Embedding organisational quality improvement through middle manager ownership

Abstract

There are many theories regarding the importance of the middle manager role in QI, but little empirical research into exactly what this role may be and how it may be strengthened. This research adds to the knowledge base, and provides clear steps for achieving increased staff involvement and QI implementation.

Determinants of quality management systems implementation in hospitals

“…This factor reflects the organization capability to use the quality management tools. The organization technical factors reviewed were education and training on the quality paradigm and method [1,17,20], scientific problem-solving approach, information system as well as system for data analysis and reporting [1,20]. Empirical investigation by Huq and Martin [17] and Lee et al [1] established a positive relationship between technical factors and QMS implementation.…”

“…from the top management [16,19], middle management [20] governance board or senior physicians, or from voluntary "heroic individual" physicians or senior respected nurses [19,21,22]. On the one hand, it is generally accepted that any bottom up quality action might fail without support from the hospital top management [16,19,20,23]. On the other hand, studies also noted some successful instances of implementation initiated by a committed physician without hospital management leadership support [12,21].…”

“…Even though most of the leadership and quality theory refers to top management, the review findings identified various sources of quality leadership, i.e. from the top management [16,19], middle management [20] governance board or senior physicians, or from voluntary "heroic individual" physicians or senior respected nurses [19,21,22]. On the one hand, it is generally accepted that any bottom up quality action might fail without support from the hospital top management [16,19,20,23].…”

Strengthening clinical governance through cultivating the line management role

“…Health care professionals are trained to review their care and practise participation in improvement activities as a professional obligation, although this can play out as an individual pursuit rather than as involvement in organisational and systems-based activities. 1 The importance of these programs has been emphasised over the past decade via growing community and health professional concerns about the safety of health care, prompted in large part by information emanating from the Quality in Australian Health Care Study (QAHCS) in 1995, which described for the first time the extent of adverse events in Australian hospitals. 2 The effectiveness and credibility of health care quality programs still varies considerably, however, and involvement in improvement activities is viewed as optional by some personnel.…”

“…13,26 Managers are more likely to embrace a clinical governance role if the goals and activities clearly demonstrate improvements for patients and staff, and provide a platform for innovative problem solving and service development. 1 A collaborative approach to planning the goals and rollout of the clinical governance program affords managers at all levels the opportunity to explore these issues, develop a common understanding of why and how clinical governance should be implemented and to clarify role expectations. This lays the foundation for ongoing commitment and involvement at all levels, and may assist in addressing some of the scepticism that will accompany the move towards clinical governance.…”