This paper introduces the construct of leader inclusiveness—words and deeds exhibited by leaders that invite and appreciate others' contributions. We propose that leader inclusiveness helps cross‐disciplinary teams overcome the inhibiting effects of status differences, allowing members to collaborate in process improvement. The existence of a professional hierarchy in medicine and the differential status accorded to those in different disciplines is well established in the health care literature, as is the need for quality improvement. We build on this foundation to suggest that profession‐derived status is positively associated with psychological safety (H1)—a key antecedent of speaking up and learning behavior—in health care teams. We hypothesize that this effect varies across teams (H2), and furthermore, that leader inclusiveness predicts psychological safety (H3) and moderates the relationship between status and psychological safety (H4). Finally, we suggest psychological safety predicts engagement in quality improvement work (H5) and mediates the relationship between leader inclusiveness and engagement (H6). Survey data collected in 23 neonatal intensive care units involved in quality improvement projects support our hypotheses. These results provide insight into antecedents of and strategies for fostering improvement efforts in health care and other sectors in which cross‐disciplinary teams engage in collaborative learning to improve products or services. Copyright © 2006 John Wiley & Sons, Ltd.

O utcomes research examines the effects of medical care interventions and policies on the health outcomes of individuals and society. 1 Investigators conducting outcomes research seek to inform the development of clinical practice guidelines, to evaluate the quality of medical care, and to foster effective interventions to improve the quality of care. 2 Outcomes research has traditionally used quantitative sciences to examine the utilization, cost, and clinical effectiveness of medical care through randomized and nonrandomized experimental designs. Quantitative methods are not as well suited to measure other complex aspects of the healthcare delivery system, such as organizational change, clinical leadership in implementing evidence-based guidelines, and patient perceptions of quality of care, which are also critical issues in outcomes research. [3][4][5][6][7] These more nuanced aspects of healthcare delivery may be most appropriately examined with qualitative research methods. 8 -10 Qualitative approaches are becoming more common in clinical medicine and health services research. 5,[11][12][13][14][15] Federal encouragement of qualitative research is regularly reflected in funding program announcements issued by the National Institutes of Health. 16 For more than a decade, federal agencies and foundations such as the National Science Foundation have demonstrated a commitment to supporting qualitative research through funding scientific conferences, workshops, and monographs on this field of inquiry. [17][18][19][20] Despite this steady growth in qualitative research, outcomes investigators in cardiology have relatively little guidance on when and how best to implement these methods in their investigations.The purpose of the present report is to introduce qualitative methods as providing unique and critical contributions to outcomes research. This report will describe the situations in which qualitative approaches are most helpful; summarize the primary principles and practices in study design, sampling, data collection, and data analysis for qualitative studies; present representative examples of cardiovascular outcomes research that uses qualitative methods; and synthesize current standards for ensuring rigor and enhancing credibility of qualitative research. Defining Qualitative ResearchQualitative research is a form of scientific inquiry that spans different disciplines, fields, and subject matter and comprises many varied approaches. 21 Qualitative methods can be used to understand complex social processes, to capture essential aspects of a phenomenon from the perspective of study participants, 5 and to uncover beliefs, values, and motivations that underlie individual health behaviors. [22][23][24] Such research can also illuminate aspects of organizational context and healthcare delivery that influence organizational performance and quality of care. 10,25 Qualitative studies are often exploratory in nature and seek to generate novel insights 9,23,26,27 using inductive (starting with observations and dev...

BackgroundDespite decades of efforts to improve quality of health care, poor performance persists in many aspects of care. Less than 1% of the enormous national investment in medical research is focused on improving health care delivery. Furthermore, when effective innovations in clinical care are discovered, uptake of these innovations is often delayed and incomplete. In this paper, we build on the established principle of 'positive deviance' to propose an approach to identifying practices that improve health care quality.MethodsWe synthesize existing literature on positive deviance, describe major alternative approaches, propose benefits and limitations of a positive deviance approach for research directed toward improving quality of health care, and describe an application of this approach in improving hospital care for patients with acute myocardial infarction.ResultsThe positive deviance approach, as adapted for use in health care, presumes that the knowledge about 'what works' is available in existing organizations that demonstrate consistently exceptional performance. Steps in this approach: identify 'positive deviants,' i.e., organizations that consistently demonstrate exceptionally high performance in the area of interest (e.g., proper medication use, timeliness of care); study the organizations in-depth using qualitative methods to generate hypotheses about practices that allow organizations to achieve top performance; test hypotheses statistically in larger, representative samples of organizations; and work in partnership with key stakeholders, including potential adopters, to disseminate the evidence about newly characterized best practices. The approach is particularly appropriate in situations where organizations can be ranked reliably based on valid performance measures, where there is substantial natural variation in performance within an industry, when openness about practices to achieve exceptional performance exists, and where there is an engaged constituency to promote uptake of discovered practices.ConclusionThe identification and examination of health care organizations that demonstrate positive deviance provides an opportunity to characterize and disseminate strategies for improving quality.

The value of teams in new product development (NPD) is undeniable. Both the interdisciplinary nature of the work and industry trends necessitate that professionals from different functions work together on development projects to create the highestquality product in the shortest time. Understanding the conditions that facilitate teamwork has been a pursuit of researchers for nearly a half century. The present paper reviews existing literature on teams and team learning in organizational behavior and technology and innovation to offer insights for research on NPD teams. Building on prior work, the organizational benefits of NPD teams are summarized, and five attributes of these teams are identified that hinder attainment of their potential:(1) project complexity; (2) cross-functionality; (3) temporary membership; (4) fluid team boundaries; and (5) embeddedness in organizational structures. It is argued here that effective management of these five attributes allows not only organization-level benefits but also team-level benefits in the form of new capabilities and team member resilience. The critical roles of leadership and of communication and conflict management training are then highlighted as strategies for overcoming the challenges to team effectiveness in NPD as well as for realizing five team benefits: (1) project management skills; (2) broad perspective; (3) teaming skills; (4) expanded social network; and (5) boundary-spanning skills. The paper concludes with a discussion of the implications of these ideas for conducting future team research.