Building capacity for a transformation initiative

Harrison, Michael I.; Kimani, James

doi:10.1097/01.hmr.0000342979.91931.d9

Cited by 46 publications

(45 citation statements)

References 20 publications

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“…There is little implementation research that focuses primarily on the overall context itself or, more specifically, on contextual factors related to institutionalization of EBP as a routine way of practicing (See definitions, Appendix 1). If one considers EBP institutionalization as an example of a strategic organizational transformation, then Harrison and Kimani's observations seem relevant to this knowledge gap [19]; i.e ., 'accounts of transformation initiatives often reveal little about past organizational and contextual conditions that contributed to success. Instead, these accounts concentrate on change barriers.'…”

Section: Introductionmentioning

confidence: 99%

Institutionalizing evidence-based practice: an organizational case study using a model of strategic change

Ritchie²,

et al. 2009

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BackgroundThere is a general expectation within healthcare that organizations should use evidence-based practice (EBP) as an approach to improving the quality of care. However, challenges exist regarding how to make EBP a reality, particularly at an organizational level and as a routine, sustained aspect of professional practice.MethodsA mixed method explanatory case study was conducted to study context; i.e., in terms of the presence or absence of multiple, inter-related contextual elements and associated strategic approaches required for integrated, routine use of EBP ('institutionalization'). The Pettigrew et al. Content, Context, and Process model was used as the theoretical framework. Two sites in the US were purposively sampled to provide contrasting cases: i.e., a 'role model' site, widely recognized as demonstrating capacity to successfully implement and sustain EBP to a greater degree than others; and a 'beginner' site, self-perceived as early in the journey towards institutionalization.ResultsThe two sites were clearly different in terms of their organizational context, level of EBP activity, and degree of institutionalization. For example, the role model site had a pervasive, integrated presence of EBP versus a sporadic, isolated presence in the beginner site. Within the inner context of the role model site, there was also a combination of the Pettigrew and colleagues' receptive elements that, together, appeared to enhance its ability to effectively implement EBP-related change at multiple levels. In contrast, the beginner site, which had been involved for a few years in EBP-related efforts, had primarily non-receptive conditions in several contextual elements and a fairly low overall level of EBP receptivity. The beginner site thus appeared, at the time of data collection, to lack an integrated context to either support or facilitate the institutionalization of EBP.ConclusionOur findings provide evidence of some of the key contextual elements that may require attention if institutionalization of EBP is to be realized. They also suggest the need for an integrated set of receptive contextual elements to achieve EBP institutionalization; and they further support the importance of specific interactions among these elements, including ways in which leadership affects other contextual elements positively or negatively.

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Section: Introductionmentioning

confidence: 99%

Institutionalizing evidence-based practice: an organizational case study using a model of strategic change

Ritchie²,

et al. 2009

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“…Two of these redesigns aimed to implement process orientation for all patient services, including outpatients' and clinical care (PG, LRI) [33-37]. The other redesigns were limited to clinical care (DH, FMC) [44,45] and three clinical care lines (heart and vascular care, oncology and paediatric care) (UWHC) [46]. All redesigns aimed to improve the patient flow through the hospital.…”

Section: Resultsmentioning

confidence: 99%

“…All redesigns aimed to improve the patient flow through the hospital. Some redesigns had additional goals: cost reductions/efficiency improvements [33-37,45,46], patient safety [45], patient satisfaction [45,46], and job satisfaction [45]. …”

Section: Resultsmentioning

confidence: 99%

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Towards an organisation-wide process-oriented organisation of care: A literature review

Vos

Chalmers

Dückers³

et al. 2011

Implementation Sci

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BackgroundMany hospitals have taken actions to make care delivery for specific patient groups more process-oriented, but struggle with the question how to deal with process orientation at hospital level. The aim of this study is to report and discuss the experiences of hospitals with implementing process-oriented organisation designs in order to derive lessons for future transitions and research.MethodsA literature review of English language articles on organisation-wide process-oriented redesigns, published between January 1998 and May 2009, was performed.ResultsOf 329 abstracts identified, 10 articles were included in the study. These articles described process-oriented redesigns of five hospitals. Four hospitals tried to become process-oriented by the implementation of coordination measures, and one by organisational restructuring. The adoption of the coordination mechanism approach was particularly constrained by the functional structure of hospitals. Other factors that hampered the redesigns in general were the limited applicability of and unfamiliarity with process improvement techniques.ConclusionsDue to the limitations of the evidence, it is not known which approach, implementation of coordination measures or organisational restructuring (with additional coordination measures), produces the best results in which situation. Therefore, more research is needed. For this research, the use of qualitative methods in addition to quantitative measures is recommended to contribute to a better understanding of preconditions and contingencies for an effective application of approaches to become process-oriented. Hospitals are advised to take the factors for failure described into account and to take suitable actions to counteract these obstacles on their way to become process-oriented organisations.

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“…Studies have acknowledged the importance to ensure a solid organizational foundation and to assure that appropriate organizational and contextual conditions are in place or are being developed when launching LSTs in healthcare e.g. [17]. …”

Section: Introductionmentioning

confidence: 99%

Strategies to facilitate implementation and sustainability of large system transformations: a case study of a national program for improving quality of care for elderly people

Nyström

Strehlenert

Hansson

et al. 2014

BMC Health Serv Res

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BackgroundLarge-scale change initiatives stimulating change in several organizational systems in the health and social care sector are challenging both to lead and evaluate. There is a lack of systematic research that can enrich our understanding of strategies to facilitate large system transformations in this sector. The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill elderly people in Sweden. The program outcomes were also addressed to assess the impact of these strategies.MethodsA longitudinal case study design with multiple data collection methods was applied. Archival data (n = 795), interviews with key stakeholders (n = 11) and non-participant observations (n = 23) were analysed using content analysis. Outcome data was obtained from national quality registries.ResultsThis study presents an approach for implementing a large national change program that is characterized by initial flexibility and dynamism regarding content and facilitation strategies and a growing complexity over time requiring more structure and coordination. The description of activities and strategies show that the program management team engaged a variety of stakeholders and actor groups and accordingly used a palate of different strategies. The main strategies used to influence change in the target organisations were to use regional improvement coaches, regional strategic management teams, national quality registries, financial incentives and annually revised agreements. Interactive learning sessions, intense communication, monitor and measurements, and active involvement of different experts and stakeholders, including elderly people, complemented these strategies. Program outcomes showed steady progress in most of the five target areas, less so for the target of achieving coordinated care.ConclusionsThere is no blue-print on how to approach the challenging task of leading large scale change programs in complex contexts, but our conclusion is that more attention has to be given to the multidimensional strategies that program management need to consider. This multidimensionality comprises different strategies depending on types of actors, system levels, contextual factors, program progress over time, program content, types of learning and change processes, and the conditions for sustainability.

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Building capacity for a transformation initiative

Cited by 46 publications

References 20 publications

Institutionalizing evidence-based practice: an organizational case study using a model of strategic change

Institutionalizing evidence-based practice: an organizational case study using a model of strategic change

Towards an organisation-wide process-oriented organisation of care: A literature review

Strategies to facilitate implementation and sustainability of large system transformations: a case study of a national program for improving quality of care for elderly people

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