Designing Effective Governance for Quality and Safety in Canadian Healthcare

Baker, G. Ross; Denis, Jean‐Louis; Pomey, Marie‐Pascale; MacIntosh-Murray, Anu

doi:10.12927/hcq.2013.21244

Cited by 56 publications

(89 citation statements)

References 23 publications

(6 reference statements)

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“…There is evidence that leaders are more likely to be successful if they choose strategically significant improvements which are amenable to improvement interventions, skilfully adapt the methods for the situation, and persistently follow and revise the programme 22 23. There is far less evidence about operational managers actions in improvement, and none which gives good evidence of the effects of their actions.…”

Section: Which Specific Leader Actions Have Been Found To Be Associatmentioning

confidence: 99%

Improvement leaders: what do they and should they do? A summary of a review of research

Øvretveit

2010

BMJ Quality & Safety

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Section: Which Specific Leader Actions Have Been Found To Be Associatmentioning

confidence: 99%

Improvement leaders: what do they and should they do? A summary of a review of research

Øvretveit

2010

BMJ Quality & Safety

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“…2 These moves respond to an emerging international consensus that board leadership is a vital element of high-quality care. [3][4][5][6][7][8][9][10] A growing body of international research suggests that hospitals with boards that are actively engaged in quality issues are more likely to have quality-improvement programs in place and to perform better on indicators such as risk-adjusted mortality rates. 9,11 Early evidence from hospital systems overseas suggests that whereas some boards perform strongly, others lack understanding of patient safety problems and receive inadequate information for sound decision making.…”

mentioning

confidence: 99%

The role of boards in clinical governance: activities and attitudes among members of public health service boards in Victoria

Bismark¹,

Walter²,

Studdert³

2013

Aust. Health Review

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Objectives. To determine the nature and extent of governance activities by health service boards in relation to quality and safety of care and to gauge the expertise and perspectives of board members in this area.Methods. This study used an online and postal survey of the Board Chair, Quality Committee Chair and two randomly selected members from the boards of all 85 health services in Victoria. Seventy percent (233/332) of members surveyed responded and 96% (82/85) of boards had at least one member respond.Results. Most boards had quality performance as a standing item on meeting agendas (79%) and reviewed data on medication errors and hospital-acquired infections at least quarterly (77%). Fewer boards benchmarked their service's quality performance against external comparators (50%) or offered board members formal training on quality (53%). Eighty-two percent of board members identified quality as a top priority for board oversight, yet members generally considered their boards to be a relatively minor force in shaping the quality of care. There was a positive correlation between the size of health services (total budget, inpatient separations) and their board's level of engagement in quality-related activities. Ninety percent of board members indicated that additional training in quality and safety would be 'moderately useful' or 'very useful'. Almost every respondent believed the overall quality of care their service delivered was as good as, or better than, the typical Victorian health service.Conclusions. Collectively, health service boards are engaged in an impressive range of clinical governance activities. However, the extent of engagement is uneven across boards, certain knowledge deficits are evident and there was wide agreement among board members that further training in quality-related issues would be useful. What is known about the topic?There is an emerging international consensus that effective board leadership is a vital element of high-quality healthcare. In Australia, new National Health Standards require all public health service boards to have a 'system of governance that actively manages patient safety and quality risks'. What does this paper add? Our survey of all public health service Boards in Victoria found that, overall, boards are engaged in an impressive range of clinical governance activities. However, tensions are evident. First, whereas some boards are strongly engaged in clinical governance, others report relatively little activity. Second, despite 8 in 10 members rating quality as a top board priority, few members regarded boards as influential players in determining it. Third, although members regarded their boards as having strong expertise in quality, there were signs of knowledge limitations, including: near consensus that (additional) training would be useful; unfamiliarity with key national quality documents; and overly optimistic beliefs about quality performance. What are the implications for practitioners? There is scope to improve board expertise in clinical g...

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“…Leadership implies the existence of people who are capable of navigating the system to get things done. The ‘evidence’ for factors such as these is overwhelming 2 3…”

Section: Discussionmentioning

confidence: 99%

“…For example, Ferlie and Shortell emphasise four groups of success factors for quality improvement: leadership at all levels, a culture supportive of learning and change, teamwork and appropriate information systems 1. Other researchers have added structural, political and strategic factors 2 3. Similarly, Sexton, Pronovost and colleagues point to the importance of clinical culture in successfully implementing patient safety initiatives 4 5.…”

mentioning

confidence: 99%

Beyond evidence: the micropolitics of improvement

Langley

Denis

2011

BMJ Quality & Safety

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This paper aims to draw attention to the social and micropolitical dimensions of attempting to implement improvements within healthcare organisations. It is argued that quality improvement initiatives, like other forms of organisational innovation, will fail unless they are conceived and implemented in such a way as to take into account the pattern of interests, values and power relationships that surround them. Drawing on examples, it is suggested that innovators can intervene more successfully if they understand how the benefits and costs of interventions are likely to be distributed among stakeholders within their setting, how different but equally legitimate value sets may structure peoples' understanding of them and how the nature of the interventions themselves (and, in particular, the shape of their hard core and soft periphery) might provide scope for redesigning or adapting interventions in ways that are likely to make them both more effective and politically feasible.

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Designing Effective Governance for Quality and Safety in Canadian Healthcare

Cited by 56 publications

References 23 publications

Improvement leaders: what do they and should they do? A summary of a review of research

Improvement leaders: what do they and should they do? A summary of a review of research

The role of boards in clinical governance: activities and attitudes among members of public health service boards in Victoria

Beyond evidence: the micropolitics of improvement

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