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Antonopoulou V, Meyer C, Chadwick P, Gibson B, Sniehotta FF, Vlaev I, Vassova A, Goffe L, Lorencatto F, McKinlay A, Chater AM. Understanding healthcare professionals' responses to patient complaints in secondary and tertiary care in the UK: A systematic review and behavioural analysis using the Theoretical Domains Framework. Health Res Policy Syst 2024; 22:137. [PMID: 39354470 PMCID: PMC11443808 DOI: 10.1186/s12961-024-01209-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/01/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND The path of a complaint and patient satisfaction with complaint resolution is often dependent on the responses of healthcare professionals (HCPs). It is therefore important to understand the influences shaping HCP behaviour. This systematic review aimed to (1) identify the key actors, behaviours and factors influencing HCPs' responses to complaints, and (2) apply behavioural science frameworks to classify these influences and provide recommendations for more effective complaints handling behaviours. METHODS A systematic literature review of UK published and unpublished (so-called grey literature) studies was conducted (PROSPERO registration: CRD42022301980). Five electronic databases [Scopus, MEDLINE/Ovid, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Health Management Information Consortium (HMIC)] were searched up to September 2021. Eligibility criteria included studies reporting primary data, conducted in secondary and tertiary care, written in English and published between 2001 and 2021 (studies from primary care, mental health, forensic, paediatric or dental care services were excluded). Extracted data included study characteristics, participant quotations from qualitative studies, results from questionnaire and survey studies, case studies reported in commentaries and descriptions, and summaries of results from reports. Data were synthesized narratively using inductive thematic analysis, followed by deductive mapping to the Theoretical Domains Framework (TDF). RESULTS In all, 22 articles and three reports met the inclusion criteria. A total of 8 actors, 22 behaviours and 24 influences on behaviour were found. Key factors influencing effective handling of complaints included HCPs' knowledge of procedures, communication skills and training, available time and resources, inherent contradictions within the role, role authority, HCPs' beliefs about their ability to handle complaints, beliefs about the value of complaints, managerial and peer support and organizational culture and emotions. Themes mapped onto nine TDF domains: knowledge, skills, environmental context and resources, social/professional role and identity, social influences, beliefs about capability, intentions and beliefs about consequences and emotions. Recommendations were generated using the Behaviour Change Wheel approach. CONCLUSIONS Through the application of behavioural science, we identified a wide range of individual, social/organizational and environmental influences on complaints handling. Our behavioural analysis informed recommendations for future intervention strategies, with particular emphasis on reframing and building on the positive aspects of complaints as an underutilized source of feedback at an individual and organizational level.
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Affiliation(s)
- Vivi Antonopoulou
- Centre for Behaviour Change (CBC), Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
- NIHR Policy Research Unit (PRU) in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK.
| | - Carly Meyer
- Centre for Behaviour Change (CBC), Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- NIHR Policy Research Unit (PRU) in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Paul Chadwick
- Centre for Behaviour Change (CBC), Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- NIHR Policy Research Unit (PRU) in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Beckie Gibson
- NIHR Policy Research Unit (PRU) in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
- Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Falko F Sniehotta
- NIHR Policy Research Unit (PRU) in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, UK
- Department of Public Health, Preventive and Social Medicine, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
| | - Ivo Vlaev
- NIHR Policy Research Unit (PRU) in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
- Warwick Business School, University of Warwick, Coventry, UK
| | - Anna Vassova
- Centre for Behaviour Change (CBC), Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Louis Goffe
- NIHR Policy Research Unit (PRU) in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, UK
- NIHR Health Determinants Research Collaboration, Gateshead Council, Gateshead, NE8 1HH, UK
| | - Fabiana Lorencatto
- Centre for Behaviour Change (CBC), Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- NIHR Policy Research Unit (PRU) in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Alison McKinlay
- Centre for Behaviour Change (CBC), Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- NIHR Policy Research Unit (PRU) in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Angel Marie Chater
- Centre for Behaviour Change (CBC), Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- NIHR Policy Research Unit (PRU) in Behavioural and Social Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
- Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Polhill Avenue, Bedford, MK41 9EA, UK
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Crossette-Thambiah G, Berleant D, AbuHalimeh A. An Information Quality Framework for Managed Health Care. J Healthc Leadersh 2024; 16:343-364. [PMID: 39359406 PMCID: PMC11445674 DOI: 10.2147/jhl.s473833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 09/03/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction Data and information quality play a critical role in the managed healthcare sector, where accurate and reliable information is crucial for optimal decision-making, operations, and patient outcomes. However, managed care organizations face significant challenges in ensuring information quality due to the complexity of data sources, regulatory requirements, and the need for effective data management practices. The goal of this article is to develop and justify an information quality framework for managed healthcare, thereby enabling the sector to better meet its unique information quality challenges. Methods The information quality framework provided here was designed using other information quality frameworks as exemplars, as well as a qualitative survey involving interviews of twenty industry leaders structured around 17 questions. The responses were analyzed and tabulated to obtain insights into the information quality needs of the managed healthcare domain. Results The novel framework we present herein encompasses strategies for data integration, standardization and validation, and is followed by a justification section that draws upon existing literature and information quality frameworks in addition to the survey of leaders in the industry. Discussion Emphasizing objectivity, utility, integrity, and standardization as foundational pillars, the proposed framework provides practical guidelines to empower healthcare organizations in effectively managing information quality within the managed care model.
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Affiliation(s)
| | - Daniel Berleant
- Department of Information Science, University of Arkansas at Little Rock, Little Rock, AR, USA
| | - Ahmed AbuHalimeh
- Department of Information Science, University of Arkansas at Little Rock, Little Rock, AR, USA
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Dyar R, Mattick K, Griffiths A. Kindness in healthcare leadership and management: an evaluation and analysis of the concept. BMJ LEADER 2024:leader-2023-000742. [PMID: 38902022 DOI: 10.1136/leader-2023-000742] [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: 01/18/2023] [Accepted: 05/31/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Healthcare leadership and management impacts every patient journey and every staff experience. Good leadership results in positive outcomes. Kindness is an understudied and underused leadership strategy. The research questions addressed in this study are the following: (1) Does kindness in healthcare leadership and management currently meet the criteria of a mature concept?; (2) Using concept analysis methodology, can we develop our understanding of kindness within this context? METHODS A systematic search of the peer-reviewed literature was conducted to inform a concept evaluation, followed by a concept analysis. Search terms consisted of 'leader*' or 'manage*' and 'kindness'; databases searched comprised MEDLINE, HMIC, SPP, APA PsycInfo and CINAHL. Data extraction and thematic analysis of the data were performed manually according to concept analysis principles. RESULTS The 10 papers included from the search suggested that within healthcare leadership and management, kindness is an 'emerging' rather than a 'mature' concept. Concept analysis demonstrated a cluster of recurring attributes, allowing a theoretical definition to be put forth. CONCLUSIONS Despite being a commonly used lay term, kindness in the context of healthcare leadership and management is not yet a mature concept. Work developing this concept is needed to validate the proposed theoretical definition. Observational studies and systematic review of the grey literature are recommended.
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Affiliation(s)
- Rebecca Dyar
- Anaesthetics and Intensive Care Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Andrew Griffiths
- Mid and South Essex Integrated Care Organisation, Chelmsford, UK
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Zhao J, Wang BL, Qin X, Liu Y, Liu T. Core elements of excellent hospital leadership: lessons from the five top-performing hospitals in China. Int J Qual Health Care 2024; 36:mzae046. [PMID: 38804900 PMCID: PMC11168336 DOI: 10.1093/intqhc/mzae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/22/2024] [Accepted: 05/27/2024] [Indexed: 05/29/2024] Open
Abstract
Substantial evidence indicates that leadership plays a critical role in an organization's success. Our study aims to conduct case studies on leadership attributes among China's five top-performing hospitals, examining their common practices. A semi-structured interview was conducted with 8 leaders, 39 managers, 19 doctors, and 16 nurses from the five sample hospitals in China. We collected information from these hospitals on the role of senior leadership, organizational governance, and social responsibility, aligning with the leadership assessment guidelines in the Baldrige Excellence Framework. Qualitative data underwent interpretation through content analysis, thematic analysis, and comparative analysis. This study adhered to the consolidated criteria for reporting qualitative research guidelines for reporting qualitative research. Our study revealed that the leaders of the five top-performing hospitals in China consistently established "Patient Needs First" as the core element of the hospital culture. Striving to build world-renowned hospitals with Chinese characteristics, the interviewees all believed strongly in scientific vigor, professionalism, and cooperative culture. The leaders adhered to a staff-centered approach, placing special emphasis on talent recruitment and development, creating a compensation system, and fostering a supportive environment conducive to enhancing medical knowledge, skills, and professional ethics. In terms of organizational governance, they continuously enhanced the communication between various departments and levels of staff, improved the quality and safety of medical care, and focused on innovative medical and scientific research, thereby establishing evidence-based, standardized hospital management with a feedback loop. Meanwhile, regarding social responsibility, they prioritized improvements in the quality of healthcare by providing international and domestic medical assistance, community outreach, and other programs. To a large extent, the excellent leadership of China's top-performing hospitals can be attributed to their commitment to a "Two-Pillared Hospital Culture," which prioritizes putting patient needs first and adopting a staff-centered approach. Furthermore, the leaders of these hospitals emphasize hospital performance, operations management, and social responsibility.
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Affiliation(s)
- Jinhong Zhao
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 9, Dongdansantiao Street, Dongcheng District, Beijing 100730, China
| | - Bing-Long Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 9, Dongdansantiao Street, Dongcheng District, Beijing 100730, China
| | - Xiaoping Qin
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 9, Dongdansantiao Street, Dongcheng District, Beijing 100730, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 9, Dongdansantiao Street, Dongcheng District, Beijing 100730, China
| | - Tingfang Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 9, Dongdansantiao Street, Dongcheng District, Beijing 100730, China
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Buttigieg SC, Riva N, Tomaselli G, Said E, Grech E, Cassar V. PROTOCOL: Do hospital leadership styles predict patient safety indicators? A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1338. [PMID: 37425619 PMCID: PMC10327627 DOI: 10.1002/cl2.1338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
This is the protocol for a Campbell systematic review. The objectives are as follows: The main aim of this systematic review is to identify whether hospital leadership styles predict patient safety as measured through several indicators over time. The second aim is to assess the extent to which the prediction of hospital leadership styles on patient safety indicators varies as a function of the leader's hierarchy level in the organization.
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Affiliation(s)
- Sandra C. Buttigieg
- Department of Health Systems Management and Leadership, Faculty of Health SciencesUniversity of MaltaMsidaMalta
| | - Nicoletta Riva
- Department of Pathology, Faculty of Medicine and SurgeryUniversity of MaltaMsidaMalta
| | - Gianpaolo Tomaselli
- Department of Health Systems Management and Leadership, Faculty of Health SciencesUniversity of MaltaMsidaMalta
| | - Emanuel Said
- Department of Marketing, Faculty of Economics, Management and AccountancyUniversity of MaltaMsidaMalta
| | - Elaine Grech
- Department of Marketing, Faculty of Economics, Management and AccountancyUniversity of MaltaMsidaMalta
| | - Vincent Cassar
- Department of Business and Enterprise Management, Faculty of Economics Management and AccountancyUniversity of MaltaMsidaMalta
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Nilsen KH, Lauritzen C, Vis SA, Iversen A. Factors affecting child welfare and protection workers' intention to quit: a cross-sectional study from Norway. HUMAN RESOURCES FOR HEALTH 2023; 21:43. [PMID: 37277828 DOI: 10.1186/s12960-023-00829-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION High turnover rates have been a problem for Norwegian child welfare and protection services for years. The main aim of this study was to identify which factors affect Norwegian child welfare and protection (CWP) workers intention to quit their job and whether there is a difference between experienced (< 3 years) and less experienced workers. METHODS A cross-sectional survey was performed among 225 Norwegian child welfare and protection workers. Data were collected using a self-report questionnaire. Turnover intention was examined using a variety of job demands and resources as possible predictors. T tests were used to study mean differences in variable scores between experienced and less experienced workers and linear regression analysis was employed determining predictors of intention to quit. RESULTS For the total sample (N = 225) the most important predictors for intention to quit were workload, burnout, engagement, and views on leadership. Higher emotional exhaustion and cynicism, and low professional efficacy predicted a higher score on the intention to quit scale. High engagement and leadership satisfaction predicted lower scores. The effect of workload was moderated, such that intention to quit among less experienced workers increased more with high workload than it did among more experienced child welfare workers. CONCLUSIONS The conclusions are that job demands affect experienced and less experienced CWP workers differently and that when designing preventive efforts to reduce turnover this must be considered.
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Affiliation(s)
- Kristel Høie Nilsen
- RKBU Institute, UiT The Arctic University of Norway, Langnes, PO Box 6050, 9037, Tromsø, Norway.
| | - Camilla Lauritzen
- RKBU Institute, UiT The Arctic University of Norway, Langnes, PO Box 6050, 9037, Tromsø, Norway
| | - Svein Arild Vis
- RKBU Institute, UiT The Arctic University of Norway, Langnes, PO Box 6050, 9037, Tromsø, Norway
| | - Anita Iversen
- Centre for Faculty Development, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Aldersley K, Gibb J, Grainger C, Abou-El-Ela-Bourquin B, Badhrinarayanan S, Bhanot R, Clark R, Douglas H, Fukui A, Hana Z, Imtiaz I, Kalsi T, Kerwan A, Khera R, MacLachlan E, McGrath J, Meredith E, Penrice S, Saleh D, Tank V, Vadeyar S, Devine OP. Medical leadership training varies substantially between UK medical schools: Report of the leadership in undergraduate medical education national survey (LUMENS). MEDICAL TEACHER 2023; 45:58-67. [PMID: 35981566 DOI: 10.1080/0142159x.2022.2078185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Doctors are increasingly expected to demonstrate medical leadership and management (MLM) skills. The Faculty of Medical Leadership and Management (FMLM) has published an indicative undergraduate curriculum to guide the development of MLM content at UK medical schools. METHOD Students from 30 medical schools were surveyed to determine their understanding of MLM teaching at their school. Timetables for 21 schools were searched for MLM-related keywords. Student-reported teaching and timetabled teaching were coded according to predefined themes. Aggregated demographic and postgraduate performance data were obtained through collaboration with the Medical Student Investigators Collaborative (msico.org). RESULTS Whilst 88% of medical students see MLM teaching as relevant, only 18% believe it is well integrated into their curriculum. MLM content represented ∼2% of timetabled teaching in each 5-year undergraduate medical course. Most of this teaching was dedicated to teamwork, performance/reflection and communication skills. There was minimal association between how much of a topic students believed they were taught, and how much they were actually taught. We found no association between the volume of MLM teaching and performance in postgraduate examinations, trainee career destinations or fitness to practice referrals. CONCLUSION Our findings demonstrate limited and variable teaching of MLM content. Delivery was independent of broader teaching and assessment factors.
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Affiliation(s)
- Katherine Aldersley
- Brighton and Sussex Medical School, Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Jonathan Gibb
- School of Medical Sciences, University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Charlotte Grainger
- University of Birmingham Medical School, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Bilal Abou-El-Ela-Bourquin
- University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Shreya Badhrinarayanan
- Brighton and Sussex Medical School, Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Ravina Bhanot
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom of Great Britain and Northern Ireland
| | - Ryan Clark
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Hannah Douglas
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Akiko Fukui
- St George's University of London, London, United Kingdom of Great Britain and Northern Ireland
| | - Zac Hana
- GKT School of Medical Education, King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Inshal Imtiaz
- UCL Medical School, University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Tejinder Kalsi
- Hull York Medical School, Hull York Medical School, York, United Kingdom of Great Britain and Northern Ireland
| | - Ahmed Kerwan
- Medical Sciences Division, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Rajkumar Khera
- School of Medicine, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Eloisa MacLachlan
- School of Medicine, University of Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Jack McGrath
- School of Medicine, Cardiff University, Cardiff, United Kingdom of Great Britain and Northern Ireland
| | - Ellen Meredith
- School of Medical Education, Newcastle University, Newcastle, United Kingdom of Great Britain and Northern Ireland
| | - Sam Penrice
- School of Medicine, University of Dundee, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Dina Saleh
- Imperial College School of Medicine, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Vivek Tank
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom of Great Britain and Northern Ireland
| | - Sharvari Vadeyar
- School of Medicine, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Oliver Patrick Devine
- UCL Medical School, University College London, London, United Kingdom of Great Britain and Northern Ireland
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Mannocci A, Marigliano M, La Torre G. An assessment of organizational well-being, organizational health, and work-related stress: A cross-sectional study of nurses involved with COVID-19 interventions. Work 2022; 75:29-39. [PMID: 36591689 DOI: 10.3233/wor-220274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Nurses have been affected by stress, developing many related consequences during the health emergency caused by the SARS-CoV-2 (COVID-19) pandemic. It is essential for healthcare organizations to protect their human resources because there is a strong correlation between the health status of healthcare workers and the quality of care provided. OBJECTIVE The aim of the study was to measure the perception of the organizational health level of the workplace among COVID-19 nurses (i.e. nurses who directly dealt with COVID-19 countermeasures) as an influence on work quality and work-related stress. METHODS A cross-sectional study was carried out by administering the Nursing Questionnaire on Organizational Health (QISO) to nurses in contact with COVID-19 patients. The search period ranged between August and September 2021 with nurses who work and/or worked in Lazio. RESULTS 123 questionnaires were collected. The scores with a value below the recommended level (2,6) are: "Comfort of the working environment" (mean = 2,57; SD = 0,66); "Valorization of skills" (mean = 2,40; SD = 0,62); "Openness to innovation" (mean = 2,46; SD = 0,77); "Satisfaction with top management" (mean = 2,48; SD = 0,81); the inverse scale "Fatigue" (mean = 2,94; SD = 0,55). CONCLUSION Management of healthcare organizations should define action strategies to promote and increase organizational well-being and reduce work-related stress risk factors. Some action strategies that could be used include improving the elements of the work environment to make it more comfortable for workers; strengthening and improving communication; improving the relationship between nurses and senior management; and establishing a team of experts for psychological assistance.
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Affiliation(s)
| | - Manuela Marigliano
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
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Korku C, Kaya S. Relationship Between Authentic Leadership, Transformational Leadership and Innovative Work Behaviour: Mediating Role of Innovation Climate. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2022:1-7. [PMID: 35947759 DOI: 10.1080/10803548.2022.2112445] [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: 10/15/2022]
Abstract
Purpose. This study aimed to demonstrate the effect of transformational and authentic leaderships characteristics of healthcare managers on employees' innovative work behavior and the mediating role of innovation climate. Methods. The study was conducted in 19 hospitals in Turkey and 263 managers participated in the study. The data were collected using the Transformational Leadership Questionnaire, the Authentic Leadership Questionnaire, Innovative Climate Assessment Tool, and Innovative Work Behavior Scale. Path analysis was performed to demonstrate the relationship between the variables. Results. When transformational and authentic leadership were put into the model separately through the innovation climate, transformational leadership had an effect of 0.39 units (0.22 units direct, 0.17 units indirect) and a uthentic leadership had a 0.44 unit (0.29 unit direct, 0.15 unit indirect) effect on innovative work behavior. When transformational and authentic leadership were put together in the model, the total (direct and indirect) effect of them increased to 0.52 units. In this case, the effect of authentic leadership characteristics of health managers on innovative work behavior of their followers (0.42 units) was greater than the effect of transformational leadership characteristics (0.10 units). Conclusions. Although both types of leadership affect innovative work behavior, authentic leadership was more effective than transformational leadership.
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Affiliation(s)
- Cahit Korku
- Department of Healthcare Management, Niğde Zübeyde Hanım School of Health, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Sıdıka Kaya
- Department of Healthcare Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
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Do VQ, Mitchell R, Clay-Williams R, Taylor N, Ting HP, Arnolda G, Braithwaite J. Safety climate, leadership and patient views associated with hip fracture care quality and clinician perceptions of hip fracture care performance. Int J Qual Health Care 2021; 33:6432125. [PMID: 34849951 DOI: 10.1093/intqhc/mzab152] [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: 07/12/2021] [Revised: 10/07/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hip fracture is a major public health concern for older adults, requiring surgical treatment for patients presenting at hospitals across Australia. Although guidelines have been developed to drive appropriate care of hip fracture patients in hospitals, data on health outcomes suggest these are not well-followed. OBJECTIVE This study aims to examine whether clinician measures of safety, teamwork and leadership, and patient perceptions of care are associated with key indicators of hip fracture care and the extent to which there is agreement between clinician perceptions of hip fracture care performance and actual hospital performance of hip fracture care. METHODS Retrospective analysis was performed on a series of questionnaires used to assess hospital department- and patient-level measures from the Deepening our Understanding of Quality in Australia study. Data were analysed from 32 public hospitals that encompassed 23 leading hip fracture clinicians, 716 patient medical records and 857 patients from orthopaedic public hospital wards. RESULTS Aggregated across all hospitals, only 5 of 12 of the key hip fracture indicators had ≥50% adherence. Adherence to indicators requiring actions to be performed within a recommended time period was poor (7.2-25.6%). No Patient Measure of Safety or clinician-based measures of teamwork, safety climate or leadership were associated with adherence to key indicators of hip fracture care. Simple proportionate agreement between clinician perceptions and actual hospital performance was generally strong, but few agreement coefficients were compelling. CONCLUSION The development of strong quality management processes requires ongoing effort. The findings of this study provide important insights into the relationship between hospital care and outcomes for hip fracture patients and could drive the design of targeted interventions for improved quality assurance of hip fracture care.
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Affiliation(s)
- Vu Quang Do
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council New South Wales, 153 Dowling Street, Sydney, Woolloomooloo, NSW 2011, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Hsuen Pei Ting
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW 2109, Australia
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Gauld R, Horsburgh S. Did healthcare professional perspectives on the quality and safety environment in New Zealand public hospitals change from 2012 to 2017? J Health Organ Manag 2021; 34:775-788. [PMID: 32979044 DOI: 10.1108/jhom-11-2019-0331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The work environment is known to influence professional attitudes toward quality and safety. This study sought to measure these attitudes amongst health professionals working in New Zealand District Health Boards (DHBs), initially in 2012 and again in 2017. DESIGN/METHODOLOGY/APPROACH Three questions were included in a national New Zealand health professional workforce survey conducted in 2012 and again in 2017. All registered health professionals employed with DHBs were invited to participate in an online survey. Areas of interest included teamwork amongst professionals; involvement of patients and families in efforts to improve patient care and ease of speaking up when a problem with patient care is perceived. FINDINGS In 2012, 57% of respondents (58% in 2017) agreed health professionals worked as a team; 71% respondents (73% in 2017) agreed health professionals involved patients and families in efforts to improve patient care and 69% (65% in 2017) agreed it was easy to speak up in their clinical area, with none of these changes being statistically significant. There were some response differences by respondent characteristics. PRACTICAL IMPLICATIONS With no change over time, there is a demand for improvement. Also for leadership in policy, management and amongst health professionals if goals of improving quality and safety are to be delivered upon. ORIGINALITY/VALUE This study provides a simple three-question method of probing perceptions of quality and safety and an important set of insights into progress in New Zealand DHBs.
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Affiliation(s)
- Robin Gauld
- Dean's Office and Centre for Health Systems and Technology, School of Business, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Preventive and Social Medicine and Centre for Health Systems and Technology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Leach L, Hastings B, Schwarz G, Watson B, Bouckenooghe D, Seoane L, Hewett D. Distributed leadership in healthcare: leadership dyads and the promise of improved hospital outcomes. Leadersh Health Serv (Bradf Engl) 2021; ahead-of-print. [PMID: 34245498 DOI: 10.1108/lhs-03-2021-0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This paper aims to extend the consideration of distributed leadership in health-care settings. Leadership is typically studied from the classical notion of the place of single leaders and continues to examine distributed leadership within small teams or horizontally. The purpose is to develop a practical understanding of how distributed leadership may occur vertically, between different layers of the health-care leadership hierarchy, examining its influence on health-care outcomes across two hospitals. DESIGN/METHODOLOGY/APPROACH Using semi-structured interviews, data were collected from 107 hospital employees (including executive leadership, clinical management and clinicians) from two hospitals in Australia and the USA. Using thematic content analysis, an iterative process was adopted characterized by alternating between social identity and distributed leadership literature and empirical themes to answer the question of how the practice of distributed leadership influences performance outcomes in hospitals? FINDINGS The perceived social identities of leadership groups shaped communication and performance both positively and negatively. In one hospital a moderating structure emerged as a leadership dyad, where leadership was distributed vertically between hospital hierarchal layers, observed to overcome communication limitations. Findings suggest dyad creation is an effective mechanism to overcome hospital hierarchy-based communication issues and ameliorate health-care outcomes. ORIGINALITY/VALUE The study demonstrates how current leadership development practices that focus on leadership relational and social competencies can benefit from a structural approach to include leadership dyads that can foster these same competencies. This approach could help develop future hospital leaders and in doing so, improve hospital outcomes.
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Affiliation(s)
- Lori Leach
- Queensland Health Mental Health and Specialized Services, Darling Downs West Moreton Health Service District, Toowoomba, Australia
| | | | | | | | - Dave Bouckenooghe
- Goodman School of Business, Brock University, Saint Catharine's, Canada
| | | | - David Hewett
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Herston, Australia
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Salmasi MY, Jarral OA, Athanasiou T. What can we learn from outliers in cardiac surgery? J Card Surg 2021; 36:1832-1834. [PMID: 33682962 DOI: 10.1111/jocs.15481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Affiliation(s)
- M Yousuf Salmasi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Omar A Jarral
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
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14
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de las Heras-Rosas C, Herrera J, Rodríguez-Fernández M. Organisational Commitment in Healthcare Systems: A Bibliometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052271. [PMID: 33668880 PMCID: PMC7967696 DOI: 10.3390/ijerph18052271] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
Business organisations are subject to high pressure to ensure their sustainability and competitiveness. In the case of healthcare institutions, moreover, there are unique characteristics where human resource management is of vital importance. The workforce in these institutions is at a critical moment where the shortages of qualified staff, burnout, or job dissatisfaction represent some of the detrimental aspects for the performance of the organisation, and more importantly, they diminish the quality of patient care. The promotion of organisational commitment is positioned as one of the tools that organisations have to face this problem. This paper aims to increase knowledge about research trends that analyse organisational commitment in healthcare institutions. To this end, using bibliometric techniques, a sample of 448 publications on this subject from journals indexed in Web of Science between 1992 and 2020 is analysed. The results obtained suggest a growing interest in this subject and a visible concern for the management of human resources in these institutions. Research has focussed mainly on organisational factors related to nursing staff. The most analysed topics have been job satisfaction, the implications of stress and high turnover, burnout syndrome, and the possibility of leaving the job. On the other hand, issues emerged such as empowerment in the workplace and others related to organisational management such as quality of service or performance. Finally, there is a lack of research that deals more deeply with other groups working in health centres, such as doctors or administrative staff. There is also a need for further development in the analysis of the implications of the ideological psychological contract in relation to normative organisational commitment in the field of healthcare organisations. The contribution of this work focusses on expanding knowledge about commitment in healthcare organisations and creating points of support for future research as well as helping healthcare managers make decisions in HR management.
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Affiliation(s)
| | - Juan Herrera
- Correspondence: (C.d.l.H.-R.); (J.H.); (M.R.-F.)
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Clay-Williams R, Taylor N, Ting HP, Arnolda G, Winata T, Braithwaite J. Do quality management systems influence clinical safety culture and leadership? A study in 32 Australian hospitals. Int J Qual Health Care 2020; 32:60-66. [PMID: 32026935 DOI: 10.1093/intqhc/mzz107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/21/2019] [Accepted: 09/12/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aimed to explore the associations between the organization-level quality arrangements, improvement and implementation and department-level safety culture and leadership measures across 32 large Australian hospitals. DESIGN Quantitative observational study, using linear and multi-level modelling to identify relationships between quality management systems and clinician safety culture and leadership. SETTING Thirty-two large Australian public hospitals. PARTICIPANTS Quality audit at organization level, senior quality manager at each participating hospital, 1382 clinicians (doctors, nurses and allied health professionals). MAIN OUTCOME MEASURES Associations between organization-level quality measures and department-level clinician measures of teamwork climate, safety climate and leadership for acute myocardial infarction (AMI), hip fracture and stroke treatment conditions. RESULTS We received 1332 valid responses from participants. The quality management systems index (QMSI, a questionnaire-based measure of the hospitals' quality management structures) was 'positively' associated with all three department-level scales in the stroke department, with safety culture and leadership in the emergency department, but with none of the three scales in the AMI and hip fracture departments. The quality management compliance index (QMCI, an external audit-based measure of the quality improvement activities) was 'negatively' associated with teamwork climate and safety climate in AMI departments, after controlling for QMSI, but not in other departments. There was no association between QMCI and leadership in any department, after controlling for QMSI, and there was no association between the clinical quality implementation index (CQII, an external audit-based measure of the level of implementation of quality activities) and any of the three department-level scales in any of the four departments, after controlling for both QMSI and QMCI. CONCLUSIONS The influence of organization-level quality management systems on clinician safety culture and leadership varied depending on the hospital department, suggesting that whilst there was some consistency on patient safety attitudes and behaviours throughout the organizations, there were also other factors at play.
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Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia.,Faculty of Health Sciences, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
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Clay-Williams R, Taylor N, Ting HP, Winata T, Arnolda G, Braithwaite J. The clinician safety culture and leadership questionnaire: refinement and validation in Australian public hospitals. Int J Qual Health Care 2020; 32:52-59. [PMID: 31725871 DOI: 10.1093/intqhc/mzz106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/13/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study aimed to refine and validate a tool to measure safety culture and leadership in Australian hospitals. DESIGN The clinician safety culture and leadership questionnaire was constructed by combining and refining the following two previously validated scales: Safety Attitudes Questionnaire and the Leadership Effectiveness Survey. Statistical processes were used to explore the factor structure, reliability, validity and descriptive statistics of the new instrument. SETTING Thirty-two large Australian public hospitals. PARTICIPANTS 1382 clinicians (doctors, nurses and allied health professionals). MAIN OUTCOME MEASURE(S) Descriptive statistics, structure and validity of clinician safety culture and leadership scale. RESULTS We received 1334 valid responses from participants. The distribution of ratings was left-skewed, with a small ceiling effect, meaning that scores were clustered toward the high end of the scale. Using confirmatory factor analysis, we confirmed the structure of the three scales as a combined measure of safety culture and leadership. The data were divided into equal calibration and validation datasets. For the calibration dataset, the Chi-square: df ratio was 4.4, the root mean square error of approximation RMSEA (a measure of spread of the data) was 0.071, the standardized root mean square residual SRMR (an absolute measure of the fit of the data) was 0.058 and the Confirmatory Fit Index (CFI) (another test confirming the fit of the data) was 0.82; while none of the indices suggested good fit, all but CFI fell within acceptable thresholds. All factors demonstrated adequate internal consistency and construct reliability, as desired. All three domains achieved discriminant validity through cross-loadings, meaning that the three domains were determined to be independent constructs. Results for the validation dataset were effectively identical to those found in the calibration dataset. CONCLUSIONS While the model may benefit from additional refinement, we have validated the tool for measuring clinician safety culture and leadership in our Australian sample. The DUQuA safety culture and leadership scale can be used by Australian hospitals to assess clinician safety culture and leadership, and is readily modifiable for other health systems depending on their needs.
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Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia
| | - Natalie Taylor
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia.,Faculty of Health Sciences, University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia
| | - Teresa Winata
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW 2109, Australia
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17
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Savage M, Savage C, Brommels M, Mazzocato P. Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature. BMJ Open 2020; 10:e035542. [PMID: 32699130 PMCID: PMC7375428 DOI: 10.1136/bmjopen-2019-035542] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The influx of management ideas into healthcare has triggered considerable debate about if and how managerial and medical logics can coexist. Recent reviews suggest that clinician involvement in hospital management can lead to superior performance. We, therefore, sought to systematically explore conditions that can either facilitate or impede the influence of medical leadership on organisational performance. DESIGN Systematic review using thematic synthesis guided by the Enhancing Transparency in Reporting the synthesis of Qualitative research statement. DATA SOURCES We searched PubMed, Web of Science and PsycINFO from 1 January 2006 to 21 January 2020. ELIGIBILITY CRITERIA We included peer-reviewed, empirical, English language articles and literature reviews that focused on physicians in the leadership and management of healthcare. DATA EXTRACTION AND SYNTHESIS Data extraction and thematic synthesis followed an inductive approach. The results sections of the included studies were subjected to line-by-line coding to identify relevant meaning units. These were organised into descriptive themes and further synthesised into analytic themes presented as a model. RESULTS The search yielded 2176 publications, of which 73 were included. The descriptive themes illustrated a movement from 1. medical protectionism to management through medicine; 2. command and control to participatory leadership practices; and 3. organisational practices that form either incidental or willing leaders. Based on the synthesis, the authors propose a model that describes a virtuous cycle of management through medicine or a vicious cycle of medical protectionism. CONCLUSIONS This review helps individuals, organisations, educators and trainers better understand how medical leadership can be both a boon and a barrier to organisational performance. In contrast to the conventional view of conflicting logics, medical leadership would benefit from a more integrative model of management and medicine. Nurturing medical engagement requires participatory leadership enabled through long-term investments at the individual, organisational and system levels.
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Affiliation(s)
- Mairi Savage
- Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Carl Savage
- Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Mats Brommels
- Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Pamela Mazzocato
- Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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19
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Gong CL, Song AY, Horak R, Friedlich PS, Lakshmanan A, Pruetz JD, Yieh L, Ram Kumar S, Williams RG. Impact of Confounding on Cost, Survival, and Length-of-Stay Outcomes for Neonates with Hypoplastic Left Heart Syndrome Undergoing Stage 1 Palliation Surgery. Pediatr Cardiol 2020; 41:996-1011. [PMID: 32337623 DOI: 10.1007/s00246-020-02348-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
Abstract
The objective of this analysis was to update trends in LOS and costs by survivorship and ECMO use among neonates with hypoplastic left heart syndrome (HLHS) undergoing stage 1 palliation surgery using 2016 data from the Healthcare Cost and Utilization Project Kids' Inpatient Database. We identified neonates ≤ 28 days old with HLHS undergoing Stage 1 surgery, defined as a Norwood procedure with modified Blalock-Taussig (BT) shunt, Sano modification, or both. Multivariable regression with year random effects was used to compare LOS and costs by hospital region, case volume, survivorship, and ECMO vs. no ECMO. An E-value analysis, an approach for conducting sensitivity analysis for unmeasured confounding, was performed to determine if unmeasured confounding contributed to the observed effects. Significant differences in total costs, LOS, and mortality were noted by hospital region, ECMO use, and sub-analyses of case volume. However, other than ECMO use and mortality, the maximum E-value confidence interval bound was 1.71, suggesting that these differences would disappear with an unmeasured confounder 1.71 times more associated with both the outcome and exposure (e.g., socioeconomic factors, environment, etc.) Our findings confirm previous literature demonstrating significant resource utilization among Norwood patients, particularly those undergoing ECMO use. Based on our E-value analysis, differences by hospital region and case volume can be explained by moderate unobserved confounding, rather than a reflection of the quality of care provided. Future analyses on surgical quality must account for unobserved factors to provide meaningful information for quality improvement.
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Affiliation(s)
- Cynthia L Gong
- Division of Neonatology, Department of Pediatrics, Fetal & Neonatal Institute, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA. .,Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, Los Angeles, USA. .,Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA.
| | - Ashley Y Song
- Division of Neonatology, Department of Pediatrics, Fetal & Neonatal Institute, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Robin Horak
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA.,Department of Anesthesia and Critical Care, Children's Hospital Los Angeles, Los Angeles, USA
| | - Philippe S Friedlich
- Division of Neonatology, Department of Pediatrics, Fetal & Neonatal Institute, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA
| | - Ashwini Lakshmanan
- Division of Neonatology, Department of Pediatrics, Fetal & Neonatal Institute, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, Los Angeles, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Jay D Pruetz
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA.,Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Los Angeles, Los Angeles, USA
| | - Leah Yieh
- Division of Neonatology, Department of Pediatrics, Fetal & Neonatal Institute, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, Los Angeles, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA
| | - S Ram Kumar
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA.,Division of Cardiothoracic Surgery, Department of Surgery, Heart Institute, Children's Hospital Los Angeles, Los Angeles, USA
| | - Roberta G Williams
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA.,Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Los Angeles, Los Angeles, USA
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Grote H, Smith J, Little J, Horridge M. Clinical leadership fellow schemes for junior doctors: a brief overview of available schemes and how to apply. Future Healthc J 2019; 6:172-176. [PMID: 31660520 PMCID: PMC6798011 DOI: 10.7861/fhj.2019-0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Medical training in the UK provides limited exposure to formal training in leadership and management, and yet the role of a consultant or general practitioner requires such skills which deal with commissioning arrangements, service transformation, quality improvement, Care Quality Commission visits, complaints and supervision of junior colleagues. A number of clinical fellowships in leadership now exist to bridge this gap, and provide training in leadership and management, together with experiential learning in a complex organisation. Well-established leadership schemes suited to junior doctors include the National Medical Director's Clinical Fellow Scheme, the Royal College of Physicians' chief registrar scheme, the Darzi Fellowship scheme and local schemes run by Health Education England. Here we describe and compare our experience of these schemes, and outline what junior doctors should consider when applying for a clinical fellowship.
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Affiliation(s)
- Helen Grote
- Imperial College Healthcare NHS Trust, London, UK and clinical fellow, Care Quality Commission, London, UK
| | | | - Jayne Little
- Manchester University NHS Foundation Trust, Manchester, UK
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Hewison A, Sawbridge Y, Tooley L. Compassionate leadership in palliative and end-of-life care: a focus group study. Leadersh Health Serv (Bradf Engl) 2019; 32:264-279. [PMID: 30945603 DOI: 10.1108/lhs-09-2018-0044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to explore compassionate leadership with those involved in leading system-wide end-of-life care. Its purpose was to: define compassionate leadership in the context of palliative and end-of-life care; collect accounts of compassionate leadership activity from key stakeholders in end-of-life and palliative care; and identify examples of compassionate leadership in practice. DESIGN/METHODOLOGY/APPROACH Four focus groups involving staff from a range of healthcare organisations including hospitals, hospices and community teams were conducted to access the accounts of staff leading palliative and end-of-life care. The data were analysed thematically. FINDINGS The themes that emerged from the data included: the importance of leadership as role modelling and nurturing; how stories were used to explain approaches to leading end-of-life care; the nature of leadership as challenging existing practice; and a requirement for leaders to manage boundaries effectively. Rich and detailed examples of leadership in action were shared. RESEARCH LIMITATIONS/IMPLICATIONS The findings indicate that a relational approach to leadership was enacted in a range of palliative and end-of-life care settings. PRACTICAL IMPLICATIONS Context-specific action learning may be a means of further developing compassionate leadership capability in palliative and end-of-life care and more widely in healthcare settings. ORIGINALITY/VALUE This paper presents data indicating how compassionate leadership, as a form of activity, is envisaged and enacted by staff in healthcare.
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Affiliation(s)
| | - Yvonne Sawbridge
- College of Social Sciences, University of Birmingham , Birmingham, UK
| | - Laura Tooley
- West Midlands Clinical Networks and Clinical Senate, NHS England, Birmingham, UK
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Leggat SG, Balding C. Effective quality systems: implementation in Australian public hospitals. Int J Health Care Qual Assur 2019; 31:1044-1057. [PMID: 30415611 DOI: 10.1108/ijhcqa-02-2017-0037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to review the implementation of seven components of quality systems (QSs) linked with quality improvement in a sample of Australian hospitals. DESIGN/METHODOLOGY/APPROACH The authors completed a systematic review to identify QS components associated with measureable quality improvement. Using mixed methods, the authors then reviewed the current state of these QS components in a sample of eight Australian hospitals. FINDINGS The literature review identified seven essential QS components. Both the self-evaluation and focus group data suggested that none of the hospitals had all of these seven components in place, and that there were some implementation issues with those components that were in use. Although board and senior executives could point to a large number of quality and safety documents that they felt were supporting a vision and framework for safe, high-quality care, middle managers and clinical staff described the QSs as compliance driven and largely irrelevant to their daily pursuit of safe, high-quality care. The authors also found little specific training in quality improvement for staff, lack of useful data for clinicians on the quality of care they provide and confusion about how organisational QSs work. PRACTICAL IMPLICATIONS This study provides a clearer picture of why QSs are not yet achieving the results that boards and executives want to achieve, and that patients require. ORIGINALITY/VALUE This is the first study to explore the implementation of QSs in hospitals in-depth from the perspective of hospital staff, linking the findings to the implementation of QS component identified in the literature.
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Harte S, McGlade K. Developing excellent leaders - the role of Executive Coaching for GP specialty trainees. EDUCATION FOR PRIMARY CARE 2018; 29:286-292. [PMID: 30129393 DOI: 10.1080/14739879.2018.1501770] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Given an increasingly complex healthcare environment, doctors need to rise to the challenges of leadership. Executive coaching offers innovative and workable means of realising excellence in leadership. Coaching creates an empowering, 'high challenge, high support' environment for significant growth. This study sought to determine general practice (GP) specialty trainee (ST3) knowledge of coaching, views on leadership training, and reflections on the experience of receiving coaching. All GP ST3s in one UK region completed a questionnaire about coaching and developing leadership abilities. Six received professional coaching sessions, followed by a semi-structured interview. Baseline knowledge of coaching was sparse. Trainees felt under-equipped for leadership, but were keen to develop themselves. The short intervention appeared to result in a shift in leadership mind-set in four key areas: courage, passion, impact, and vision. A new enthusiasm was apparent, as well as a willingness and desire to increase leadership responsibilities. This is the first UK study examining professional executive face-to-face coaching as an educational method for doctors. Coaching helps provide leadership 'language' and 'identity'. It appears to 'name' clients as 'leaders' and challenges 'imposter phenomenon'. Coaching provided bespoke, deep, experiential learning, with transferable benefits not otherwise available in the Specialty Training programme.
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Affiliation(s)
- Stephen Harte
- a Centre for Medical Education , Queen's University Belfast , UK
| | - Kieran McGlade
- a Centre for Medical Education , Queen's University Belfast , UK
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Woznyj HM, Heggestad ED, Kennerly S, Yap TL. Climate and organizational performance in long-term care facilities: The role of affective commitment. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2018. [DOI: 10.1111/joop.12235] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mathole T, Lembani M, Jackson D, Zarowsky C, Bijlmakers L, Sanders D. Leadership and the functioning of maternal health services in two rural district hospitals in South Africa. Health Policy Plan 2018; 33:ii5-ii15. [PMID: 30053038 PMCID: PMC6037108 DOI: 10.1093/heapol/czx174] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/02/2022] Open
Abstract
Maternal mortality remains high in Eastern Cape Province, South Africa, despite over 90% of pregnant women utilizing maternal health services. A recent survey showed wide variation in performance among districts in the province. Heterogeneity was also found at the district level, where maternal health outcomes varied considerably among district hospitals. In ongoing research, leadership emerged as one of the key health systems factors affecting the performance of maternal health services at facility level. This article reports on a subsequent case study undertaken to examine leadership practices and the functioning of maternal health services in two resource-limited hospitals with disparate maternal health outcomes. An exploratory mixed-methods case study was undertaken with the two rural district hospitals as the units of analysis. The hospitals were purposively selected based on their maternal health outcomes: one reported good maternal health outcomes (pseudonym: Chisomo) and the other had poor outcomes (pseudonym: Tinyade). Comparative data were collected through a facility survey, non-participant observation of management and perinatal meetings, record reviews and interviews with hospital leadership, staff and patients to elicit information about leadership practices including supervision, communication and teamwork. Descriptive and thematic data analysis was undertaken. The two hospitals had similar infrastructure and equipment. Hospital managers at Chisomo used their innovation and entrepreneurial skills to improve quality of care, and leadership style was described as supportive, friendly, approachable but 'firm'. They also undertook frequent and supportive supervisory meetings. Each department at Chisomo developed its own action plan and used data to monitor their actions. Good performers were acknowledged in group meetings. Staff in this facility were motivated and patients were happy about the quality of services. The situation was different at Tinyade hospital. Participants described the leadership style of their senior managers as authoritarian. Managers were rarely available in the office and did not hold regular meetings, leading to poor communication across teams and poor coordination to address resource constraints. This demotivated the staff. The differences in leadership style, structures, processes and work culture affected teamwork, managerial supervision and support. The study demonstrates how leadership styles and practices influence maternal health care services in resource limited hospitals. Supportive leadership manifested itself in the form of focused efforts to build teamwork, enhance entrepreneurship and in management systems that are geared to improving maternal care.
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Affiliation(s)
- T Mathole
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
| | - M Lembani
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
| | - D Jackson
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
| | - C Zarowsky
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
- University of Montreal Hospital Research Centre (CR-CHUM), 850, rue St-Denis, Montreal (Québec) Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal 7101 av du Parc, Ste, Montreal, Québec H3N 1X9 Canada
| | - L Bijlmakers
- Radboud University Medical Centre, Radboud Institute for Health Sciences (RIHS), Geert Grooteplein-Noord 21 EZ Nijmegen, The Netherlands and
| | - D Sanders
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
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Sandoval GA, Brown AD, Wodchis WP, Anderson GM. Adoption of high technology medical imaging and hospital quality and efficiency: Towards a conceptual framework. Int J Health Plann Manage 2018; 33. [PMID: 29770971 DOI: 10.1002/hpm.2547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 11/11/2022] Open
Abstract
Measuring the value of medical imaging is challenging, in part, due to the lack of conceptual frameworks underlying potential mechanisms where value may be assessed. To address this gap, this article proposes a framework that builds on the large body of literature on quality of hospital care and the classic structure-process-outcome paradigm. The framework was also informed by the literature on adoption of technological innovations and introduces 2 distinct though related aspects of imaging technology not previously addressed specifically in the literature on quality of hospital care: adoption (a structural hospital characteristic) and use (an attribute of the process of care). The framework hypothesizes a 2-part causality where adoption is proposed to be a central, linking factor between hospital structural characteristics, market factors, and hospital outcomes (ie, quality and efficiency). The first part indicates that hospital structural characteristics and market factors influence or facilitate the adoption of high technology medical imaging within an institution. The presence of this technology, in turn, is hypothesized to improve the ability of the hospital to deliver high quality and efficient care. The second part describes this ability throughout 3 main mechanisms pointing to the importance of imaging use on patients, to the presence of staff and qualified care providers, and to some elements of organizational capacity capturing an enhanced clinical environment. The framework has the potential to assist empirical investigations of the value of adoption and use of medical imaging, and to advance understanding of the mechanisms that produce quality and efficiency in hospitals.
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Affiliation(s)
- Guillermo A Sandoval
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
| | - Adalsteinn D Brown
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
| | - Geoffrey M Anderson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
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Hewison A, Sawbridge Y, Cragg R, Rogers L, Lehmann S, Rook J. Leading with compassion in health care organisations. J Health Organ Manag 2018; 32:338-354. [PMID: 29624142 DOI: 10.1108/jhom-10-2017-0266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to report an evaluation of a leading-with-compassion recognition scheme and to present a new framework for compassion derived from the data. Design/methodology/approach Qualitative semi-structured interviews, a focus group and thematic data analysis. Content analysis of 1,500 nominations of compassionate acts. Findings The scheme highlighted that compassion towards staff and patients was important. Links to the wider well-being strategies of some of the ten organisations involved were unclear. Awareness of the scheme varied and it was introduced in different ways. Tensions included the extent to which compassion should be expected as part of normal practice and whether recognition was required, association of the scheme with the term leadership, and the risk of portraying compassion as something separate, rather than an integral part of the culture. A novel model of compassion was developed from the analysis of 1,500 nominations. Research limitations/implications The number of respondents in the evaluation phase was relatively low. The model of compassion contributes to the developing knowledge base in this area. Practical implications The model of compassion can be used to demonstrate what compassion "looks like", and what is expected of staff to work compassionately. Originality/value A unique model of compassion derived directly from descriptions of compassionate acts which identifies the impact of compassion on staff.
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Affiliation(s)
- Alistair Hewison
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK
| | - Yvonne Sawbridge
- Health Services Management Centre, School of Social Policy, College of Social Sciences, University of Birmingham , Birmingham, UK
| | - Robert Cragg
- Department of Organisational Development, Education & Learning, Cwn Taf University Health Board, Abercynon, UK
| | - Laura Rogers
- Health Education England, Leicester, UK.,North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, UK
| | - Sarah Lehmann
- Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Jane Rook
- Shropshire and Staffordshire Local Education and Training Council, Stafford, UK
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Martinussen M, Kaiser S, Adolfsen F, Patras J, Richardsen AM. Reorganisation of healthcare services for children and families: Improving collaboration, service quality, and worker well-being. J Interprof Care 2017; 31:487-496. [PMID: 28481168 DOI: 10.1080/13561820.2017.1316249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study is an evaluation of a reorganisation of different services for children and their families in a Norwegian municipality. The main aim of the reorganisation was to improve interprofessional collaboration through integrating different social services for children and their parents. The evaluation was guided by the Job Demands-Resources Model with a focus on social and healthcare workers' experiences of their work, including job demands and resources, service quality, and well-being at work. The survey of the employees was conducted at three measurement points: before (T1) and after (T2, T3) the reorganisation took place, and included between 87 and 122 employees. A secondary aim was to examine the impact of different job resources and job demands on well-being (burnout, engagement, job satisfaction), and service quality. A one-way ANOVA indicated a positive development on many scales, such as collaboration, work conflict, leadership, and perceived service quality, especially from T1 to T2. No changes were detected in burnout, engagement, or job satisfaction over time. Moderated regression analyses (at T3) indicated that job demands were particularly associated with burnout, and job resources with engagement and job satisfaction. Perceived service quality was predicted by both job demands and resources, in addition to the interaction between workload and collaboration. The reorganisation seems to have contributed to a positive development in how collaboration, work conflict, leadership, and service quality were evaluated, but that other changes are needed to increase worker well-being. The value of the study rests on the findings that support co-locating and merging services for children and their families, and that collaboration is an important resource for healthcare professionals.
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Affiliation(s)
- Monica Martinussen
- a Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU-North), Faculty of Health Sciences , UiT-The Arctic University of Norway , Tromsø , Norway
| | - Sabine Kaiser
- a Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU-North), Faculty of Health Sciences , UiT-The Arctic University of Norway , Tromsø , Norway
| | - Frode Adolfsen
- a Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU-North), Faculty of Health Sciences , UiT-The Arctic University of Norway , Tromsø , Norway
| | - Joshua Patras
- a Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU-North), Faculty of Health Sciences , UiT-The Arctic University of Norway , Tromsø , Norway
| | - Astrid M Richardsen
- b Department of Leadership and Organizational Behavior , BI Norwegian Business School , Oslo , Norway
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Cinaroglu S, Baser O. Understanding the relationship between effectiveness and outcome indicators to improve quality in healthcare. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2016. [DOI: 10.1080/14783363.2016.1253467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Songul Cinaroglu
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
| | - Onur Baser
- Department of Surgery, Center for Innovation & Outcomes Research, Columbia University, New York, NY, USA
- Department of Economics, MEF University, New York, NY, USA
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Brown BB, Haines M, Middleton S, Paul C, D'Este C, Klineberg E, Elliott E. Development and validation of a survey to measure features of clinical networks. BMC Health Serv Res 2016; 16:531. [PMID: 27716364 PMCID: PMC5045605 DOI: 10.1186/s12913-016-1800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 09/27/2016] [Indexed: 11/19/2022] Open
Abstract
Background Networks of clinical experts are increasingly being implemented as a strategy to improve health care processes and outcomes and achieve change in the health system. Few are ever formally evaluated and, when this is done, not all networks are equally successful in their efforts. There is a need to formatively assess the strategic and operational management and leadership of networks to identify where functioning could be improved to maximise impact. This paper outlines the development and psychometric evaluation of an Internet survey to measure features of clinical networks and provides descriptive results from a sample of members of 19 diverse clinical networks responsible for evidence-based quality improvement across a large geographical region. Methods Instrument development was based on: a review of published and grey literature; a qualitative study of clinical network members; a program logic framework; and consultation with stakeholders. The resulting domain structure was validated for a sample of 592 clinical network members using confirmatory factor analysis. Scale reliability was assessed using Cronbach’s alpha. A summary score was calculated for each domain and aggregate level means and ranges are reported. Results The instrument was shown to have good construct validity across seven domains as demonstrated by a high level of internal consistency, and all Cronbach’s α coefficients were equal to or above 0.75. In the survey sample of network members there was strong reported commitment and belief in network-led quality improvement initiatives, which were perceived to have improved quality of care (72.8 %) and patient outcomes (63.2 %). Network managers were perceived to be effective leaders and clinical co-chairs were perceived as champions for change. Perceived external support had the lowest summary score across the seven domains. Conclusions This survey, which has good construct validity and internal reliability, provides a valid instrument to use in future research related to clinical networks. The survey will be of use to health service managers to identify strengths and areas where networks can be improved to increase effectiveness and impact on quality of care and patient outcomes. Equally, the survey could be adapted for use in the assessment of other types of networks. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1800-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Mary Haines
- Sax Institute, PO Box K617, Haymarket, NSW, 1240, Australia.,School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Sandy Middleton
- Nursing Research Institute, St. Vincent's Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5, St Vincent's Hospital, deLacy Building, Victoria Street, Darlinghurst, NSW, 2010, Australia.
| | - Christine Paul
- School of Medicine and Public Health, Priority Research Centre for Health Behaviour & Hunter Medical Research Institute, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Catherine D'Este
- National Centre for Epidemiology & Population Health, Research School of Population Health, ANU College of Medicine, Biology & Environment, Australian National University, Building 62, Cnr of Eggleston and Mills Roads, Canberra, ACT, 2601, Australia
| | - Emily Klineberg
- New South Wales Health, 73 Miller Street, North Sydney, NSW, 2060, Australia
| | - Elizabeth Elliott
- School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
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Affiliation(s)
- Peter Lees
- Faculty of Medical Leadership and Management, London, UK
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Taylor N, Clay-Williams R, Hogden E, Pye V, Li Z, Groene O, Suñol R, Braithwaite J. Deepening our Understanding of Quality in Australia (DUQuA): a study protocol for a nationwide, multilevel analysis of relationships between hospital quality management systems and patient factors. BMJ Open 2015; 5:e010349. [PMID: 26644128 PMCID: PMC4679999 DOI: 10.1136/bmjopen-2015-010349] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Despite the growing body of research on quality and safety in healthcare, there is little evidence of the association between the way hospitals are organised for quality and patient factors, limiting our understanding of how to effect large-scale change. The 'Deepening our Understanding of Quality in Australia' (DUQuA) study aims to measure and examine relationships between (1) organisation and department-level quality management systems (QMS), clinician leadership and culture, and (2) clinical treatment processes, clinical outcomes and patient-reported perceptions of care within Australian hospitals. METHODS AND ANALYSIS The DUQuA project is a national, multilevel, cross-sectional study with data collection at organisation (hospital), department, professional and patient levels. Sample size calculations indicate a minimum of 43 hospitals are required to adequately power the study. To allow for rejection and attrition, 70 hospitals across all Australian jurisdictions that meet the inclusion criteria will be invited to participate. Participants will consist of hospital quality management professionals; clinicians; and patients with stroke, acute myocardial infarction and hip fracture. Organisation and department-level QMS, clinician leadership and culture, patient perceptions of safety, clinical treatment processes, and patient outcomes will be assessed using validated, evidence-based or consensus-based measurement tools. Data analysis will consist of simple correlations, linear and logistic regression and multilevel modelling. Multilevel modelling methods will enable identification of the amount of variation in outcomes attributed to the hospital and department levels, and the factors contributing to this variation. ETHICS AND DISSEMINATION Ethical approval has been obtained. Results will be disseminated to individual hospitals in de-identified national and international benchmarking reports with data-driven recommendations. This ground-breaking national study has the potential to influence decision-making on the implementation of quality and safety systems and processes in Australian and international hospitals.
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Affiliation(s)
- Natalie Taylor
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Emily Hogden
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Victoria Pye
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Zhicheng Li
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Oliver Groene
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rosa Suñol
- Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain
- Red de investigación en servicios de salud en enfermedades crónicas REDISSEC, Barcelona, Spain
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
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Allan HT, Odelius AC, Hunter BJ, Bryan K, Knibb W, Shawe J, Gallagher A. Supporting staff to respond effectively to informal complaints: findings from an action research study. J Clin Nurs 2015; 24:2106-14. [PMID: 25661674 DOI: 10.1111/jocn.12770] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2014] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVE To understand how nurses and midwives manage informal complaints at ward level. BACKGROUND The provision of high quality, compassionate clinical nursing and midwifery is a global priority. Complaints management systems have been established within the National Health Service in the UK to improve patient experience yet little is known about effective responses to informal complaints in clinical practice by nurses and midwives. DESIGN Collaborative action research. METHODS Four phases of data collection and analysis relating to primarily one National Health Service trust during 2011-2014 including: scoping of complaints data, interviews with five service users and six key stakeholders and eight reflective discussion groups with six midwives over a period of nine months, two sessions of communications training with separate groups of midwives and one focus group with four nurses in the collaborating trust. RESULTS Three key themes emerged from these data: multiple and domino complaints; ward staff need support; and unclear complaints systems. CONCLUSIONS Current research does not capture the complexities of complaints and the nursing and midwifery response to informal complaints. RELEVANCE TO CLINICAL PRACTICE Robust systems are required to support clinical staff to improve their response to informal complaints and thereby improve the patient experience.
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Affiliation(s)
| | | | | | | | | | - Jill Shawe
- University of Surrey, Guildford, Surrey, UK
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Gardner S, Bray D. Compassionate Conversations. BMJ QUALITY IMPROVEMENT REPORTS 2014; 3:bmjquality_uu204059.w2102. [PMID: 26734308 PMCID: PMC4645938 DOI: 10.1136/bmjquality.u204059.w2102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/06/2014] [Accepted: 09/02/2014] [Indexed: 11/22/2022]
Abstract
Staff engagement is much more than just a bonus in any organisation. CQC data shows that it is very clearly linked to positive results in both patient and staff outcomes (fewer complaints, improved safety, reduced sickness, fewer accidents, and more as per Michael West). Staff engagement may seem nebulous but is in fact measured routinely annually in the National Staff Survey. The problem is that often Trust Boards with poor Staff Survey results may struggle to increase staff engagement as staff see management initiatives as ‘management fads’ or ‘tick-box exercises’ purely for targets, not their own benefit. Compassionate Conversations are a ground-level initiative focused primarily on supporting and motivating individual staff as the primary focus. This allows the benefits to patients and in Human Resources to be an unspoken anticipated benefit. They are led by a Psychologist and Consultant in a coaching supportive atmosphere in an open or selected group. The Conversations have been rated 9/10 or higher by 64% of participants, while 75% of all participants voluntarily provided feedback. Feedback initially was that Conversations were too clinically-focused and further Conversations were more wide-ranging in topic and included departmental roadshows.
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Gauld R, Horsburgh S. Healthcare professional perspectives on quality and safety in New Zealand public hospitals: findings from a national survey. AUST HEALTH REV 2014; 38:109-14. [PMID: 24351789 DOI: 10.1071/ah13116] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 11/11/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few studies have sought to measure health professional perceptions of quality and safety across an entire system of public hospitals. Therefore, three questions that gauge different aspects of quality and safety were included in a national New Zealand survey of clinical governance. METHODS Three previously used questions were adapted. A total of 41040 registered health professionals employed in District Health Boards were invited to participate in an online survey. Analyses were performed using the R statistical environment. Proportional odds mixed models were used to quantify associations between demographic variables and responses on five-point scales. Relationships between other questions in the survey and the three quality and safety questions were quantified with the Pearson correlation coefficient. RESULTS A 25% response rate delivered 10303 surveys. Fifty-seven percent of respondents (95% CI: 56-58%) agreed that health professionals in their District Health Board worked together as a team; 70% respondents (95% CI: 69-70%) agreed that health professionals involved patients and families in efforts to improve patient care; and 69% (95% CI: 68-70%) agreed that it was easy to speak up in their clinical area if they perceived a problem with patient care. Correlations showed links between perceptions of stronger clinical leadership and performances on the three questions, as well as with other survey items. The proportional mixed model also revealed response differences by respondent characteristics. CONCLUSIONS The findings suggest positive commitment to quality and safety among New Zealand health professionals and their employers, albeit with variations by district, profession, gender and age, but also scope for improvement. The study also contributes to the literature indicating that clinical leadership is an important contributor to quality improvement. WHAT IS KNOWN ABOUT THE TOPIC? Various studies have explored aspects of healthcare quality and safety, generally within a hospital or group of hospitals, using a lengthy tool such as the 'safety climate survey'. WHAT DOES THIS PAPER ADD? We used a simple three-question survey approach (derived from existing measures) to measuring healthcare professionals' perceptions of quality and safety in New Zealand's public hospitals. In doing so, we also collected the first such information on this. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? New Zealand policy makers and health professionals can take some comfort in our findings, but also note that there is considerable scope for improvement. Our finding that more positive perceptions of quality and safety were related to perceptions of stronger clinical leadership adds to the international literature indicating the importance of this. Policy makers and hospital managers should support strong clinical leadership.
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Affiliation(s)
- Robin Gauld
- Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand
| | - Simon Horsburgh
- Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand
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Romley JA, Chen AY, Goldman DP, Williams R. Hospital costs and inpatient mortality among children undergoing surgery for congenital heart disease. Health Serv Res 2014; 49:588-608. [PMID: 24138064 PMCID: PMC3976188 DOI: 10.1111/1475-6773.12120] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine the association between hospital costs and risk-adjusted inpatient mortality among children undergoing surgery for congenital heart disease (CHD) in U.S. acute-care hospitals. DATA SOURCES/STUDY SETTINGS Retrospective cohort study of 35,446 children in 2003, 2006, and 2009 Kids' Inpatient Database (KID). STUDY DESIGN Cross-sectional logistic regression of risk-adjusted inpatient mortality and hospital costs, adjusting for a variety of patient-, hospital-, and community-level confounders. DATA COLLECTION/EXTRACTION METHODS We identified relevant discharges in the KID using the AHRQ Pediatric Quality Indicator for pediatric heart surgery mortality, and linked these records to hospital characteristics from American Hospital Association Surveys and community characteristics from the Census. PRINCIPAL FINDINGS Children undergoing CHD surgery in higher cost hospitals had lower risk-adjusted inpatient mortality (p=.002). An increase from the 25th percentile of treatment costs to the 75th percentile was associated with a 13.6 percent reduction in risk-adjusted mortality. CONCLUSIONS Greater hospital costs are associated with lower risk-adjusted inpatient mortality for children undergoing CHD surgery. The specific mechanisms by which greater costs improve mortality merit further exploration.
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Affiliation(s)
- John A Romley
- Address correspondence to John A. Romley, Ph.D., Price School of Public Policy, University of Southern California, 3335 S. Figueroa St., Unit A, Los Angeles, CA 90089; e-mail:
| | - Alex Y Chen
- Price School of Public Policy, University of Southern California3335 S. Figueroa St., Unit A, Los Angeles, CA 90089
- Keck School of Medicine, University of Southern California, Children's Hospital Los AngelesLos Angeles, CA
- Price School of Public Policy and the School of Pharmacy at the University of Southern CaliforniaLos Angeles, CA
| | - Dana P Goldman
- Price School of Public Policy, University of Southern California3335 S. Figueroa St., Unit A, Los Angeles, CA 90089
- Keck School of Medicine, University of Southern California, Children's Hospital Los AngelesLos Angeles, CA
- Price School of Public Policy and the School of Pharmacy at the University of Southern CaliforniaLos Angeles, CA
| | - Roberta Williams
- Price School of Public Policy, University of Southern California3335 S. Figueroa St., Unit A, Los Angeles, CA 90089
- Keck School of Medicine, University of Southern California, Children's Hospital Los AngelesLos Angeles, CA
- Price School of Public Policy and the School of Pharmacy at the University of Southern CaliforniaLos Angeles, CA
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Hesselink G, Kuis E, Pijnenburg M, Wollersheim H. Measuring a caring culture in hospitals: a systematic review of instruments. BMJ Open 2013; 3:e003416. [PMID: 24065697 PMCID: PMC3787470 DOI: 10.1136/bmjopen-2013-003416] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To identify instruments or components of instruments that aim to measure aspects of a caring culture-shared beliefs, norms and values that direct professionals and managers to act caring in hospitals, and to evaluate their psychometric properties. DESIGN Systematic review. DATA SOURCES PubMed, CINAHL, EMBASE, PsychInfo, Web of Science and the International bibliography of the Social Sciences. STUDY SELECTION Peer-reviewed articles describing (components of) instruments measuring aspects of a caring culture in a hospital setting. Studies had to report psychometric data regarding the reliability or validity of the instrument. Potentially useful instruments that were identified after the title and abstract scan were assessed on relevance by an expert panel (n=12) using the RAND-modified Delphi procedure. RESULTS Of the 6399 references identified, 75 were examined in detail. 7 studies each covering a unique instrument met our inclusion criteria. On average, 24% of the instrument's items were considered relevant for measuring aspects of the hospital's caring culture. Studies showed moderate-to-high validity and reliability scores. Validity was addressed for 6 of the 7 instruments. Face, content (90%) and construct (60%) validity were the most frequently reported psychometric properties described. One study (14%) reported discriminant validity of the instrument. Reliability data were available for all of the instruments. Internal consistency was the most frequently reported psychometric property for the instruments and demonstrated by: a Cronbach's α coefficient (80%), subscale intercorrelations (60%), and item-total correlations (40%). CONCLUSIONS The ultimate standard for measuring a caring culture in hospitals does not exist. Existing instruments provide partial coverage and lack information on discriminant validity, responsiveness and feasibility. Characteristics of the instruments included in this review could provide useful input for the design of a reliable and valid instrument for measuring a caring culture in hospitals.
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Affiliation(s)
- G Hesselink
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Buttigieg SC, West MA. Senior management leadership, social support, job design and stressor-to-strain relationships in hospital practice. J Health Organ Manag 2013; 27:171-92. [PMID: 23802397 DOI: 10.1108/14777261311321761] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to examine the effect of the quality of senior management leadership on social support and job design, whose main effects on strains, and moderating effects on work stressors-to-strains relationships were assessed. DESIGN/METHODOLOGY/APPROACH A survey involving distribution of questionnaires was carried out on a random sample of health care employees in acute hospital practice in the UK. The sample comprised 65,142 respondents. The work stressors tested were quantitative overload and hostile environment, whereas strains were measured through job satisfaction and turnover intentions. Structural equation modelling and moderated regression analyses were used in the analysis. FINDINGS Quality of senior management leadership explained 75 per cent and 94 per cent of the variance of social support and job design respectively, whereas work stressors explained 51 per cent of the variance of strains. Social support and job design predicted job satisfaction and turnover intentions, as well as moderated significantly the relationships between quantitative workload/hostility and job satisfaction/turnover intentions. RESEARCH LIMITATIONS/IMPLICATIONS The findings are useful to management and to health employees working in acute/specialist hospitals. Further research could be done in other counties to take into account cultural differences and variations in health systems. The limitations included self-reported data and percept-percept bias due to same source data collection. PRACTICAL IMPLICATIONS The quality of senior management leaders in hospitals has an impact on the social environment, the support given to health employees, their job design, as well as work stressors and strains perceived. ORIGINALITY/VALUE The study argues in favour of effective senior management leadership of hospitals, as well as ensuring adequate support structures and job design. The findings may be useful to health policy makers and human resources managers.
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Affiliation(s)
- Sandra C Buttigieg
- Department of Health Services Management, University of Malta, Msida, Malta, UK.
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Hewison A, Gale N, Yeats R, Shapiro J. An evaluation of staff engagement programmes in four National Health Service Acute Trusts. J Health Organ Manag 2013; 27:85-105. [PMID: 23734478 DOI: 10.1108/14777261311311816] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to report the findings from an evaluation project conducted to investigate the impact of two staff engagement programmes introduced to four National Health Service (NHS) hospital Trusts in England. It seeks to examine this development in the context of current policy initiatives aimed at increasing the level of staff involvement in decision-making, and the related literature. DESIGN/METHODOLOGY/APPROACH A mixed-methods approach incorporating document analysis, interviews, a survey and appreciative inquiry, informed by the principles of impact evaluation design, was used. FINDINGS The main finding to emerge was that leadership was crucial if widespread staff engagement was to be achieved. Indeed, in some of the trusts the staff engagement programmes were seen as mechanisms for developing leadership capability. The programmes had greater impact when they were "championed" by the Chief Executive. Effective communication throughout the organisations was reported to be a prerequisite for staff engagement. Problems were identified at the level of middle management where the lack of confidence in engaging with staff was a barrier to implementation. PRACTICAL IMPLICATIONS The nature of the particular organisational context is crucial to the success of efforts to increase levels of staff engagement. The measures that were found to work in the trusts would need to be adapted and applied to best meet the needs of other organisations. ORIGINALITY/VALUE Many health care organisations in England will need to harness the efforts of their workforce if they are to meet the significant challenges of dealing with financial restraint and increasing patient demand. This paper provides some insights on how this can be done.
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Affiliation(s)
- Alistair Hewison
- School of Health and Population Sciences, The University of Birmingham, Birmingham, UK.
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Reader TW, Gillespie A. Patient neglect in healthcare institutions: a systematic review and conceptual model. BMC Health Serv Res 2013; 13:156. [PMID: 23631468 PMCID: PMC3660245 DOI: 10.1186/1472-6963-13-156] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 04/24/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patient neglect is an issue of increasing public concern in Europe and North America, yet remains poorly understood. This is the first systematic review on the nature, frequency and causes of patient neglect as distinct from patient safety topics such as medical error. METHOD The Pubmed, Science Direct, and Medline databases were searched in order to identify research studies investigating patient neglect. Ten articles and four government reports met the inclusion criteria of reporting primary data on the occurrence or causes of patient neglect. Qualitative and quantitative data extraction investigated (1) the definition of patient neglect, (2) the forms of behaviour associated with neglect, (3) the reported frequency of neglect, and (4) the causes of neglect. RESULTS Patient neglect is found to have two aspects. First, procedure neglect, which refers to failures of healthcare staff to achieve objective standards of care. Second, caring neglect, which refers to behaviours that lead patients and observers to believe that staff have uncaring attitudes. The perceived frequency of neglectful behaviour varies by observer. Patients and their family members are more likely to report neglect than healthcare staff, and nurses are more likely to report on the neglectful behaviours of other nurses than on their own behaviour. The causes of patient neglect frequently relate to organisational factors (e.g. high workloads that constrain the behaviours of healthcare staff, burnout), and the relationship between carers and patients. CONCLUSION A social psychology-based conceptual model is developed to explain the occurrence and nature of patient neglect. This model will facilitate investigations of i) differences between patients and healthcare staff in how they perceive neglect, ii) the association with patient neglect and health outcomes, iii) the relative importance of system and organisational factors in causing neglect, and iv) the design of interventions and health policy to reduce patient neglect.
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Affiliation(s)
- Tom W Reader
- Institute of Social Psychology, London School of Economics, Houghton Street, London WC2A 2AE, UK
| | - Alex Gillespie
- Institute of Social Psychology, London School of Economics, Houghton Street, London WC2A 2AE, UK
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Drach‐Zahavy A, Somech A. Linking task and goal interdependence to quality service. JOURNAL OF SERVICE MANAGEMENT 2013. [DOI: 10.1108/09564231311323944] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Brand CA, Barker AL, Morello RT, Vitale MR, Evans SM, Scott IA, Stoelwinder JU, Cameron PA. A review of hospital characteristics associated with improved performance. Int J Qual Health Care 2012; 24:483-94. [PMID: 22871420 DOI: 10.1093/intqhc/mzs044] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The objective of this review was to critically appraise the literature relating to associations between high-level structural and operational hospital characteristics and improved performance. DATA SOURCES The Cochrane Library, MEDLINE (Ovid), CINAHL, proQuest and PsychINFO were searched for articles published between January 1996 and May 2010. Reference lists of included articles were reviewed and key journals were hand searched for relevant articles. STUDY SELECTION and data extraction Studies were included if they were systematic reviews or meta-analyses, randomized controlled trials, controlled before and after studies or observational studies (cohort and cross-sectional) that were multicentre, comparative performance studies. Two reviewers independently extracted data, assigned grades of evidence according to the Australian National Health and Medical Research Council guidelines and critically appraised the included articles. Data synthesis Fifty-seven studies were reported within 12 systematic reviews and 47 observational articles. There was heterogeneity in use and definition of performance outcomes. Hospital characteristics investigated were environment (incentives, market characteristics), structure (network membership, ownership, teaching status, geographical setting, service size) and operational design (innovativeness, leadership, organizational culture, public reporting and patient safety practices, information technology systems and decision support, service activity and planning, workforce design, staff training and education). The strongest evidence for an association with overall performance was identified for computerized physician order entry systems. Some evidence supported the associations with workforce design, use of financial incentives, nursing leadership and hospital volume. CONCLUSION There is limited, mainly low-quality evidence, supporting the associations between hospital characteristics and healthcare performance. Further characteristic-specific systematic reviews are indicated.
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Affiliation(s)
- Caroline A Brand
- Centre for Research Excellence in Patient Safety, Monash University, The Alfred Centre, Prahran Victoria, Australia.
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DeCourcy A, West E, Barron D. The National Adult Inpatient Survey conducted in the English National Health Service from 2002 to 2009: how have the data been used and what do we know as a result? BMC Health Serv Res 2012; 12:71. [PMID: 22436670 PMCID: PMC3355017 DOI: 10.1186/1472-6963-12-71] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 03/21/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND When it was initiated in 2001, England's national patient survey programme was one of the first in the world and has now been widely emulated in other healthcare systems. The aim of the survey programme was to make the National Health Service (NHS) more "patient centred" and more responsive to patient feedback. The national inpatient survey has now been running in England annually since 2002 gathering data from over 600,000 patients. The aim of this study is to investigate how the data have been used and to summarise what has been learned about patients' evaluation of care as a result. METHODS Two independent researchers systematically gathered all research that included analyses of the English national adult inpatient survey data. Journals, databases and relevant websites were searched. Publications prior to 2002 were excluded. Articles were also identified following consultation with experts. All documents were then critically appraised by two co-authors both of whom have a background in statistical analysis. RESULTS We found that the majority of the studies identified were reports produced by organisations contracted to gather the data or co-ordinate the data collection and used mainly descriptive statistics. A few articles used the survey data for evidence based reporting or linked the survey to other healthcare data. The patient's socio-demographic characteristics appeared to influence their evaluation of their care but characteristics of the workforce and the. At a national level, the results of the survey have been remarkably stable over time. Only in those areas where there have been co-ordinated government-led campaigns, targets and incentives, have improvements been shown. The main findings of the review are that while the survey data have been used for different purposes they seem to have incited little academic interest. CONCLUSIONS The national inpatient survey has been a useful resource for many authors and organisations but the full potential inherent in this large, longitudinal publicly available dataset about patients' experiences has not as yet been fully exploited.This review suggests that the presence of survey results alone is not enough to improve patients' experiences and further research is required to understand whether and how the survey can be best used to improve standards of care in the NHS.
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Affiliation(s)
- Anna DeCourcy
- School of Health and Social Care, University of Greenwich, London, UK
| | - Elizabeth West
- School of Health and Social Care, University of Greenwich, London, UK
| | - David Barron
- Reader in Organisational Sociology, Said Business School, University of Oxford, Oxford, UK
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Robert GB, Anderson JE, Burnett SJ, Aase K, Andersson-Gare B, Bal R, Calltorp J, Nunes F, Weggelaar AM, Vincent CA, Fulop NJ. A longitudinal, multi-level comparative study of quality and safety in European hospitals: the QUASER study protocol. BMC Health Serv Res 2011; 11:285. [PMID: 22029712 PMCID: PMC3212959 DOI: 10.1186/1472-6963-11-285] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 10/26/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND although there is a wealth of information available about quality improvement tools and techniques in healthcare there is little understanding about overcoming the challenges of day-to-day implementation in complex organisations like hospitals. The 'Quality and Safety in Europe by Research' (QUASER) study will investigate how hospitals implement, spread and sustain quality improvement, including the difficulties they face and how they overcome them. The overall aim of the study is to explore relationships between the organisational and cultural characteristics of hospitals and how these impact on the quality of health care; the findings will be designed to help policy makers, payers and hospital managers understand the factors and processes that enable hospitals in Europe to achieve-and sustain-high quality services for their patients. METHODS/DESIGN in-depth multi-level (macro, meso and micro-system) analysis of healthcare quality policies and practices in 5 European countries, including longitudinal case studies in a purposive sample of 10 hospitals. The project design has three major features: • a working definition of quality comprising three components: clinical effectiveness, patient safety and patient experience • a conceptualisation of quality as a human, social, technical and organisational accomplishment • an emphasis on translational research that is evidence-based and seeks to provide strategic and practical guidance for hospital practitioners and health care policy makers in the European Union. Throughout the study we will adopt a mixed methods approach, including qualitative (in-depth, narrative-based, ethnographic case studies using interviews, and direct non-participant observation of organisational processes) and quantitative research (secondary analysis of safety and quality data, for example: adverse incident reporting; patient complaints and claims). DISCUSSION the protocol is based on the premise that future research, policy and practice need to address the sociology of improvement in equal measure to the science and technique of improvement, or at least expand the discipline of improvement to include these critical organisational and cultural processes. We define the 'organisational and cultural characteristics associated with better quality of care' in a broad sense that encompasses all the features of a hospital that might be hypothesised to impact upon clinical effectiveness, patient safety and/or patient experience.
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Affiliation(s)
- Glenn B Robert
- National Nursing Research Unit, King's College London, 57 Waterloo Road, London, SE1 8WA, UK
| | - Janet E Anderson
- King's Patient Safety and Service Quality Research Centre, King's College London, 150 Stamford Street, London, SE1 9NH, UK
| | - Susan J Burnett
- Centre for Patient Safety & Service Quality, Imperial College, St Mary's Campus, Norfolk Place, London, W2 1PG, UK, UK
| | - Karina Aase
- Department for Media, Cultural and Social Studies, University of Stavanger, 4036 Stavanger, Norway
| | - Boel Andersson-Gare
- The Jönköping Academy for Improvement of Health and Welfare, Box 1026, 551 11 Jönköping, Sweden
| | - Roland Bal
- Institute of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, the Netherlands
| | - Johan Calltorp
- The Jönköping Academy for Improvement of Health and Welfare, Box 1026, 551 11 Jönköping, Sweden
| | - Francisco Nunes
- Instituto Superior de Ciências do Trabalho e da Empresa (ISCTE), Av.ª das Forças Armadas, 1649-026 Lisboa, Portugal
| | - Anne-Marie Weggelaar
- Institute of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, the Netherlands
| | - Charles A Vincent
- Centre for Patient Safety & Service Quality, Imperial College, St Mary's Campus, Norfolk Place, London, W2 1PG, UK, UK
| | - Naomi J Fulop
- King's Patient Safety and Service Quality Research Centre, King's College London, 42 Weston Street, London, SE1 3QD, UK
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Carlet J, Garrouste-Orgeas M, Dumay MF, Diaw F, Guidet B, Timsit JF, Misset B. Managing intensive care units: Make LOVE, not war! J Crit Care 2010; 25:359.e9-359.e12. [DOI: 10.1016/j.jcrc.2009.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 09/07/2009] [Accepted: 12/29/2009] [Indexed: 11/30/2022]
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Vincent C. Social scientists and patient safety: critics or contributors? Soc Sci Med 2009; 69:1777-9. [PMID: 19853340 DOI: 10.1016/j.socscimed.2009.09.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Indexed: 11/25/2022]
Abstract
Patient safety has been high on the national and international agenda in healthcare for almost a decade. It is proving to be a tough problem; tough in cultural, technical, clinical, and psychological terms and because of its massive scale and heterogeneity. While many of the challenges and problems of patient safety are social and organisational, few social scientists are involved in patient safety. Clinicians and clinical researchers are for the most part open to other perspectives, but that they may not fully appreciate the potential contribution of the social sciences. Social scientists can, for instance, assist in drawing attention to the need to take an account of the social and cultural context of patient safety interventions, by drawing on narratives and stories to illuminate organisational processes and by encouraging greater use of ethnographic and observational research. However, if social scientists are to have a real impact they need to do more than simply offer critiques of patient safety and move to active engagement with clinicians and patient safety researchers.
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Affiliation(s)
- Charles Vincent
- Imperial Centre for Patient Safety & Service Quality, Department of Biosurgery & Technology, Imperial College London, United Kingdom.
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Langabeer JR, DelliFraine JL, Heineke J, Abbass I. Implementation of Lean and Six Sigma quality initiatives in hospitals: A goal theoretic perspective. OPERATIONS MANAGEMENT RESEARCH 2009. [DOI: 10.1007/s12063-009-0021-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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