Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative

Abstract

BackgroundBetween 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used.MethodsThe approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators.ResultsMQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports.ConclusionsIt is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects.

Organisational learning in hospitals: A concept analysis

“…Evidence suggests that contextual factors play an important role in translating experiences into organisational learning. Contextual factors conducive to organisational learning include (a) a shared purpose and motivation to improve the organisation's performance (Davis, ; Nes & Moen, ; Olson, Tooman, & Alvarado, ), (b) interpersonal connections among members of the organisation (Filice et al, ; Rangachari et al, ), (c) a sense of psychological safety (Crofts, ; Edmondson, ; Singer et al, ), (d) sufficient time, space and resources for interaction and collective reflection (Ding, ; Gregory, Hopwood, & Boud, ); Singer et al, ), (e) the individual and collective skills necessary for effective reflection and communication (Dückers, Wagner, Vos, & Groenewegen, ; Olson et al, ) and (f) leaders who foster organisational learning (Chamberlain, ; Ford & Angermeier, ). All of these factors may be strengthened as the team members gain more experience working with one another.…”

Organizational learning in hospitals: A realist review

“…Purpose can be represented by a vision statement (Trajkovski, Schmied, Vickers, & Jackson, 2015), meeting to achieve a common goal (Nes & Moen, 2010), or responding to a crisis (Müller-Seitz & Macpherson, 2014). A shared purpose provides common ground where team members can discuss diverse strategies (Thim & Weber, 2012), while remaining focused on organizational needs (Dückers, Wagner, Vos, & Groenewegen, 2011;Melo & Beck, 2015).…”

“…Various skills related to organizational learning were identified in 27.9% (N = 41) of the studies reviewed. Examples of organizational learning skills include collaborative decision-making (Dückers et al, 2011;Ford & Angermeier, 2008;Trajkovski et al, 2015), learning from errors (Chamberlain, 2013), speaking up when necessary (Adelman, 2012;Edmondson, Boehmer, & Pisano, 2000), problem-solving (Davis, 2011;Tucker, 2007), and interprofessional collaboration (Dias & Escoval, 2015;Filice et al, 2013). Developing organizational learning skills is associated with functioning as an advanced learning organization -characterized by creating knowledge, collaborating with other organizations, and disseminating information (Dias & Escoval, 2015).…”

Sustainability of healthcare innovations (SUSHI): long term effects of two implemented surgical care programmes (protocol)

“…In its simplest form, it can be seen as ‘holding the gains’ and ‘evolving as required’. Different definitions regarding sustainability are used, for example “maintaining the health benefits [12]”, “continuation of the programme activities within an organisational structure [13]” and “building the capacity of a recipient community [14]” [11,15,16]. Sustainability is generally seen as a dynamic process of continuous improvement.…”