Integrating

Abstract

Our research explores an understudied element of how clinics can implement improvement despite barriers: integrating stakeholders within and outside the clinic into the process. It provides clinic managers with an actionable path for implementing improvement.

Leadership perspectives on key elements influencing implementing a family‐focused intervention in mental health services

“…The findings confirm the pivotal role of leadership and how structures they provide to support practice, their approach to change, their knowledge of the intervention and the change process are influential to implementation (Aarons, 2006;Aarons, Hurlburt, & Horwitz, 2011;Aarons & Sommerfeld, 2012;Kerrissey, Satterstrom, Leydon, Schiff, & Singer, 2017;Stirman et al, 2016). The approaches to change seen in this study highlight how different styles of leadership can impact implementation.…”

“…Middle managers approach to change affected their ability to effectively fit Let's Talk to current practice. This integrating mechanism, as described as "sense-making," is described as vital to support the workforce to integrate new ways of working (Kerrissey et al, 2017). Despite the difficulty of prioritizing within a crowded space, the findings emphasize the benefit of investing in middle management to enable them to fit Let's Talk to the service and lead change.…”

“…Middle management's approach to change coupled with their experience of conflicts of paradigms and priorities can lead to powerlessness in the implementation process (Glaser, Fourné, & Elfring, 2015;Radaelli & Sitton-Kent, 2016). Senior management's role at clearly setting achievable priorities for staff and enabling the priorities to be actioned through resource allocation may help to minimize the paradigm and priority conflicts embedded in their systems (Heyden et al, 2017;Kerrissey et al, 2017).…”

Physicians in the management and leadership of health care: A systematic review of the conditions conducive to organizational performance

“…Co-designing performance measures with clinicians, motivates, provides autonomy, makes measurement meaningful, enables local improvement, and can reinforce professionalism in ways that improve the manager-clinician relationship. [24,35,38,39,48,54–56] Physicians can be engaged through continual dialogue to align agendas for quality and safety[21,39,57] and through the design of service delivery. [3,15] Anchoring quality improvement in professional practice, and combining it with education and research, lead to positive views on further improvement initiatives.…”

“…[55,57,66] Top-level teams should be stable and acknowledge physicians’ medical expertise and academic competence,[52,65] and foster collaborative relationships, effective communication, diffusion of expert knowledge between managers and professionals, and demonstrate a proactive culture for decision-making. [24,32,49,54,63,67] They also need to remove barriers to medical leadership, e.g. reduce the burden of administrative tasks related to information technology, performance analysis, and financial management; lack of financial incentives; time commitment pressures; overall lack of support, and challenges tied to the timing, location, and process of managerial meetings.…”