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  • 1. McAlearney, Ann Scheck
    et al.
    Terris, Darcey
    Hardacre, Jeanne
    Spurgeon, Peter
    Brown, Claire
    Baumgart, Andre
    Nyström, Monica E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change2014In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 23, no 4, p. 254-267Article in journal (Refereed)
    Abstract [en]

    Objective: We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations. Methods: We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model. Results and Conclusions: We suggest that organizational coherencemay be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

  • 2. McAlearney, Ann Scheck
    et al.
    Terris, Darcey
    Hardacre, Jeanne
    Spurgeon, Peter
    Brown, Claire
    Baumgart, Andre
    Nyström, Monica E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change2013In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 22, no 2, p. 86-99Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations.

    METHODS: We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model.

    RESULTS AND CONCLUSIONS: We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

  • 3.
    Nyström, Monica
    Medical Management Centre, Department of Learning,Informatics, Management & Ethics, Karolinska Institutet, Stockholm, Sweden.
    Characteristics of health care organizations associated with learning and development: lessons from a pilot study2009In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 18, no 4, p. 285-294Article in journal (Refereed)
    Abstract [en]

    Characteristics of health care organizationsassociated with an ability to learn from experiencesand to develop and manage change were exploredin this study. Understanding of these characteristicsis necessary to identify factors influencing successin learning from the past and achieving futurehealth care quality objectives. A literature review ofthe quality improvement, strategic organizationaldevelopment and change management,organizational learning, and microsystems fieldsidentified 20 organizational characteristics, groupedunder (a) organizational systems, (b) key actors, and(c) change management processes. Qualitativemethods, using interviews, focus group reports, andarchival records, were applied to find associationsbetween identified characteristics and 6 Swedishhealth care units externally evaluated as deliveringhigh-quality care. Strong support for a characteristicwas defined as units having more than 4 sourcesdescribing the characteristic as an importantsuccess factor. Eighteen characteristics had strongsupport from at least 2 units. The strongest evidencewas found for the following: (i) key actors havelong-term commitment, provide support, and makesense of ambiguous situations; (ii) organizationalsystems encourage employee commitment,participation, and involvement; and (iii) changemanagement processes are employedsystematically. Based on the results, a new model of“characteristics associated with learning anddevelopment in health care organizations” isproposed.

  • 4.
    Nyström, Monica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Characteristics of health care organizations associated with learning and development: lessons from a pilot study2009In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 18, no 4, p. 285-294Article in journal (Refereed)
    Abstract [en]

    Characteristics of health care organizations associated with an ability to learn from experiences and to develop and manage change were explored in this study. Understanding of these characteristics is necessary to identify factors influencing success in learning from the past and achieving future health care quality objectives. A literature review of the quality improvement, strategic organizational development and change management, organizational learning, and microsystems fields identified 20 organizational characteristics, grouped under (a) organizational systems, (b) key actors, and (c) change management processes. Qualitative methods, using interviews, focus group reports, and archival records, were applied to find associations between identified characteristics and 6 Swedish health care units externally evaluated as delivering high-quality care. Strong support for a characteristic was defined as units having more than 4 sources describing the characteristic as an important success factor. Eighteen characteristics had strong support from at least 2 units. The strongest evidence was found for the following: (i) key actors have long-term commitment, provide support, and make sense of ambiguous situations; (ii) organizational systems encourage employee commitment, participation, and involvement; and (iii) change management processes are employed systematically. Based on the results, a new model of "characteristics associated with learning and development in health care organizations" is proposed.

  • 5.
    Nyström, Monica E
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Terris, Darcey D
    Sparring, Vibeke
    Tolf, Sara
    Brown, Claire R
    Perceived organizational problems in health care: a pilot test of the structured problem and success inventory2012In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 21, no 2, p. 93-103Article in journal (Refereed)
    Abstract [en]

    Our objective was to test whether the Structured Problem and Success Inventory (SPI) instrument could capture mental representations of organizational and work-related problems as described by individuals working in health care organizations and to test whether these representations varied according to organizational position. A convenience sample (n = 56) of middle managers (n = 20), lower-level managers (n = 20), and staff (n = 16) from health care organizations in Stockholm (Sweden) attending organizational development courses during 2003-2004 was recruited. Participants used the SPI to describe the 3 most pressing organizational and work-related problems. Data were systematically reviewed to identify problem categories and themes. One hundred sixty-four problems were described, clustered into 13 problem categories. Generally, middle managers focused on organizational factors and managerial responsibilities, whereas lower-level managers and staff focused on operational issues and what others did or ought to do. Furthermore, we observed similarities and variation in perceptions and their association with respondents' position within an organization. Our results support the need for further evaluation of the SPI as a promising tool for health care organizations. Collecting structured inventories of organizational and work-related problems from multiple perspectives may assist in the development of shared understandings of organizational challenges and lead to more effective and efficient processes of solution planning and implementation.

  • 6. Vedin, Tomas
    et al.
    Edelhamre, Marcus
    Karlsson, Mathias
    Bergenheim, Michael
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Larsson, Per-Anders
    Management of Traumatic Brain Injury in the Emergency Department: Guideline Adherence and Patient Safety2017In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 26, no 4, p. 190-195Article in journal (Refereed)
    Abstract [en]

    Background: Traumatic brain injury is a common reason not only for emergency visits worldwide but also for significant morbidity and mortality. Several clinical guidelines exist but adherence is generally low.

    Aim: To study attitudes toward computed tomography of the head among emergency department Change to physicians throughout the article who manage patients with trauma to the head and doctors' adherence to guidelines.

    Methods: Quantitative questionnaire study with questionnaires collected over 3 months before introduction of new guidelines. After introduction, intermission of 8 months passed when information and education were given. Thereafter, questionnaires were collected for another 3 months.

    Results: A total of 694 patients were registered at the emergency department. A total of 161 questionnaires were analyzed; 50.9% did not use guidelines, 39% before intermission, and 60.5% after. When Canadian CT Head Rule was applied, 30.4% of patients with no loss of consciousness were referred to computed tomography, violating guideline recommendation.

    Conclusion: Guidelines are designed to improve performance but are not always applied correctly or as frequently as intended. Information and education did not increase guideline adherence. To improve guideline adherence, more innovative measures than formal guidelines must be undertaken. To find out what these measures are, we suggest qualitative studies to elucidate interventions that will have bigger impact on performance.

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