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Category: Health Leadership

• RMOs in Clinical Governance at Waitemata DHB

  Quality Improvement Workshop

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• Influencing Organisational Culture to Improve Hospital Performance in Care of Patients with Acute Myocardial Infarction

  BMJ Journals

  Curry, L; Brault, M; Linnander, Erika; McNatt, Z; Brewster, A; Cherlin, E; Peterson Flieger, S; Ting, H; Bradley, E

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  BACKGROUND
  Hospital organisational culture affects patient outcomes including mortality rates for patients with acute myocardial infarction; however, little is known about whether and how culture can be positively influenced.

  METHOD
  This is a 2-year, mixed-methods interventional study in 10 US hospitals to foster improvements in five domains of organisational culture: (1) learning environment, (2) senior management support, (3) psychological safety, (4) commitment to the organisation and (5) time for improvement. Outcomes were change in culture, uptake of five strategies associated with lower risk-standardised mortality rates (RSMR) and RSMR. Measures included a validated survey at baseline and at 12 and 24 months (n=223; average response rate 88%); in-depth interviews (n=393 interviews with 197 staff); and RSMR data from the Centers for Medicare and Medicaid Services.

  RESULTS
  We observed significant changes (p<0.05) in culture between baseline and 24 months in the full sample, particularly in learning environment (p<0.001) and senior management support (p<0.001). Qualitative data indicated substantial shifts in these domains as well as psychological safety. Six of the 10 hospitals achieved substantial improvements in culture, and four made less progress. The use of evidence-based strategies also increased significantly (per hospital average of 2.4 strategies at baseline to 3.9 strategies at 24 months; p<0.05). The six hospitals that demonstrated substantial shifts in culture also experienced significantly greater reductions in RSMR than the four hospitals that did not shift culture (reduced RSMR by 1.07 percentage points vs 0.23 percentage points; p=0.03) between 2011–2014 and 2012–2015.

  CONCLUSIONS
  Investing in strategies to foster an organisational culture that supports high performance may help hospitals in their efforts to improve clinical outcomes.

  - leadership

  - quality improvement

  - qualitative research

• How Guiding Coalitions Promote Positive Culture Change in Hospitals

  BMJ Journals

  Bradley, E; Brewster, A; McNatt, Z; Linnander, E; Cherlin, E; Fosburgh, H; Ting, H; Curry, L

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  BACKGROUND
  Quality collaboratives are widely endorsed as a potentially effective method for translating and spreading best practices for acute myocardial infarction (AMI) care. Nevertheless, hospital success in improving performance through participation in collaboratives varies markedly. We sought to understand what distinguished hospitals that succeeded in shifting culture and reducing 30-day risk-standardised mortality rate (RSMR) after AMI through their participation in the Leadership Saves Lives (LSL) collaborative.

  PROCEDURES
  We conducted a longitudinal, mixed methods intervention study of 10 hospitals over a 2-year period; data included surveys of 223 individuals (response rates 83%–94% depending on wave) and 393 in-depth interviews with clinical and management staff most engaged with the LSL intervention in the 10 hospitals. We measured change in culture and RSMR, and key aspects of working related to team membership, turnover, level of participation and approaches to conflict management.

  MAIN FINDINGS
  The six hospitals that experienced substantial culture change and greater reductions in RSMR demonstrated distinctions in: (1) effective inclusion of staff from different disciplines and levels in the organisational hierarchy in the team guiding improvement efforts (referred to as the ‘guiding coalition’ in each hospital); (2) authentic participation in the work of the guiding coalition; and (3) distinct patterns of managing conflict. Guiding coalition size and turnover were not associated with success (p values>0.05). In the six hospitals that experienced substantial positive culture change, staff indicated that the LSL learnings were already being applied to other improvement efforts.

  PRINCIPAL CONCLUSIONS
  Hospitals that were most successful in a national quality collaborative to shift hospital culture and reduce RSMR showed distinct patterns in membership diversity, authentic participation and capacity for conflict management.

  - Quality improvement

  - Teams

  - Teamwork

• 3 Ways Hospital Culture Can Save Lives (LSL) [Poster]

  Leadership Saves Lives

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  3 Ways Hospital Culture Can Save Lives

  1. Senior management support
  2. Safety to speak up
  3. Learning and problem solving

   

   

   

• Culture Change to Save Lives (LSL) [Poster]

  Leadership Saves Lives

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  Culture Change to Save Lives

  - Create a Coalition

  - Set a Shared Goal

  - Commit to Learning

   

   

   

   

   

• Leadership and Talent

  State Services Commission NZ

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  The State Services Commission (SSC) is putting in place a programme that is significantly changing how the State sector identifies, develops and utilises leaders and talented people from the start of their careers to their most senior levels.

  Our new talent management system will provide the tools and approaches to help leaders and people reach their full potential.

  By maximising our potential leadership and talent across the public system, we will achieve better results for New Zealanders.

  SSC is building leadership and talent across the State services by:

  • strengthening leadership across the system  
  • encouraging and supporting leaders to step into more challenging and complex roles
  • supporting the move away from a Wellington-centric view, encouraging diversity within the Public Service
  • identifying our most talented people, developing them and placing them where they are most needed. 

• Leadership and Leadership Development in Health Care: The Evidence Base

  The King's Fund, Faculty of Medical Leadership and Management (FMLM) and the Center for Creative Leadership (CCL)

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  The key challenge facing all NHS organisations is to nurture cultures that ensure the delivery of continuously improving high quality, safe and compassionate healthcare. Leadership is the most influential factor in shaping organisational culture and so ensuring the necessary leadership behaviours, strategies and qualities are developed is fundamental. What do we really know about leadership of health services?

  The Faculty of Medical Leadership and Management (FMLM), The King’s Fund and the Center for Creative Leadership (CCL) share a commitment to evidence-based approaches to developing leadership and collectively initiated a review of the evidence by a team including clinicians, managers, psychologists, practitioners and project managers. This document summarises the evidence emerging from that review.

  The summary describes key messages from the review in relation to leadership at different levels of analysis: it includes a description of the leadership task and the most effective leadership behaviours at individual, team, board and national levels. 

• Health LEADS Australia: The Australian Health Leadership Framework

  HealthWorkforce Australia

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  Leadership has similarities in all industries although health is recognised for its complexity and its purposes. Health leaders strive to improve clinical and quality of life indicators, and the wellbeing of the health system. Research shows ‘the quality of health leadership directly and indirectly affects the quality of patient care and is an important factor supporting best practice.’ Leaders affect ‘people, their satisfaction, trust in management, commitment, individual and team effectiveness (and) the culture and climate of organisations. While other factors are important, leadership plays a central role in mobilising people towards a common goal.

• Healthcare Leadership Model: The Nine Dimensions of Leadership Behaviour

  NHS Leadership Academy

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  The Healthcare Leadership Model is to help those who work in health and care to become better leaders. It is useful for everyone – whether you have formal leadership responsibility or not, if you work in a clinical or other service setting, and if you work with a team of five people or 5,000. It describes the things you can see leaders doing at work and is organised in a way that helps everyone to see how they can develop as a leader. It applies equally to the whole variety of roles and care settings that exist within health and care.