The United States health care system is plagued with quality problems. We draw on management research to explain why it has been so difficult to improve quality of care, despite a burgeoning body of scientific evidence on practices that result in better outcomes and the widespread adoption of quality-improving innovations based on those practices. Our analysis points to the prevalence of innovation implementation failure-organizational members' inconsistent or improper use of innovations-as a primary cause. In our review, we identify the organizational sources of this failure and offer six strategies for avoiding innovation implementation failure in health care.Between the health care we have and the care we could have lies not just a gap, but a chasm.-Institute of Medicine (2001)

Examining the work-related psychological states of nurse practitioners and physician assistants is important, given their increased role expansion. The current PRISMA-guided review examined studies published between 2000 and 2016 for both these groups. The review also examined features of the research to draw conclusions about overall quality. Applying theories in job enrichment and job demands, 32 articles were identified that contained analyses of satisfaction, burnout, stress, and turnover. Key findings include the lack of robust research designs, overemphasis on job satisfaction, lower levels of satisfaction across both groups, and higher intrinsic versus extrinsic satisfaction levels generally. The literature can develop by using larger, more representative samples, including subgroup analyses that incorporate everyday work contexts, and more predictive modeling. The results suggest that both occupations experience role expansion in both positive and negative ways that may require additional policy or managerial interventions.

Six core competencies have been developed for use by residency programs in assessing individual resident training outcomes. The authors propose that it is important to consider the role of residency culture and work context in helping residents achieve the required competencies. Specifically, the development of a learning-oriented culture and favorable work conditions that facilitate the presence of that culture should be a high priority for residency programs and the organizations (e.g., hospitals) in which they are housed. This places formal accountability at the doorstep of these programs and organizations in helping to create a "competent" resident. Using ideas from management theory, the authors identify specific attitudes, behaviors, and interactions that define a learning culture and show their usefulness when applied to residents' achievement of the competencies. They assert that current features of everyday resident work life decrease the chances that such attitudes, behaviors, and interactions will occur. Identifying and prioritizing the components of desired work environments for promoting a learning-oriented culture, in addition to assessing the presence or absence of both the components and learning best practices within residency programs, should become normal activities that complement the process of assessing competencies.