Growing Organizational Capacity Through a Systems Approach: One Health Network’s Experience

Mackenzie, Richard S.; Capuano, Terry; Durishin, Linda Drexinger; Stern, Glenn; Burke, James B.

doi:10.1016/s1553-7250(08)34009-4

Cited by 8 publications

(5 citation statements)

References 23 publications

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“…As such, any improvements in efficiency have to include participation and learning among clinical, nonclinical and administrative staff who work within a system. A study examining a systems approach where multiple, multilevel clinical and administrative staff were involved in redesigning processes and roles has been shown to increase organizational capacity and efficiency in hospitals [11]. Identifying and including all diverse groups involved in the delivery of services in reducing waste and improving efficiency of the system using the -Lean methodology‖ been shown to increase efficiency and safety in healthcare institutions [12].…”

Section: Introductionmentioning

confidence: 99%

Organizational Learning in Health Care Organizations

Ratnapalan

Uleryk

2014

Systems

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The process of collective education in an organization that has the capacity to impact an organization's operations, performance and outcomes is called organizational learning. In health care organizations, patient care is provided through one or more visible and invisible teams. These teams are composed of experts and novices from diverse backgrounds working together to provide coordinated care. The number of teams involved in providing care and the possibility of breakdowns in communication and coordinated care increases in direct proportion to sophisticated technology and treatment strategies of complex disease processes. Safe patient care is facilitated by individual professional learning; inter-professional team learning and system based organizational learning, which encompass modified context specific learning by multiple teams and team members in a health care organization. Organizational learning in health care systems is central to managing the learning requirements in complex interconnected dynamic systems where all have to know common background knowledge along with shared meta-knowledge of roles and responsibilities to execute their assigned functions, communicate and transfer the flow of pertinent information and collectively provide safe patient care. Organizational learning in health care is not a onetime intervention, but a continuing organizational phenomenon that occurs through formal and informal learning which has reciprocal association with organizational change. As such, organizational changes elicit organizational learning and organizational learning implements new knowledge and practices to create organizational changes.

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Section: Introductionmentioning

confidence: 99%

Organizational Learning in Health Care Organizations

Ratnapalan

Uleryk

2014

Systems

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“… Horbar et al [ 30 ] Newborns received first dose of surfactant sooner compared to previous period (21 vs. 78 min post birth, p < 0.001). Kegler et al [ 25 ] More collaborative working practices Khan et al [ 31 ] Reduction in average brain function impediment score, drop from 19.21 to 14.75 MacKenzie et al [ 32 ] Turnaround time for beds reduced 210 to 54 min in 2004, maintained (2007) Moody-Thomas et al [ 33 , 34 ] Smoking quit rates increased from 5.0 % in 2008 to 9.6 % in 2009. Parchman et al [ 48 , 49 ], Noël et al [ 47 ] Significant and sustained improvement in ACIC scores for chronic care: from 5.58 to 6.33 to 6.60 (group 1) or 5.27 to 5.99 (group 2), both p < 0.05.…”

Section: Resultsmentioning

confidence: 99%

“…Many studies did not describe any barriers to implementation [ 28 , 30 – 32 , 38 , 43 , 45 , 46 ]. Difficulties in changing the larger health system and entrenched practices or habits of others were the most commonly cited barriers to applying systemic thinking usefully [ 11 , 24 , 25 , 29 , 39 , 40 , 42 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

Do complexity-informed health interventions work? A scoping review

Brainard

Hunter

2015

Implementation Sci

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BackgroundThe lens of complexity theory is widely advocated to improve health care delivery. However, empirical evidence that this lens has been useful in designing health care remains elusive. This review assesses whether it is possible to reliably capture evidence for efficacy in results or process within interventions that were informed by complexity science and closely related conceptual frameworks.MethodsSystematic searches of scientific and grey literature were undertaken in late 2015/early 2016. Titles and abstracts were screened for interventions (A) delivered by the health services, (B) that explicitly stated that complexity science provided theoretical underpinning, and (C) also reported specific outcomes. Outcomes had to relate to changes in actual practice, service delivery or patient clinical indicators. Data extraction and detailed analysis was undertaken for studies in three developed countries: Canada, UK and USA. Data were extracted for intervention format, barriers encountered and quality aspects (thoroughness or possible biases) of evaluation and reporting.ResultsFrom 5067 initial finds in scientific literature and 171 items in grey literature, 22 interventions described in 29 articles were selected. Most interventions relied on facilitating collaboration to find solutions to specific or general problems. Many outcomes were very positive. However, some outcomes were measured only subjectively, one intervention was designed with complexity theory in mind but did not reiterate this in subsequent evaluation and other interventions were credited as compatible with complexity science but reported no relevant theoretical underpinning. Articles often omitted discussion on implementation barriers or unintended consequences, which suggests that complexity theory was not widely used in evaluation.ConclusionsIt is hard to establish cause and effect when attempting to leverage complex adaptive systems and perhaps even harder to reliably find evidence that confirms whether complexity-informed interventions are usually effective. While it is possible to show that interventions that are compatible with complexity science seem efficacious, it remains difficult to show that explicit planning with complexity in mind was particularly valuable. Recommendations are made to improve future evaluation reports, to establish a better evidence base about whether this conceptual framework is useful in intervention design and implementation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0492-5) contains supplementary material, which is available to authorized users.

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“…Interventions to reduce ED overcrowding are a common focus for ED and hospital based QI activities [ 16 – 20 ]. Published literature demonstrates that workflow process changes can improve ED throughput times [ 18 , 21 ] and are cost effective quality interventions [ 21 ]. However, no single recipe for success is apparent [ 16 , 22 ] and the evidence for this is largely limited to case studies from high-income countries.…”

Section: Discussionmentioning

confidence: 99%

Identifying priorities for quality improvement at an emergency Department in Ghana

2017

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BackgroundHealthcare quality improvement (QI) is a global priority, and understanding the perspectives of frontline healthcare workers can help guide sustainable and meaningful change. We report a qualitative investigation of emergency department (ED) staff priorities for QI at a tertiary care hospital in Ghana. The aims of the study were to educate staff about the World Health Organization’s (WHO) definition of quality in healthcare, and to identify an initial focus for building a departmental QI program.MethodsSemi-structured interviews were conducted with ED staff using open-ended questions to probe their understanding and valuation of the six dimensions of quality defined by the WHO. Participants were then asked to rank the dimensions in order of importance for QI. Qualitative responses were thematically analyzed, and ordinal rank-order was determined for quantitative data regarding QI priorities.ResultsTwenty (20) members of staff of different cadres participated, including ED physicians, nurses, orderlies, a security officer, and an accountant. A majority of participants (61%) ranked access to emergency healthcare as high priority for QI. Two recurrent themes - financial accessibility and hospital bed availability - accounted for the majority of discussions, each linked to all the dimensions of healthcare quality.ConclusionsED staff related all of the WHO quality dimensions to their work, and prioritized access to emergency care as the most important area for improvement. Participants expressed a high degree of motivation to improve healthcare quality, and the study helped with the development of a departmental QI program focused on the broad topic of access to ED services.Electronic supplementary materialThe online version of this article (10.1186/s12873-017-0139-0) contains supplementary material, which is available to authorized users.

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Growing Organizational Capacity Through a Systems Approach: One Health Network’s Experience

Cited by 8 publications

References 23 publications

Organizational Learning in Health Care Organizations

Organizational Learning in Health Care Organizations

Do complexity-informed health interventions work? A scoping review

Identifying priorities for quality improvement at an emergency Department in Ghana

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