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Clinical microsystems, Part 3.: Transformation of two hospitals using microsystem, mesosystem, and macrosystem strategies.
Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work.
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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.

Place, publisher, year, edition, pages
2008. Vol. 34, no 10, 591-603 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-21748PubMedID: 18947119OAI: oai:DiVA.org:hj-21748DiVA: diva2:640653
Available from: 2013-08-14 Created: 2013-08-14 Last updated: 2017-01-16Bibliographically approved
In thesis
1. Improvement Capability at the Front Lines of Healthcare: Helping through Leading and Coaching
Open this publication in new window or tab >>Improvement Capability at the Front Lines of Healthcare: Helping through Leading and Coaching
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
Health care improvement, interprofessional teams, leadership of improvement, team coaching, clinical microsystem
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-21751 (URN)978-91-85835-45-4 (ISBN)
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

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