Moving Forward with Research and Action

Gittell, Jody Hoffer; Ali, Hebatallah Naim

doi:10.4324/9781003036371-11

Cited by 11 publications

(39 citation statements)

References 1 publication

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“…Trust increases the space for action (Tillitsdelegationen, 2019), and trust is established through relationships. This is strongly aligned with the relationship theories on how to achieve, among others, higher quality and efficiency in an organization (Hoffer-Gitell and Ali, 2021). However, this study indicates a paradox of whether this is a culture to build with the existing organizational resources, or if you must recruit the right people.…”

Section: Discussionsupporting

confidence: 66%

Balancing a seesaw – leaders perspectives on design and traditional quality improvement in healthcare

Boström

Hillborg²,

Lilja

2023

TQM

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PurposeThe purpose of this paper is to explore and describe the perspectives and reasoning of senior development leaders in healthcare organizations, when reflecting on design as theory and practice in relation to more traditional methods and tools for improving quality and support innovation.Design/methodology/approachThe paper is based on a qualitative interview design with five development and innovation leaders from separate healthcare regions in Sweden. They have, to varying degrees, applied design theory and practice for quality improvement and innovation in their organizations. The interview transcript was analysed using a content analysis together with an interpretive approach.FindingsThe major findings are to be found in the balancing act for leadership and organizations in healthcare when it comes to introducing and combining different theories and practices for improving quality and support innovation. The balance is between the change in power dynamics and pushing traditional boundaries in a complex healthcare world.Practical implicationsThe narratives from the leaders' experience of applying design theory and practice for improving healthcare quality can help us create readiness and knowledge about how we prevent and/or facilitate planning and implementing design theories, practices, methods and tools in a healthcare context.Originality/valueThe study provides a unique insight when it captures and illustrates five different organizations' experiences when applying design for developing healthcare quality.

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Section: Discussionsupporting

confidence: 66%

Balancing a seesaw – leaders perspectives on design and traditional quality improvement in healthcare

Boström

Hillborg²,

Lilja

2023

TQM

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“…See Table 1 for these questions. The dimensions were then combined into an equally weighted total index for each participant (Cronbach’s α = .90) as described by Gittell and Ali (2021).…”

Section: Methodsmentioning

confidence: 99%

Relationships and resilience at work and at home

Ali

Gittell

Deng

et al. 2022

Health Care Manage Rev

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BackgroundThe COVID-19 pandemic has been an unusually comprehensive crisis that has taken a toll on people in their roles both at work and at home, giving rise to a new normal.PurposeRelational coordination theory shows how communicating and relating for the purpose of task integration drives positive outcomes for workers, their clients, and their employers. The ecological theory of work–family spillover shows how relational dynamics from work spillover into family life, and vice versa. We build upon these two theories to understand how relationships at work impact work–life balance and worker well-being, especially in times of crisis.MethodologyThis study was based on surveys of clinicians affiliated with a large California health system during the COVID-19 pandemic. Mediation and multilevel logistic regression models were used to assess how relational coordination among colleagues impacts well-being (job satisfaction and lack of burnout) through its effects on work–life balance (schedule control and personal time).ResultsA 1-point increase in relational coordination tripled clinician odds of having schedule control (OR = 3.33, p < .001) and nearly doubled the odds of having adequate personal time (OR = 1.83, p < .001). A 1-point increase in relational coordination nearly quadrupled odds of being satisfied with their job (OR = 3.92, p < .001) and decreased odds of burnout by 64% (OR = 0.36, p < .001). The impact of relational coordination on worker well-being was mediated by greater schedule control and personal time.ConclusionRelational coordination among colleagues impacts worker well-being by enabling greater control over one’s schedule and more personal time, thus creating a positive spillover from work to home in times of crisis.Practice ImplicationsIn times of crisis, leaders should prioritize relational coordination among colleagues in order to support their resilience both at work and at home.

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“…In the case of patient-focused care, coordinators are expected to bridge a network of care venues and providers, leveraging their ties across the network to facilitate information sharing (Gittell & Ali, 2021). Their networks and how information is shared across them is likely to be affected by their predominant location within a specific organization.…”

Section: Theorymentioning

confidence: 99%

Trade-offs in locational choices for care coordination resources in accountable care organizations

Tsuei

Alcusky

Florio

et al. 2023

Health Care Manage Rev

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Background Care coordination is central to accountable care organizations (ACOs), especially in Medicaid where many patients have complex medical and social needs. Little is known about how to best organize care coordination resources in this context, particularly whether to centralize them. We examined how care coordinators’ location, management, and colocation of both (within ACO headquarters, practice sites, or other organizations) relate to care quality and coordination. Methods We conducted a cross-sectional analysis of surveys administered to a sample of practice sites covering all 17 Medicaid ACOs in Massachusetts (n = 225, response rate = 64%). We applied controlled, cluster-robust regressions, adjusting the significance threshold for the number of ACO clusters, to assess how clinical information sharing across settings, care quality improvement, knowledge of social service referral, and cross-resource coordination (i.e., the ability of multiple resources to work well together) relate to where care coordinators were physically located and/or managed. Results Centralizing care coordinators at ACO headquarters was associated with greater information sharing. Embedding care coordinators in practices was associated with greater care quality improvement. Embedding coordinators at other organizations was associated with less information sharing and care quality improvement. Managing coordinators at practice sites and other organizations were associated with better care quality improvement and cross-resource coordination, respectively. Colocating the two functions showed no significant differences. Practice Implications Choosing care coordinators’ locations may present trade-offs. ACOs may strategically choose embedding care coordinators at practice sites for enhanced care quality versus centralizing them at the ACO to facilitate information sharing.

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Moving Forward with Research and Action

Cited by 11 publications

References 1 publication

Balancing a seesaw – leaders perspectives on design and traditional quality improvement in healthcare

Balancing a seesaw – leaders perspectives on design and traditional quality improvement in healthcare

Relationships and resilience at work and at home

Trade-offs in locational choices for care coordination resources in accountable care organizations

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