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Charns MP, Lerner B, Yakovchenko V, Urech TH, Shin MH, Kim B, Engle RL, Vashi AA. Achieving transformation to lean management systems in health care. Health Serv Res 2023; 58:343-355. [PMID: 36129687 PMCID: PMC10012231 DOI: 10.1111/1475-6773.14072] [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] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To understand what factors and organizational dynamics enable Lean transformation of health care organizations. DATA SOURCES Primary data were collected through two waves of interviews in 2016-2017 with leaders and staff at seven veterans affairs medical centers participating in Lean enterprise transformation. STUDY DESIGN Using an observational study design, for each site we coded and rated seven potential enablers of transformation. The outcome measure was the extent of Lean transformation, constructed by coding and rating 11 markers of depth and spread of transformation. Using multivalue coincidence analysis (CNA), we identified enablers that distinguished among sites having different levels of transformation. We identified representative quotes for the enablers. DATA COLLECTION METHODS We interviewed 121 executive leaders, middle managers, expert consultants, systems redesign staff, frontline supervisors, and staff. PRINCIPAL FINDINGS Two sites achieved high Lean transformation, three medium, and two low. Together leadership support and capability development were sufficient for the three-level Lean transformation outcomes with 100% consistency and 100% coverage. High scores on both corresponded to high Lean transformation; medium on either one corresponded to medium transformation; and low on both corresponded to low transformation. Additionally, low scores in communication and availability of data and very low scores in alignment characterized low-transformation sites. Sites with high leadership support also had a high veteran engagement. CONCLUSIONS This multisite study develops a novel measure of the extent of organization-wide Lean transformation and uses CNA to identify enablers linked to transformation. It provides insights into why and how some organizations are more successful at transformation than others. Findings support the applicability of the organization transformation model that guided the study and highlight the roles of executive leadership and capability development in the dynamics of transformation.
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Affiliation(s)
- Martin P. Charns
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonMassachusettsUSA
- Department of Health Law, Policy & ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Barbara Lerner
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonMassachusettsUSA
| | - Vera Yakovchenko
- Center for Health Equity and Research Promotion (CHERP)VA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - Tracy H. Urech
- Center for Innovation to Implementation (Ci2i)VA Palo Alto Healthcare SystemMenlo ParkCaliforniaUSA
| | - Marlena H. Shin
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonMassachusettsUSA
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Ryann L. Engle
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonMassachusettsUSA
| | - Anita A. Vashi
- Center for Innovation to Implementation (Ci2i)VA Palo Alto Healthcare SystemMenlo ParkCaliforniaUSA
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Emergency Medicine (Affiliated)Stanford UniversityStanfordCaliforniaUSA
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Molin F, Norrman Brandt E. Transformational Change and Digitalization-The Case of the Swedish Road and Transport Administration. Behav Sci (Basel) 2023; 13:110. [PMID: 36829340 PMCID: PMC9952028 DOI: 10.3390/bs13020110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Digitalization is one of the drivers of change in both public and private organizations. It is therefore relevant to understand how a government agency like the Swedish Transport Administration manage and experience change. METHODS In this qualitative study, interviews (n = 15) with respondents with insight and connection to digitalization and change highlight factors related to digitalization and change-capacity within the agency. RESULTS The results of the interviews are presented in a thematic analysis. Five themes were identified: Digitalization, management control, stability requirements, organizational culture, and lack of a comprehensive view. The research literature in the field of change creates a fund for a discussion about the Administration's situation regarding digitalization, development, and transformational change. CONCLUSIONS The results indicate that the Transport Administration still has a long way to travel in terms of organizational readiness for change. To address this issue, the Transport Administration should prioritize the development and implementation of a comprehensive change management strategy including clear communication, active engagement, and participation from all employees, and a focus on building a culture of adaptability and continuous improvement.
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Affiliation(s)
- Fredrik Molin
- IPF, The Institute for Organizational and Leadership Development, Uppsala University, 753 20 Uppsala, Sweden
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, 752 37 Uppsala, Sweden
| | - Eva Norrman Brandt
- IPF, The Institute for Organizational and Leadership Development, Uppsala University, 753 20 Uppsala, Sweden
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Yan L, Wang L, Shen X, Li P, Guo J. The Effect of Transformational Change on Performance: An Employee’s Stress Appraisals Perspective. Front Psychol 2022; 13:897769. [PMID: 35693516 PMCID: PMC9174754 DOI: 10.3389/fpsyg.2022.897769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022] Open
Abstract
This study aims to determine the specific impact of employees’ perceptions of transformational change on in-role performance and how stress assessment can mediate the relationship between transformational change and in-role performance. According to the cognitive appraisal theory, the same individual has different appraisals of the same stressors, including challenge, and hindrance appraisal. As an important stressor, transformational change also affects individuals differently depending on their assessments. This study integrates employees’ challenge or hindrance appraisal of transformational change into a conceptual model to distinguish between the roles of the two appraisals. It examines it as a mediating mechanism between transformational change and in-role performance. Additionally, 313 employees who recently experienced transformational change were used as samples to test the hypothesis. The results show that transformational change negatively affects employees’ in-role performance; hindrance appraisal negatively mediates the relationship between transformational change and in-role performance, and challenge appraisal positively mediates the relationship between transformational change and in-role performance. The originality and value of this research extend the application of stress appraisals in organizational change management. Research shows that, in the context of major change, employees’ in-role performance is reduced by the impact of transformational change. However, when employees positively appraise organizational change, the negative effects of change are weakened.
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Affiliation(s)
- Lei Yan
- School of Business Administration, Jeonbuk National University, Jeonju, South Korea
| | - Li Wang
- School of Business Administration, Anhui University of Finance and Economics, Bengbu, China
- *Correspondence: Li Wang,
| | - Xiangdong Shen
- Business School, Changshu Institute of Technology, Changshu, China
- Xiangdong Shen,
| | - Pengfei Li
- School of Business Administration, Daejeon University, Daejeon, South Korea
| | - Jia Guo
- School of Business Administration, Anhui University of Finance and Economics, Bengbu, China
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Organizational Framework Conditions for Workplace Health Management in Different Settings of Nursing—A Cross-Sectional Analysis in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063693. [PMID: 35329379 PMCID: PMC8952851 DOI: 10.3390/ijerph19063693] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022]
Abstract
Studies show that workplace health promotion (WHP) can reduce sickness-related absenteeism among employees and secure long-term workability. Embedding WHP in workplace health management (WHM) can contribute to sustainability and holism. This study aimed to investigate organizational framework conditions for WHM in different settings of nursing in Germany (acute care hospital, long-term care (LTC) facilities and home-based LTC). In a project on WHM implementation, managers with personnel responsibility for nurses (n = 16) were surveyed. In total, 46 close-ended questions on organizational framework conditions of WHM in their care facility were answered at the beginning of the project. No significant differences were found for the indexes of health promoting willingness, health promoting management, social capital and workplace health activity. Descriptive analysis showed that home-based LTC performed slightly better on average. Home-based LTC and LTC facilities had higher ratings in health promoting willingness than in actually managing the process (health promoting management), while the results for acute care hospitals were reversed. Acute care hospitals showed the lowest values for the topics of health as a leadership topic and evaluation of incidents of violence, which were generally rated lower among all settings. Need for action can be identified in improving personal, financial and time resources, evaluation and information on WHM.
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Melder A, Robinson T, McLoughlin I, Iedema R, Teede H. An overview of healthcare improvement: unpacking the complexity for clinicians and managers in a learning health system. Intern Med J 2020; 50:1174-1184. [PMID: 32357287 DOI: 10.1111/imj.14876] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 03/12/2020] [Accepted: 04/05/2020] [Indexed: 11/28/2022]
Abstract
Given the pace of technological advancement and government mandates for healthcare and system transformation, there is an imperative for change. Health systems are highly complex in their design, networks and interacting components, and experience demonstrates that change is very challenging to enact, sustain and scale. Policy-makers, academics and clinicians all need better insight into the nature of this complexity and an understanding of the evidence-base that can support healthcare improvement (HCI), or quality improvement, interventions and make them more effective in driving change. The evidence base demonstrates the vital role of clinical engagement and leadership in HCI, and it is imperative that clinicians engage to improve front-line healthcare. The literature on HCI is vast, applies different and inconsistent terminology and encompasses often loosely defined and overlapping concepts. An increasingly broad range of disciplines has contributed to the available evidence base, but often discipline-specific perspectives frame these contributions. Available literature can also be overly driven by the generation of theoretical concepts and the advancement of academic understanding. It does not necessarily primarily provide focussed and pragmatic insights to guide and inform frontline practice. We aim to address these issues by summarising theories, frameworks, models and success factors for improvement in complex health systems to assist clinicians and others to engage and lead change. We integrate the field of HCI into the learning health system highlighting the key role of the clinician. We seek to inform stakeholders; clinicians and managers to guide the planning, enacting, sustaining and scaling of HCI.
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Affiliation(s)
- Angela Melder
- Monash Health, Australia.,Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Tracy Robinson
- School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Canberra, New South Wales, Australia
| | - Ian McLoughlin
- Monash Business School, Monash University, Melbourne, Victoria, Australia
| | | | - Helena Teede
- Monash Health, Australia.,Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
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Sligo J, Roberts V, Gauld R, Villa L, Thirlwall S. A checklist for healthcare organisations undergoing transformational change associated with large-scale health information systems implementation. HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Turner K, Weinberger M, Renfro C, Powell BJ, Ferreri S, Trodgon JG, Mark N, Trygstad T, Shea CM. Stages of Change: Moving Community Pharmacies From a Drug Dispensing to Population Health Management Model. Med Care Res Rev 2019; 78:57-67. [PMID: 30939978 DOI: 10.1177/1077558719841159] [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: 12/21/2022]
Abstract
Given their clinical training and accessibility, community pharmacists are well positioned to support primary care, especially in providing medication management services. There is limited evidence, however, on implementation of community pharmacist-led services in coordination with other health care providers. The aim of this study was to examine the implementation process of community pharmacies in North Carolina participating in a Medicaid population health management intervention. We conducted semistructured interviews with 40 representatives from high- and low-performing community pharmacies from June to August 2017. We analyzed for themes organized around Rogers's Stages in the Innovation Process in Organizations. Community pharmacies employed numerous implementation strategies such as developing relationships with providers and redefining job responsibilities to ensure pharmacists and pharmacy technicians are working at the top of their license. Findings also revealed differences in the implementation process among high- and low-performing pharmacies. Continued research is needed to determine which implementation strategies improve program performance.
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Affiliation(s)
- Kea Turner
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Chelsea Renfro
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Byron J Powell
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stefanie Ferreri
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Justin G Trodgon
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nicole Mark
- Community Care of North Carolina, Raleigh, NC, USA
| | - Troy Trygstad
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Community Care of North Carolina, Raleigh, NC, USA
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Sheridan SL, Donahue KE, Brenner AT. Beginning with high value care in mind: A scoping review and toolkit to support the content, delivery, measurement, and sustainment of high value care. PATIENT EDUCATION AND COUNSELING 2019; 102:238-252. [PMID: 30553576 DOI: 10.1016/j.pec.2018.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 05/01/2018] [Accepted: 05/15/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To create a shared vision for the content, delivery, measurement, and sustainment of patient-centered high value care. METHODS We performed a scoping review and translated findings into toolkit for system leaders. For our scoping review, we searched Medline, 2005-November 2015, for literature on patient-centered care (PCC) and its relationship to a high value care change model. We supplemented searches with key author, Google Scholar, and key website searches. One author reviewed all titles, abstracts, and articles for inclusion; another reviewed a random 20%. To develop our toolkit, we translated evidence into simple, actionable briefs on key topics and added resources. We then iteratively circulated briefs and the overall toolkit to potential users, making updates as needed. RESULTS In our scoping review, we found multiple interventions and measures to support the components of PCC and our change model. We found little on the overall effects of PCC or how PCC creates value. Potential users reported our toolkit was simple, understandable, thorough, timely, and likely to be globally useful. CONCLUSIONS Considerable evidence supports patient-centered high value care and a toolkit garnered enthusiasm. PRACTICE IMPLICATIONS The toolkit is ready for use, but needs comparison to other approaches.
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Affiliation(s)
| | - Katrina E Donahue
- Reaching for High Value Care Team, Chapel Hill, NC, USA; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Family and Community Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison T Brenner
- Reaching for High Value Care Team, Chapel Hill, NC, USA; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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10
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Harrison MI, Grantham S. Learning from implementation setbacks: Identifying and responding to contextual challenges. Learn Health Syst 2018; 2:e10068. [PMID: 31245592 PMCID: PMC6508762 DOI: 10.1002/lrh2.10068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction We address organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. The redesign expanded care teams and added a medical assistant assigned administrative and coordination tasks. The redesign was expected to improve care efficiency, prevention, and continuity. In response to setbacks, redesign and system leaders used understanding of context to plan system-wide changes, as well as program adjustments. Doing so enhanced the redesign's prospects and contributed to system learning. Methods We conducted a 33-month, mixed-methods study. Qualitative data included quarterly calls with the redesign leaders and 63 activity log entries. There were three site visits; 73 interviews with practice leaders, providers, and medical assistants. Data analysis used categories from an implementation research framework; these were refined and then expanded inductively using log reports, debriefings with change leaders, and documents. Quantitative analysis used system operational data on chronic care, prevention, efficiency, productivity, and patient access. Results Redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped-for gains in operational metrics. Interviews reported that team redesign was leading to improvements in chronic care and prevention and eased provider burden. Besides making small adjustments to cope with setbacks, redesign and system leaders engaged in more thorough organizational learning. They examined contextual challenges underlying setbacks and posing risks to the delivery system as a whole. Their responses to challenges helped strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value-based care and population health. Conclusions This case points to benefits for both health care researchers and change practitioners of paying closer attention to how context affects implementation of organizational change, and to opportunities and conditions for learning from setbacks during change.
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Turner A, Mulla A, Booth A, Aldridge S, Stevens S, Begum M, Malik A. The international knowledge base for new care models relevant to primary care-led integrated models: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [PMID: 29972636 DOI: 10.3310/hsdr06250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundThe Multispecialty Community Provider (MCP) model was introduced to the NHS as a primary care-led, community-based integrated care model to provide better quality, experience and value for local populations.ObjectivesThe three main objectives were to (1) articulate the underlying programme theories for the MCP model of care; (2) identify sources of theoretical, empirical and practice evidence to test the programme theories; and (3) explain how mechanisms used in different contexts contribute to outcomes and process variables.DesignThere were three main phases: (1) identification of programme theories from logic models of MCP vanguards, prioritising key theories for investigation; (2) appraisal, extraction and analysis of evidence against a best-fit framework; and (3) realist reviews of prioritised theory components and maps of remaining theory components.Main outcome measuresThe quadruple aim outcomes addressed population health, cost-effectiveness, patient experience and staff experience.Data sourcesSearches of electronic databases with forward- and backward-citation tracking, identifying research-based evidence and practice-derived evidence.Review methodsA realist synthesis was used to identify, test and refine the following programme theory components: (1) community-based, co-ordinated care is more accessible; (2) place-based contracting and payment systems incentivise shared accountability; and (3) fostering relational behaviours builds resilience within communities.ResultsDelivery of a MCP model requires professional and service user engagement, which is dependent on building trust and empowerment. These are generated if values and incentives for new ways of working are aligned and there are opportunities for training and development. Together, these can facilitate accountability at the individual, community and system levels. The evidence base relating to these theory components was, for the most part, limited by initiatives that are relatively new or not formally evaluated. Support for the programme theory components varies, with moderate support for enhanced primary care and community involvement in care, and relatively weak support for new contracting models.Strengths and limitationsThe project benefited from a close relationship with national and local MCP leads, reflecting the value of the proximity of the research team to decision-makers. Our use of logic models to identify theories of change could present a relatively static position for what is a dynamic programme of change.ConclusionsMultispecialty Community Providers can be described as complex adaptive systems (CASs) and, as such, connectivity, feedback loops, system learning and adaptation of CASs play a critical role in their design. Implementation can be further reinforced by paying attention to contextual factors that influence behaviour change, in order to support more integrated working.Future workA set of evidence-derived ‘key ingredients’ has been compiled to inform the design and delivery of future iterations of population health-based models of care. Suggested priorities for future research include the impact of enhanced primary care on the workforce, the effects of longer-term contracts on sustainability and capacity, the conditions needed for successful continuous improvement and learning, the role of carers in patient empowerment and how community participation might contribute to community resilience.Study registrationThis study is registered as PROSPERO CRD42016039552.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alison Turner
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Abeda Mulla
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shiona Aldridge
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Sharon Stevens
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Mahmoda Begum
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Anam Malik
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
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Benzer JK, Charns MP, Hamdan S, Afable M. The role of organizational structure in readiness for change: A conceptual integration. Health Serv Manage Res 2016; 30:34-46. [PMID: 28166670 DOI: 10.1177/0951484816682396] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this review is to extend extant conceptualizations of readiness for change as an individual-level phenomenon. This review-of-reviews focuses on existing conceptual frameworks from the dissemination, implementation, quality improvement, and organizational transformation literatures in order to integrate theoretical rationales for how organization structure, a key dimension of the organizational context, may impact readiness for change. We propose that the organization structure dimensions of differentiation and integration impact readiness for change at the individual level of analysis by influencing four key concepts of relevance, legitimacy, perceived need for change, and resource allocation. We identify future research directions that focus on these four key concepts.
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Affiliation(s)
- Justin K Benzer
- 1 Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.,2 Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning Veterans, Waco, TX, USA.,3 Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Martin P Charns
- 1 Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.,4 Department of Health Policy, Law, and Management, School of Public Health, Boston University, Boston, MA, USA
| | - Sami Hamdan
- 1 Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.,5 School of Medicine, Tufts University, Boston, MA, USA
| | - Melissa Afable
- 1 Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.,4 Department of Health Policy, Law, and Management, School of Public Health, Boston University, Boston, MA, USA
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Appreciative Inquiry as an intervention to change nursing practice in in-patient settings: An integrative review. Int J Nurs Stud 2016; 60:179-90. [DOI: 10.1016/j.ijnurstu.2016.04.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 04/22/2016] [Accepted: 04/26/2016] [Indexed: 11/23/2022]
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DePuccio MJ, Ozcan YA. Exploring efficiency differences between medical home and non-medical home hospitals. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2016. [DOI: 10.1080/20479700.2015.1101913] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Matthew J. DePuccio
- Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia 23298-0203, USA
| | - Yasar A. Ozcan
- Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia 23298-0203, USA
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Steele Gray C, Wilkinson A, Alvaro C, Wilkinson K, Harvey M. Building Resilience and Organizational Readiness During Healthcare Facility Redevelopment Transitions: Is It Possible to Thrive? HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2015. [PMID: 26205401 DOI: 10.1177/1937586715593552] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Hospital redevelopment constitutes a revolutionary change that can face strong resistance from employees. Few studies have examined how employee readiness for change relates to adjustment outcomes typically captured in post-occupancy evaluation (POE). The relationship between organizational readiness and employee adjustment is examined in the context of a POE conducted during a hospital redevelopment. BACKGROUND Our study focuses on the redevelopment of a complex continuing care and rehabilitation hospital that underwent complete physical redevelopment and major shifts in operational and organizational processes. METHODS Using a pretest-posttest quasi-experimental research design, staff organizational readiness was assessed using surveys at four time periods: 6 months prior to the move (n = 125), 2 months prior to the move (n = 84), 3 months after the move (n = 187), and 6 months after the move (n = 194). Measures included organizational readiness, workplace satisfaction, psychological factors (well-being and optimism), and sociodemographic information. RESULTS Findings suggest readiness changes from pre- to post-move, with notable drops just prior (2 months) and just post (3 months) hospital move. Employees demonstrated significant increases in workplace satisfaction and interprofessional relationships from 6 months prior to the move to 6 months after. Results suggest that higher readiness is related to improved employee adjustment. CONCLUSIONS A supportive change environment was found to encourage positive employee outcomes in the face of revolutionary change. It is recommended that change management activities be tailored not only to employee need but also to the timing of the change process.
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Affiliation(s)
- Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Wilkinson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Celeste Alvaro
- Department of Architectural Science, Ryerson University, Toronto, Ontario, Canada CARE Consultancy, Toronto, Ontario, Canada
| | | | - Martha Harvey
- West Park Healthcare Centre, Toronto, Ontario, Canada
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Nurturing Cultural Change in Care for Older People: Seeing the Cherry Tree Blossom. HEALTH CARE ANALYSIS 2014; 24:349-373. [DOI: 10.1007/s10728-014-0280-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Solberg LI, Stuck LH, Crain AL, Tillema JO, Flottemesch TJ, Whitebird RR, Fontaine PL. Organizational factors and change strategies associated with medical home transformation. Am J Med Qual 2014; 30:337-44. [PMID: 24788251 DOI: 10.1177/1062860614532307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There is limited information about how to transform primary care practices into medical homes. The research team surveyed leaders of the first 132 primary care practices in Minnesota to achieve medical home certification. These surveys measured priority for transformation, the presence of medical home practice systems, and the presence of various organizational factors and change strategies. Survey response rates were 98% for the Change Process Capability Questionnaire survey and 92% for the Physician Practice Connections survey. They showed that 80% to 100% of these certified clinics had 15 of the 18 organizational factors important for improving care processes and that 60% to 90% had successfully used 16 improvement strategies. Higher priority for this change (P = .001) and use of more strategies (P = .05) were predictive of greater change in systems. Clinics contemplating medical home transformation should consider the factors and strategies identified here and should be sure that such a change is indeed a high priority for them.
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Affiliation(s)
- Leif I Solberg
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - Logan H Stuck
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - A Lauren Crain
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - Juliana O Tillema
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | | | - Robin R Whitebird
- HealthPartners Institute for Education and Research, Minneapolis, MN
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Greenfield D, Kellner A, Townsend K, Wilkinson A, Lawrence SA. Health service accreditation reinforces a mindset of high-performance human resource management: lessons from an Australian study. Int J Qual Health Care 2014; 26:372-7. [PMID: 24737831 DOI: 10.1093/intqhc/mzu039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To investigate whether an accreditation program facilitates healthcare organizations (HCOs) to evolve and maintain high-performance human resource management (HRM) systems. DESIGN Cross-sectional multimethod study. SETTING AND PARTICIPANTS Healthcare organizations participating in the Australian Council on Healthcare Standards Evaluation and Quality Improvement Program (EQuIP 4) between 2007 and 2011. MAIN OUTCOME MEASURES Ratings across the EQuIP 4 HRM criteria, a clinical performance measure, surveyor reports (HRM information) and interview data (opinions and experiences regarding HRM and accreditation). RESULTS Healthcare organizations identified as high performing on accreditation HRM criteria seek excellence primarily because of internal motivations linked to best practice. Participation in an accreditation program is a secondary and less significant influence. Notwithstanding, the accreditation program provides the HCO opportunity for internal and external review and assessment of their performance; the accreditation activities are reflective learning and feedback events. CONCLUSIONS This study reveals that HCOs that pursue highly performing HRM systems use participation in an accreditation program as an opportunity. Their organizational mindset is to use the program as a tool by which to reflect and obtain feedback on their performance so to maintain or improve their management of staff and delivery of care.
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Affiliation(s)
- D Greenfield
- Faculty of Medicine, Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia
| | - A Kellner
- Centre for Work, Organisation and Wellbeing, Griffith University, Brisbane, Australia
| | - K Townsend
- Centre for Work, Organisation and Wellbeing, Griffith University, Brisbane, Australia
| | - A Wilkinson
- Centre for Work, Organisation and Wellbeing, Griffith University, Brisbane, Australia
| | - S A Lawrence
- Centre for Work, Organisation and Wellbeing, Griffith University, Brisbane, Australia
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