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Explaining organisational responses to a board-level quality improvement intervention: Findings from an evaluation in six providers in the English National Health Service
School of Health Sciences, Bangor University, G-Bangor, United Kingdom.
Department of Applied Health Research, University College London, London, United Kingdom.
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.ORCID iD: 0000-0001-8781-6675
Centre for Patient Safety and Service Quality, Imperial College London, London, United Kingdom.
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2019 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 28, no 3, p. 198-204Article in journal (Refereed) Published
Abstract [en]

Background: Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis' typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.

Methods: We conducted fieldwork over a 30-month period as part of an evaluation in six healthcare provider organisations in England. Our data comprised board member interviews (n=54), board meeting observations (24 hours) and relevant documents.

Results: Two organisations transformed their processes in a way that was consistent with the objectives of the intervention, and one customised the intervention with positive effects. In two further organisations, the intervention was only loosely coupled with organisational processes, and participation in the intervention stopped when it competed with other initiatives. In the final case, the intervention was corrupted to reinforce existing organisational processes (a focus on external regulatory requirements). The organisational response was contingent on the availability of 'slack' - expressed by participants as the 'space to think' and 'someone to do the doing' - and the presence of a functioning board.

Conclusions: Underperforming organisations, under pressure to improve, have little time or resources to devote to organisation-wide quality improvement initiatives. Our research highlights the need for policy-makers and regulators to extend their focus beyond the choice of intervention, to consider how the chosen intervention will be implemented in public sector hospitals, how this will vary between contexts and with what effects. We provide useful information on the necessary conditions for a board-level quality improvement intervention to have positive effects.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019. Vol. 28, no 3, p. 198-204
Keywords [en]
governance, organizational theory, quality improvement, adult, article, England, female, field work, health care personnel, human, interview, major clinical study, male, national health service, public sector, total quality management
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:hj:diva-42577DOI: 10.1136/bmjqs-2018-008291PubMedID: 30381330Scopus ID: 2-s2.0-85056110523Local ID: GOA HHJ 2019;HHJIMPROVEISOAI: oai:DiVA.org:hj-42577DiVA, id: diva2:1277595
Available from: 2019-01-10 Created: 2019-01-10 Last updated: 2019-03-22Bibliographically approved

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Robert, Glenn

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