Organizing for Quality The Improvement Journeys of Leading Hospitals in Europe and the United States 1st Edition by Paul Bate, Peter Mendel, Glenn Robert 1846191513 9781846191510

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ISBN 10: 1846191513

ISBN 13: 9781846191510

Author: Paul Bate; Peter Mendel; Glenn Robert

This challenging and highly practical book draws on the findings from an international study designed to help practitioners and researchers understand the factors and processes that enable healthcare organisations in the United States and Europe to achieve – and sustain – high quality services for their users. The in-depth case-studies from seven

Organizing for Quality The Improvement Journeys of Leading Hospitals in Europe and the United States 1st Table of contents:

1 Introduction

Organizing for quality

Mapping out the terrain for our journey

Five differences between this quality research expedition and previous ones

Gazing down from the sky rather than searching on the ground

Descriptions of the ‘what’ rather than explanations of the ‘how’ or ‘why’

A search for variables rather than processes

Macro- or micro-system research (but rarely both together)

A focus on clinical and technical factors and processes to the exclusion of human and organizational processes

Study methods and approach

An orientation to our journey

Fieldwork

Analysis

Looking back over the journey

2 The art, the science, and the sociology of improvement: San Diego Children’s Hospital

The science of improvement: ‘standardizing to excellence’

The sociology of improvement

Getting people’s attention, and then their intention

Correct ‘framing’ of pathways and quality improvement

Using physician and nursing leaders: pathways champions

Inclusive and team-based

Authorship equals ownership

Collaborative not coercive

Neutral and non-partisan

Conducive to learning

Easy to do and user-friendly

The art of improvement: ‘so how does it ‘feel’?’

The Allergy and Immunology Clinic: the micro-system perspective on quality

Voltage drops in meaning

Care pathways? What care pathways?

Mindful as opposed to mindless use of clinical care pathways: ‘missing the zebra’

Developing ‘community’ within the micro-system

Putting it all together

And what of the future?

Journey highlights

The art and science of improvement

Macro-system and micro-system connections

The meso paradigm for quality

Mindfulness and mindful organizing

3 Organizational and professional identity: crisis, tradition and quality at the Royal Devon and Exeter NHS Foundation Trust

Managing ‘who we are’ at the RD&E Trust

The ‘then’

Crisis as a turning point

‘Walking the talk’

The ‘now’

Tradition, reputation, and the delivery of high-quality care at the PEOC

‘The journey starts in 1927’

Commitment and tradition: ‘two very big things’

Reputation and self-esteem

Shared stories: ‘crossing the road’

Interactions and interpretations: bridging the macro- and micro-systems

Leaders as ‘issue sellers’

Trust and respect

The implications of identity for sustained quality

Identity, performance and quality

Multiple identities within the RD&E and PEOC

Organizational identity: an untapped resource?

4 Organizational learning and sustained improvement: the quality journey at Cedars-Sinai Medical Center, Los Angeles

History, culture, and the journey towards improvement at Cedars-Sinai

The journey towards improvement

Customization, bricolage and organizational learning

Organizational fads or learning?

An infrastructure for learning and improvement

Functions of the improvement infrastructure

The nature and limitations of the improvement infrastructure

Communities of learning and engagement

Clinical ownership and leadership

Learning environments and community at the micro-level

Shared commitments and community

Learning communities across the organization

The interplay of macro- and micro-systems

Macro-level actions to enhance trust

Macro-level resources for quality

A receptive, interactive context

Conclusions

5 Building a system of leadership for quality improvement: a Dutch hospital in pursuit of perfection

RdGG’s route to high-quality healthcare

A defining moment: Pursuing Perfection at RdGG

Pursuing perfection at the micro-system: the Flow Varices project

Leadership at every level

Executive board

Cluster leaders

Micro-system leaders

Quality Steering Committee: strategic leadership for quality

Quality Department: implementation and dispersal

Conclusions: rethinking the leadership of quality

6 Smart socio-technical design in healthcare organizations: sustaining quality improvement at the Luther Midelfort Mayo Health System

The (pre-)history of quality improvement at Luther Midelfort

Hospital−clinic integration, organizational slack and the enabling of improvement

Organizational slack

Knowledge harvesting and exploitation

Developing the organization’s infrastructure and capacity for improvement

Central resources for improvement

A ‘whole basket of methods’

Availability and use of data

A ‘unified’ identity

Systems thinking: mapping how patients move through the organization

The physician compact

An integrated socio-technical perspective on healthcare improvement

7 Empowering quality: demonstration and democratization at the Peterborough and Stamford Hospitals NHS Foundation Trust

Empowerment, organizational effectiveness and improvement

The macro-system

Senior leadership

Demonstration

Democratization

Enabling quality to happen

The micro-system: the Radiology Department

Structure of the micro-system

Averting the ‘precipice’

‘Allowing it to happen’ at the micro-system level

Conclusions: real empowerment and the quest for quality in healthcare

8 Mobilizing for quality: the case of an HIV/AIDS treatment center in Albany, New York

Macro system: Albany Medical Center

Micro system: AIDS Treatment Center (ATC)

Organizational strengths of the ATC

Balanced leadership

Staff commitment and work ethic

Patient-centered focus

Proactive improvement

Participating in the HIV Collaborative

The ACE campaign

Conclusions: movements, mobilization and sustained improvement

9 A practitioner’s codebook for the quality journey

The six common challenges

A ‘color-codebook’ for quality and service improvement

Blue

Yellow

Red

Green

White

Pink

Different failures of QI efforts

The codebook

Using the color codebook

Leadership

How to apply the codebook

Achieving and Sustaining Healthcare Quality

Organizational challenges and solutions

A checklist

The structural challenge

The political challenge

The cultural challenge

The educational challenge

The emotional challenge

The physical and technological challenge

10 Towards a process model of organizing for quality

The need for something more

Moving from factors and steps to processes

Visualizing quality improvement processes in healthcare organizations

Cedars-Sinai

Peterborough

Royal Devon and Exeter

Albany

A final reflection: different paths up the mountain.. . but some paths are more well-trodden than others

11 Journey’s end: epilogue and final reflections

Limitations of our research

Implications for practitioners

QI needs a particular kind of change model and a particular kind of leadership

Leaders must seek to develop their own local solutions and continually respond to outside pressures

Pay attention to human and organizational processes (as well as clinical and technical)

Implications for researchers

The need for longitudinal organizational case studies: the pace and sequencing of QI efforts

The need for multi-level process models of QI

Use novel approaches to identify and analyze organizational processes and their interactions

New theoretical insights for QI in healthcare

ANNEX 1: Achieving and sustaining healthcare quality: a codebook for quality and service improvement

Definitions and examples

The structural challenge

The political challenge

The cultural challenge

The educational challenge

The emotional challenge

The physical and technological challenge

Context

Inner context

Organization size and scale

Organization structure

Organization performance

Outer context

Political and regulatory environments

Market and resource environments

Social, cultural and professional environments

Technological environments

ANNEX 2: Codes, labels and shorthand descriptions

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