RESUMEN
Significant resources are spent on monitoring and improving the quality and safety of hospital care; however, evidence suggests that this investment is achieving disproportionately limited results. Accreditation and expectations of funders have focused hospital service quality management on compliance, with an over emphasis on the 'control' aspect of Juran's Quality Trilogy. This study compared the impact of the implementation of a strategic quality management system with existing compliance-focused quality management systems in a sample of Australian hospitals. Through action research, mixed methods data were tracked and compared implementation progress and outcomes between four experimental and four control hospitals from 2015 to 2017. While three years was not enough time to observe quality changes resulting from the implementation, three experimental hospitals made high quality care a strategic priority for their organisation and developed organisation-wide processes to achieve it. These hospitals demonstrated that including a strategic quality planning component in quality system design and implementation, as advocated by Juran but absent in many hospital quality systems, was a positive lever for staff commitment to delivering consistently high quality care.
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Administración Hospitalaria , Hospitales , Acreditación , Australia , Humanos , Calidad de la Atención de SaludRESUMEN
Objective To explore the impact of the organisational quality systems on quality of care in Victorian health services. Methods During 2015 a total of 55 focus groups were conducted with more than 350 managers, clinical staff and board members in eight Victorian health services to explore the effectiveness of health service quality systems. A review of the quality and safety goals and strategies outlined in the strategic and operating plans of the participating health services was also undertaken. Results This paper focuses on the data related to the leadership role of health service boards in ensuring safe, high-quality care. The findings suggest that health service boards are not fully meeting their governance accountability to ensure consistently high-quality care. The data uncovered major clinical governance gaps between stated board and executive aspirations for quality and safety and the implementation of these expectations at point of care. These gaps were further compounded by quality system confusion, over-reliance on compliance, and inadequate staff engagement. Conclusion Based on the existing evidence we propose five specific actions boards can take to close the gaps, thereby supporting improved care for all consumers. What is known about this topic? Effective governance is essential for high-quality healthcare delivery. Boards are required to play an active role in their organisation's pursuit of high quality care. What does this paper add? Recent government reports suggest that Australian health service boards are not fully meeting their governance requirements for high quality, safe care delivery, and our research pinpoints key governance gaps. What are the implications for practitioners? Based on our research findings we outline five evidence-based actions for boards to improve their governance of quality care delivery. These actions focus on an organisational strategy for high-quality care, with the chief executive officer held accountable for successful implementation, which is actively guided and monitored by the board.
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Actitud del Personal de Salud , Consejo Directivo , Personal de Salud/psicología , Servicios de Salud , Calidad de la Atención de Salud , Grupos Focales , Servicios de Salud/normas , Hospitales , Humanos , Liderazgo , Salud Pública , Mejoramiento de la Calidad , Calidad de la Atención de Salud/normas , VictoriaRESUMEN
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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Administración Hospitalaria/normas , Seguridad del Paciente/normas , Calidad de la Atención de Salud/organización & administración , Comités Consultivos/organización & administración , Actitud del Personal de Salud , Australia , Administradores de Hospital/organización & administración , Humanos , Capacitación en Servicio , Mejoramiento de la Calidad/organización & administración , Calidad de la Atención de Salud/normasRESUMEN
Public hospitals are required to have quality systems in place to meet accreditation standards, achieve government performance expectations and continually improve care. However, previous study suggests that there has been limited success in the implementation of effective quality systems. Using document review, self-evaluation and qualitative data from interviews and focus groups of 270 board members, managers and staff we explored the implementation of quality systems in eight Australian public hospitals. Using normalisation process theory, we found that the hospitals took a technical, top-down approach to quality system implementation and did not provide staff with opportunities for socialization of the technology that enabled them to normalise the quality work. 'Quality' was consistently described as an 'extra' set of tasks to do, rather than a means to creating sustained, safe, quality care. Despite enormous goodwill and positive intent, a lack of understanding of how to effect change in the complexity of hospitals has led the boards and senior managers in our sample to execute a technical, top-down approach based on compliance and reactive risk.
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Acreditación , Hospitales Públicos/normas , Calidad de la Atención de Salud , Australia , Humanos , Investigación CualitativaRESUMEN
OBJECTIVE: To develop clinical leadership among health professionals working in public sector organisations to improve their skills in ensuring high quality and safe health services. METHODS: A longitudinal pre-post-intervention mixed methods study that included 60 health professionals working in one state in Australia. RESULTS: The program was successful in the development of clinical leaders. CONCLUSIONS: An interdisciplinary, inter-sectoral leadership development program involving health professionals from metropolitan, regional and rural areas can be successful in developing knowledge, skills and competencies among these health professionals in health service quality and safety. IMPLICATIONS: Health professionals can participate in a development program to enhance their clinical leadership skills. While this was a post-qualification course, targeting experienced health professionals, the learnings could be applied to pre-qualification education of health professionals.
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Personal de Salud/educación , Liderazgo , Desarrollo de Programa , Mejoramiento de la Calidad , Administración de la Seguridad/métodos , Personal Administrativo/educación , Australia , Humanos , Competencia Profesional , Administración de la Seguridad/organización & administraciónRESUMEN
AIMS AND OBJECTIVES: To determine whether a formal mentoring programme assists nurse practitioner candidates to develop competence in the clinical leadership competencies required in their advanced practice roles. BACKGROUND: Nurse practitioner candidates are required to show evidence of defined clinical leadership competencies when they apply for endorsement within the Australian health care system. Aiming to assist the candidates with the development or enhancement of these leadership skills, 18 nurse practitioner candidates participated in a mentoring programme that matched them with senior nurse mentors. DESIGN: A pre-postlongitudinal intervention study. METHOD: Eighteen nurse practitioner candidates and 17 senior nurses participated in a voluntary mentoring programme that incorporated coaching and action learning over 18 months in 2012 and 2013. Participants completed a pen and paper questionnaire to document baseline measures of self-reported leadership practices prior to commencement of the programme and again at the end of the programme. RESULTS: The mentors and the nurse practitioner candidates qualitatively evaluated the programme as successful and quantitative data illustrated significant improvement in self-reported leadership practices among the nurse practitioner candidates. In particular, the nurse practitioner candidates reported greater competence in the transformational aspects of leadership, which is directly related to the nurse practitioner candidate clinical leadership standard. CONCLUSIONS: A formal, structured mentoring programme based on principles of action learning was successful in assisting Australian advanced practice nurses enhance their clinical leadership skills in preparation for formal endorsement as a nurse practitioner and for success in their advanced practice role. RELEVANCE TO CLINICAL PRACTICE: Mentoring can assist nurses to transition to new roles and develop knowledge and skills in clinical leadership essential for advanced practice roles. Nurse managers should make greater use of mentoring programmes to support nurses in their transition to new roles.
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Liderazgo , Mentores , Enfermeras Administradoras , Enfermeras Practicantes , Adulto , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Victoria , Adulto JovenRESUMEN
PURPOSE: While there has been substantial discussion about the potential for clinical leadership in improving quality and safety in healthcare, there has been little robust study. The purpose of this paper is to present the results of a qualitative study with clinicians and clinician managers to gather opinions on the appropriate content of an educational initiative being planned to improve clinical leadership in quality and safety among medical, nursing and allied health professionals working in primary, community and secondary care. DESIGN/METHODOLOGY/APPROACH: In total, 28 clinicians and clinician managers throughout the state of Victoria, Australia, participated in focus groups to provide advice on the development of a clinical leadership program in quality and safety. An inductive, thematic analysis was completed to enable the themes to emerge from the data. FINDINGS: Overwhelmingly the participants conceptualised clinical leadership in relation to organisational factors. Only four individual factors, comprising emotional intelligence, resilience, self-awareness and understanding of other clinical disciplines, were identified as being important for clinical leaders. Conversely seven organisational factors, comprising role clarity and accountability, security and sustainability for clinical leaders, selective recruitment into clinical leadership positions, teamwork and decentralised decision making, training, information sharing, and transformational leadership, were seen as essential, but the participants indicated they were rarely addressed. The human resource management literature includes these seven components, with contingent reward, reduced status distinctions and measurement of management practices, as the essential organisational underpinnings of high performance work systems. PRACTICAL IMPLICATIONS: The results of this study propose that clinical leadership is an organisational property, suggesting that capability frameworks and educational programs for clinical leadership need a broader organisation focus. ORIGINALITY/VALUE: The paper makes clear that clinical leadership was not perceived to be about vesting leadership skills in individuals, but about ensuring health care organisations were equipped to conceptualise and support a model of distributive leadership.
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Actitud del Personal de Salud , Competencia Clínica/normas , Personal de Salud/educación , Liderazgo , Garantía de la Calidad de Atención de Salud/métodos , Administración de la Seguridad/métodos , Personal Administrativo/educación , Personal Administrativo/normas , Femenino , Grupos Focales , Personal de Salud/normas , Humanos , Difusión de la Información , Relaciones Interpersonales , Masculino , Cultura Organizacional , Administración de Personal/métodos , Administración de Personal/normas , Investigación Cualitativa , Garantía de la Calidad de Atención de Salud/organización & administración , Garantía de la Calidad de Atención de Salud/normas , Administración de la Seguridad/organización & administración , Administración de la Seguridad/normas , Desarrollo de Personal/métodos , Desarrollo de Personal/normas , VictoriaRESUMEN
Healthcare has failed to make the same progress as other high-risk industries when it comes to creating safety - despite over a decade of research, education and implementation of safety systems in health services. Safe care is created by systems and standardization, and also by proactive, thinking staff working in partnership with consumers and each other; but the healthcare industry appears to struggle to reconcile these concepts. Even with our evolved knowledge of how human beings operate in organizations, and the best intentions, the dominant change paradigm in healthcare is still hierarchical, based on top-down policies implemented by managers and staff. Although the power spread in health services is being tested through generational change, we have a long way to go before proactivity and initiative at the front line are universally fostered and welcomed by healthcare managers and senior clinicians. "Front Line Ownership: Generating a Cure Mindset for Patient Safety," by Zimmerman et al., presents a persuasive example of how staff ownership of improving consumer safety is a powerful tool for change, one that deserves its place at the front line of safety and quality improvement methods.
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Infección Hospitalaria/prevención & control , Personal de Salud/normas , Control de Infecciones/normas , Seguridad del Paciente/normas , Administración de la Seguridad/normas , HumanosRESUMEN
This paper reports on a training programme using action learning sets designed to enhance the management abilities of health-care managers. Numerous independent reports in Australia, and around the world, have related the lack of management systems and processes to substandard health-care delivery. This has suggested a need for better approaches to the education, training and ongoing development of health-care managers, and this paper reports on an action learning approach trialled over a three-year period. Participant managers reported significantly greater levels of empowerment and self-efficacy after participation in the year-long action learning sets intervention. While too early to measure the translation of these reported individual improvements into specific management practice, the literature strongly supports more effective management practice among managers who report high levels of empowerment and self-efficacy.
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Administradores de Instituciones de Salud/educación , Aprendizaje , Competencia Profesional , Enseñanza/métodos , Adulto , Australia , Curriculum , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Clinical governance is seen as a relatively new concept; but a long history of health care quality improvement sits behind it. Over the last 20 years, a number of approaches have been tried and discarded, with some inadequately implemented and others poorly adapted from other industries. Quality programs have evolved slowly, hampered by a conservative and complex health care culture and a lack of focus, data and resources. Despite the advent of clinical governance, driven by a patient safety crisis, many of these issues remain unresolved, and are impacting current clinical governance implementation. Reflecting on the quality journey clearly demonstrates that the potential of clinical governance cannot be realised without the leadership, commitment and support of governing bodies and executives.
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Auditoría Clínica/organización & administración , Consejo Directivo/organización & administración , Administración Hospitalaria , Modelos Organizacionales , Australia , Auditoría Clínica/tendencias , Humanos , Liderazgo , Cultura Organizacional , Innovación Organizacional , Técnicas de Planificación , Administración de la Seguridad , Responsabilidad SocialRESUMEN
PURPOSE: To strengthen the middle manager role in a hospital quality improvement (QI) program, with a view to increasing and sustaining organisational QI implementation. DESIGN/METHODOLOGY/APPROACH: Case study based action research project, combining pre- and post-action quantitative and qualitative data collection, relating to a QI program intervention in an Australian metropolitan specialist teaching hospital. A model for enhancing the middle manager role in QI was developed and then implemented as the action over a 12-month period. FINDINGS: Middle manager understanding and ownership of the QI program and organisational QI implementation significantly increased, although their perceived enjoyment of being involved in QI decreased. RESEARCH LIMITATIONS/IMPLICATIONS: This case-study based action research project was limited to one organisation of a specific type - a large specialist metropolitan teaching hospital. The composition of the middle manager group, therefore, is necessarily limited to particular specialties. It is acknowledged that findings from case study and action research methodologies are limited in their generalisability, but assist in the development of knowledge and principles that can be adapted to different settings. PRACTICAL IMPLICATIONS: This QI implementation model can increase levels of organisational QI implementation by effecting a positive change in middle manager attitude to and involvement in QI. ORIGINALITY/VALUE: There are many theories regarding the importance of the middle manager role in QI, but little empirical research into exactly what this role may be and how it may be strengthened. This research adds to the knowledge base, and provides clear steps for achieving increased staff involvement and QI implementation.
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Administradores de Hospital , Cultura Organizacional , Propiedad , Gestión de la Calidad Total/organización & administración , Hospitales de Enseñanza , Hospitales Urbanos , Innovación Organizacional , VictoriaRESUMEN
The implementation of clinical governance in health care services introduces increased responsibility and transparency around safety and quality into all staff roles. Encouraging staff to assume these responsibilities as part of their daily routine is fundamental to achieving effective clinical governance, and requires health care managers at all levels to embrace clinical governance leadership and management. Fostering this role will need to be approached skillfully if managers are to achieve effective leadership of clinical governance activities. This paper reviews the management and quality-related literature to explore how these roles may best be developed to ensure that health care managers are equipped and willing to undertake the critical task of translating clinical governance policy into day-to-day practice.
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Administradores de Instituciones de Salud , Rol Profesional , Gestión de la Calidad Total , Programas Nacionales de Salud , Cultura Organizacional , VictoriaRESUMEN
Clinical governance is one of the current crop of "buzz terms" in the quality world. It may be new, but is it useful? And what does it really mean for those who work at the many and varied levels of the Australian healthcare system?
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Auditoría Clínica , Gestión de la Información/normas , Gestión de la Calidad Total/métodos , Australia , Humanos , Gestión de la Información/organización & administración , Gestión de la Calidad Total/organización & administraciónRESUMEN
The development of performance measures in outpatient services is trailing in the wake of an emphasis on inpatient measures. Research was undertaken at The Royal Victorian Eye and Ear Hospital (RVEEH) to determine key areas for the development of performance measures in eye outpatient services from the perspective of three stakeholder groups: clinicians, managers and patients. The study identified four key areas for the development of performance measurement: waiting time to first outpatient appointment, patient discharge from outpatient clinics, waiting time in clinic and patient throughput. It was also shown that there are some significant differences of opinion between stakeholder groups. Such similarities and differences are unlikely to be unique to RVEEH and may serve as useful prompts for other organisations considering outpatient performance measures.