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Improvement Capability at the Front Lines of Healthcare: Helping through Leading and Coaching
Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

SUMMARY

This thesis addresses improvement capability at the front lines of healthcare with a focus on interprofessional health care improvement teams who provide care and improve care. The overall aim is to explore high performing clinical microsystems and evaluate interventions to cultivate health care improvement capabilities of frontline interprofessional teams.

Methods

Descriptive and evaluative study designs were employed in the five studies which comprise this thesis. A total of 495 interprofessional health care providers from a variety of health care contexts in the United States (Study I, II, III & IV) and Sweden (Study V) participated in the studies. The mixed methods research included qualitative observation, interviews, focus groups and surveys analyzed with qualitative manifest content analysis. The quantitative data were analyzed with statistics appropriate for non-parametric data.

Findings

Study I and II describe how leaders who understand health care improvement can create conditions for interprofessional teams to provide care and simultaneously improve care. Study III evaluates adapted clinical microsystem processes and tools successfully adapted in two different hospitals. Frontline staff reported that they needed help to balance providing care and improving care. Study IV and V explored and tested team coaching to help interprofessional teams to increase their improvement capabilities within improvement collaboratives. The participants perceived team coaching mostly positively and identified supportive coaching actions. In Study V an intervention with “The Team Coaching Model” was tested in Sweden and showed increased acquisition of improvement knowledge in the intervention teams compared to teams who did not receive the coaching model.

Conclusions

The thesis findings show leaders can help cultivate health care improvement capability by designing structures, processes and outcomes of their organizational systems to support health care improvement activities, setting clear improvement expectations of all staff, developing the knowledge of every staff member in the microsystem to know their operational processes and systems to promote action learning in their daily work, and providing help with team coaching using a Team Coaching Model.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences , 2013. , 165 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 46
Keyword [en]
Health care improvement, interprofessional teams, leadership of improvement, team coaching, clinical microsystem
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-21751ISBN: 978-91-85835-45-4 (print)OAI: oai:DiVA.org:hj-21751DiVA: diva2:640804
Public defence
2013-09-05, Originalet, Qulturum, Hus B4, Ryhov County Hospital, Jönköping, 10:00 (English)
Opponent
Available from: 2013-08-14 Created: 2013-08-14 Last updated: 2013-08-14Bibliographically approved
List of papers
1. Microsystems in health care: Part 3. Planning patient-centered services.
Open this publication in new window or tab >>Microsystems in health care: Part 3. Planning patient-centered services.
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2003 (English)In: Joint Commission journal on quality and safety, ISSN 1549-3741, Vol. 29, no 4, 159-170 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Strategic focus on the clinical microsystems--the small, functional, frontline units that provide most health care to most people--is essential to designing the most efficient, population-based services. The starting place for designing or redesigning of clinical microsystems is to evaluate the four P's: the patient subpopulations that are served by the microsystem, the people who work together in the microsystem, the processes the microsystem uses to provide services, and the patterns that characterize the microsystem's functioning.

GETTING STARTED: DIAGNOSING AND TREATING A CLINICAL MICROSYSTEM: Methods and tools have been developed for microsystem leaders and staff to use to evaluate the four P's--to assess their microsystem and design tests of change for improvement and innovation.

PUTTING IT ALL TOGETHER: Based on its assessment--or diagnosis--a microsystem can help itself improve the things that need to be done better. Planning services is designed to decrease unnecessary variation, facilitate informed decision making, promote efficiency by continuously removing waste and rework, create processes and systems that support staff, and design smooth, effective, and safe patient care services that lead to measurably improved patient outcomes.

CONCLUSION: The design of services leads to critical analysis of the resources needed for the right person to deliver the right care, in the right way, at the right time.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-21746 (URN)12698806 (PubMedID)
Available from: 2013-08-14 Created: 2013-08-14 Last updated: 2017-01-16Bibliographically approved
2. Microsystems in health care: Part 8. Developing people and improving work life
Open this publication in new window or tab >>Microsystems in health care: Part 8. Developing people and improving work life
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2003 (English)In: Joint Commission journal on quality and safety, ISSN 1549-3741, Vol. 29, no 10, 512-22 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The articles in the Microsystems in Health Care series have focused on the success characteristics of high-performing clinical microsystems. Realization is growing about the importance of attracting, selecting, developing, and engaging staff. By optimizing the work of all staff members and by promoting a culture where everyone matters, the microsystem can attain levels of performance not previously experienced.

CASE STUDY: At Massachusetts General Hospital Downtown Associates (Boston), a primary care practice, the human resource processes are specified and predictable, from a candidate's initial contact through each staff member's orientation, performance management, and professional development. Early on, the new employee receives materials about the practice, including a practice overview, his or her typical responsibilities, the performance evaluation program, and continuous quality improvement. Ongoing training and education are supported with skill labs, special education nights, and cross-training. The performance evaluation program, used to evaluate the performance of all employees, is completed during the 90-day orientation and training, quarterly for one year, and annually.

CONCLUSION: Some health care settings enjoy high morale, high quality, and high productivity, but all too often this is not the case. The case study offers an example of a microsystem that has motivated its staff and created a positive and dynamic workplace.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-21747 (URN)14567260 (PubMedID)
Available from: 2013-08-14 Created: 2013-08-14 Last updated: 2017-01-16Bibliographically approved
3. Clinical microsystems, Part 3.: Transformation of two hospitals using microsystem, mesosystem, and macrosystem strategies.
Open this publication in new window or tab >>Clinical microsystems, Part 3.: Transformation of two hospitals using microsystem, mesosystem, and macrosystem strategies.
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2008 (English)In: Joint Commission Journal on Quality and Patient Safety, ISSN 1553-7250, E-ISSN 1938-131X, Vol. 34, no 10, 591-603 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Two hospitals-a large, urban academic medical center and a rural, community hospital-have each chosen a similar microsystem-based approach to improvement, customizing the engagement of the micro-, meso-, and macrosystems and the improvement targets on the basis of an understanding of the local context. CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER (CCHMC): Since 2004, strategic changes have been developed to support microsystems and their leaders through (1) ongoing improvement training for all macro-, meso-, and microsystem leaders; (2) financial support for physicians who are serving as co-leaders of clinical microsystems; (3) increased emphasis on aligning academic pursuits with improvement work at the clinical front lines; (4) microsystem leaders' continuous access to unit-level data through the organization's intranet; and (5) encouragement of unit leaders to share outcomes data with families.

COOLEY DICKINSON HOSPITAL (CDH): CDH has moved from near closure to a survival-turnaround focus, significant engagement in quality and finally, a complete reframing of a quality focus in 2004. Since then, it has deployed the clinical microsystems approach in one pilot care unit (West 2, a medical surgery unit), broadened it to two, then six more, and is now spreading it organizationwide. In "2+2 Charters," interdisciplinary teams address two strategic goals set by senior leadership and two goals set by frontline microsystem leaders and staff

DISCUSSION: CCHMC and CDH have had a clear focus on developing alignment, capability, and accountability to fuse together the work at all levels of the hospital, unifying the macrosystem with the mesosystem and microsystem. Their improvement experience suggests tips and actions at all levels of the organization that could be adapted with specific context knowledge by others.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-21748 (URN)18947119 (PubMedID)
Available from: 2013-08-14 Created: 2013-08-14 Last updated: 2017-12-06Bibliographically approved
4. Coaching interprofessional health care improvement teams: the coachee, the coach and the leader perspectives
Open this publication in new window or tab >>Coaching interprofessional health care improvement teams: the coachee, the coach and the leader perspectives
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2014 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 22, no 4, 452-464 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate health care improvement team coaching activities from the perspectives of coachees, coaches and unit leaders in two national improvement collaboratives.

BACKGROUND: Despite numerous methods to improve health care, inconsistencies in success have been attributed to factors that include unengaged staff, absence of supportive improvement resources and organisational inertia.

METHODS: Mixed methods sequential exploratory study design, including quantitative and qualitative data from interprofessional improvement teams who received team coaching. The coachees (n = 382), coaches (n = 9) and leaders (n = 30) completed three different data collection tools identifying coaching actions perceived to support improvement activities.

RESULTS: Coachees, coaches and unit leaders in both collaboratives reported generally positive perceptions about team coaching. Four categories of coaching actions were perceived to support improvement work: context, relationships, helping and technical support.

CONCLUSIONS: All participants agreed that regardless of who the coach is, emphasis should include the four categories of team coaching actions.

IMPLICATIONS FOR NURSING MANAGEMENT: Leaders should reflect on their efforts to support improvement teams and consider the four categories of team coaching actions. A structured team coaching model that offers needed encouragement to keep the team energized, seems to support health care improvement.

Keyword
coaching; collaboratives; facilitation; health care quality improvement; interprofessional teams; leadership
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-21749 (URN)10.1111/jonm.12068 (DOI)000335520500006 ()23782339 (PubMedID)2-s2.0-84899995047 (Scopus ID)HHJKvalitetIS (Local ID)HHJKvalitetIS (Archive number)HHJKvalitetIS (OAI)
Note

Special Issue: Capacity building, Issue editor: Elisabeth Severinsson

Available from: 2013-08-14 Created: 2013-08-14 Last updated: 2017-12-06Bibliographically approved
5. Testing a Team Coaching Model to develop improvement capability of frontline teams: A comparative intervention and process evaluation pilot study
Open this publication in new window or tab >>Testing a Team Coaching Model to develop improvement capability of frontline teams: A comparative intervention and process evaluation pilot study
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-21750 (URN)
Available from: 2013-08-14 Created: 2013-08-14 Last updated: 2013-08-14Bibliographically approved

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