvement Program. Radiographics 2016; 36:2170-2183. [DOI: 10.1148/rg.2016160136] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
8
|
A comprehensive model to build improvement capability in a pediatric academic medical center. Acad Pediatr 2014; 14:29-39. [PMID: 24369867 DOI: 10.1016/j.acap.2013.02.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/18/2013] [Accepted: 02/17/2013] [Indexed: 11/21/2022]
Abstract
Cincinnati Children's Hospital Medical Center developed a comprehensive model to build quality improvement (QI) capability to support its goal to transform its delivery system through a series of training courses. Two online modules orient staff to basic concepts and terminology and prepare them to participate more effectively in QI teams. The basic program (Rapid Cycle Improvement Collaborative, RCIC) is focused on developing the capability to use basic QI tools and complete a narrow-scoped project in approximately 120 days. The Intermediate Improvement Science Series (I(2)S(2)) program is a leadership course focusing on improvement skills and developing a broader and deeper understanding of QI in the context of the organization and external environment. The Advanced Improvement Methods (AIM) course and Quality Scholars Program stimulate the use of more sophisticated methods and prepare Cincinnati Children's Hospital Medical Center (CCHMC) and external faculty to undertake QI research. The Advanced Improvement Leadership Systems (AILS) sessions enable interprofessional care delivery system leadership teams to effectively lead a system of care, manage a portfolio of projects, and to deliver on CCHMC's strategic plan. Implementing these programs has shown us that 1) a multilevel curricular approach to building improvement capability is pragmatic and effective, 2) an interprofessional learning environment is critical to shifting mental models, 3) repetition of project experience with coaching and feedback solidifies critical skills, knowledge and behaviors, and 4) focusing first on developing capable interprofessional improvement leaders, versus engaging in broad general QI training across the whole organization, is effective.
Collapse
|
9
|
Nelson MF, Merriman CS, Magnusson PT, Thomassian KV, Strawn A, Martin J. Creating a physician-led quality imperative. Am J Med Qual 2013; 29:508-16. [PMID: 24259433 DOI: 10.1177/1062860613509683] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To emerge from a significant quality crisis, hospital administration recognized the need for physician leadership to drive improvements. A framework is presented for a physician-led Quality Summit to select best practice initiatives for implementation over 1 year. Results demonstrated statistically significant reductions in ventilator-associated pneumonia, decreasing from the first quarter 2009 baseline of 8.34 per 1000 ventilator days to 3.32 per 1000 ventilator days in second quarter 2010 (P = .0055). During the same time frame, catheter-associated urinary tract infections decreased from 4.35 per 1000 catheter days to 0.98 per 1000 catheter days (P = .0438), and severe sepsis/septic shock mortality declined from 33% to 13% (P = .0084). The customized World Health Organization Surgical Safety Checklist was used in 93% of surgeries within 1 month of adoption. Venous thromboembolism screening for adults became routine. The annual Quality Summit cycle engages physicians to introduce and spread quality improvement.
Collapse
|
10
|
Bernabeo E, Hood S, Iobst W, Holmboe E, Caverzagie K. Optimizing the implementation of practice improvement modules in training: lessons from educators. J Grad Med Educ 2013; 5:74-80. [PMID: 24404231 PMCID: PMC3613323 DOI: 10.4300/jgme-d-11-00281.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 05/22/2012] [Accepted: 06/22/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The American Board of Internal Medicine approved the use of Practice Improvement Modules (PIMs) to help training programs teach and assess practice-based learning and improvement (PBLI) and systems-based practice (SBP). METHODS We surveyed individuals who ordered a PIM in a residency or fellowship training program between June 2006 and August 2009. The 43 programs that volunteered to participate completed a 30-minute anonymous online survey. RESULTS Program directors or associate program directors led the PIM process in 30 programs (70%). Trainees' degrees of involvement in PIMs were highly variable between programs, and several respondents felt that trainees were either not sufficiently engaged or not engaged with enough consistency. The most common activity for trainee involvement was data collection through patient surveys or chart review, although only 17 programs (40%) provided protected time for this activity. Few trainees participated in higher level activities such as data analysis or identification for areas of improvement or were given leadership roles; yet most respondents reported that completing the PIM helped trainees learn basic principles of QI and develop competence in PBLI and SBP and that PIM completion improved the program's ability to develop QI initiatives and resulted in program or institutional improvements, including sustainable improvement in patient care. Most respondents reported that the outcome warranted the effort to complete PIMs. CONCLUSIONS PIMs may be a valuable but underused educational experience for trainees as well as training programs. Focusing on particular themes and facets of PIMs may facilitate implementation.
Collapse
|
11
|
Nash DB. Summary of Proceedings From the Association of American Medical Colleges 2011 Integrating Quality Meeting. Am J Med Qual 2012; 27:3S-37S. [DOI: 10.1177/1062860612445460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|