The impact of leadership and quality climate on hospital performance

Shipton, Helen; Armstrong, Claire W.; West, Michael; Dawson, Jeremy

doi:10.1093/intqhc/mzn037

Cited by 77 publications

(69 citation statements)

References 12 publications

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“…We knew at the onset of this research that there could be a small population of hospitals employing these initiatives, and while we are comfortable that we had 63 organizations participate, we would have liked a much larger sample that would permit greater analyses. However, many other papers have been published with sample sizes in the 50-100 respondent range (Lam et al 2008;Johnston and Michel 2008;Shipton et al 2008). Our results can be seen as an initial view into Lean and Six Sigma utilization in the industry.…”

Section: Limitations and Future Researchmentioning

confidence: 55%

Implementation of Lean and Six Sigma quality initiatives in hospitals: A goal theoretic perspective

Langabeer¹,

DelliFraine²,

Heineke

et al. 2009

Oper Manag Res

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Organizational quality improvement practices have gained wide acceptance in manufacturing industries over the last several decades. A substantial number of books have been written on Lean and Six Sigma alone, which today are the leading improvement initiatives. The healthcare industry however has been slower to adopt these methods, although anecdotal evidence suggests they are now being gradually diffused throughout hospitals on an increasing basis. Yet, these new practices have been developed substantially without a theoretical foundation (Linderman et al. J Oper Manag 21:193-203, 2003) and the question of industry "fit" is the topic of debate for many physicians and administrators (Kassirer N Engl J Med 339: [1543][1544][1545] 1998). This article provides the descriptive results from our mixed methods research, combining survey questionnaire with semi-structured interviews, that examines implementation of two quality improvement initiatives (Lean and Six Sigma) in a cross-sectional sample of hospitals. We used correlations and non-parametric tests to examine relationships between goal attainment and quality management, and present descriptive findings about reported usage and adoption of quality initiatives. Importantly, we find that the efficacy of quality improvement initiatives in healthcare may be impeded by the lack of goal clarity and measurement. We build on these initial results by offering recommendations to improve results in practice, as well as an agenda for further research of quality initiatives in healthcare. The objectives of our research are to better understand how Lean and Six Sigma fit in the healthcare industry and to explore goal and value attainment from these projects.

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Section: Limitations and Future Researchmentioning

confidence: 55%

Implementation of Lean and Six Sigma quality initiatives in hospitals: A goal theoretic perspective

Langabeer¹,

DelliFraine²,

Heineke

et al. 2009

Oper Manag Res

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“…This finding adds to a growing literature around the role and impact of leadership on healthcare quality. 17,38 The obvious ramification is that all healthcare organisations should be directing attention to supporting clinical leadership and decision making as this may promote an environment conducive to improved teamwork, patient and family involvement and to speaking up. 39,40 Healthcare organisations should be seeking to learn from one another, especially those whose performances are at the healthier end of the scale, as well as from studies into how to advance clinical involvement in improvement efforts.…”

Section: Discussionmentioning

confidence: 99%

Healthcare professional perspectives on quality and safety in New Zealand public hospitals: findings from a national survey

Gauld

Horsburgh

2014

Aust. Health Review

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Background. Few studies have sought to measure health professional perceptions of quality and safety across an entire system of public hospitals. Therefore, three questions that gauge different aspects of quality and safety were included in a national New Zealand survey of clinical governance.Methods. Three previously used questions were adapted. A total of 41 040 registered health professionals employed in District Health Boards were invited to participate in an online survey. Analyses were performed using the R statistical environment. Proportional odds mixed models were used to quantify associations between demographic variables and responses on five-point scales. Relationships between other questions in the survey and the three quality and safety questions were quantified with the Pearson correlation coefficient.Results. A 25% response rate delivered 10 303 surveys. Fifty-seven percent of respondents (95% CI: 56-58%) agreed that health professionals in their District Health Board worked together as a team; 70% respondents (95% CI: 69-70%) agreed that health professionals involved patients and families in efforts to improve patient care; and 69% (95% CI: 68-70%) agreed that it was easy to speak up in their clinical area if they perceived a problem with patient care. Correlations showed links between perceptions of stronger clinical leadership and performances on the three questions, as well as with other survey items. The proportional mixed model also revealed response differences by respondent characteristics.Conclusions. The findings suggest positive commitment to quality and safety among New Zealand health professionals and their employers, albeit with variations by district, profession, gender and age, but also scope for improvement. The study also contributes to the literature indicating that clinical leadership is an important contributor to quality improvement.What is known about the topic? Various studies have explored aspects of healthcare quality and safety, generally within a hospital or group of hospitals, using a lengthy tool such as the 'safety climate survey'. What does this paper add? We used a simple three-question survey approach (derived from existing measures) to measuring healthcare professionals' perceptions of quality and safety in New Zealand's public hospitals. In doing so, we also collected the first such information on this. What are the implications for practitioners? New Zealand policy makers and health professionals can take some comfort in our findings, but also note that there is considerable scope for improvement. Our finding that more positive perceptions of quality and safety were related to perceptions of stronger clinical leadership adds to the international literature indicating the importance of this. Policy makers and hospital managers should support strong clinical leadership.

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“…One instrument was tested in 86 hospital trusts. 35 Of the seven instruments, two were tested with only patients or relatives, 30 31 and five with only hospital (nursing, medical or support) staff. [32][33][34][35][36] The sample size for the hospital staff ranged from 52 to 17 949 and for patients or relatives from 108 to 544.…”

Section: Continuedmentioning

confidence: 99%

“…35 For five instruments, 30-33 36 more than one type of validity was reported. Face or content validity was described for six, 30-34 36 of the seven instruments.…”

Section: Validitymentioning

confidence: 99%

Measuring a caring culture in hospitals: a systematic review of instruments

et al. 2013

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ObjectiveTo identify instruments or components of instruments that aim to measure aspects of a caring culture-shared beliefs, norms and values that direct professionals and managers to act caring in hospitals, and to evaluate their psychometric properties.DesignSystematic review.Data sourcesPubMed, CINAHL, EMBASE, PsychInfo, Web of Science and the International bibliography of the Social Sciences.Study selectionPeer-reviewed articles describing (components of) instruments measuring aspects of a caring culture in a hospital setting. Studies had to report psychometric data regarding the reliability or validity of the instrument. Potentially useful instruments that were identified after the title and abstract scan were assessed on relevance by an expert panel (n=12) using the RAND-modified Delphi procedure.ResultsOf the 6399 references identified, 75 were examined in detail. 7 studies each covering a unique instrument met our inclusion criteria. On average, 24% of the instrument's items were considered relevant for measuring aspects of the hospital's caring culture. Studies showed moderate-to-high validity and reliability scores. Validity was addressed for 6 of the 7 instruments. Face, content (90%) and construct (60%) validity were the most frequently reported psychometric properties described. One study (14%) reported discriminant validity of the instrument. Reliability data were available for all of the instruments. Internal consistency was the most frequently reported psychometric property for the instruments and demonstrated by: a Cronbach's α coefficient (80%), subscale intercorrelations (60%), and item–total correlations (40%).ConclusionsThe ultimate standard for measuring a caring culture in hospitals does not exist. Existing instruments provide partial coverage and lack information on discriminant validity, responsiveness and feasibility. Characteristics of the instruments included in this review could provide useful input for the design of a reliable and valid instrument for measuring a caring culture in hospitals.

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The impact of leadership and quality climate on hospital performance

Abstract: Results offer insight into how non-clinical leadership may foster performance outcomes for health-care organizations. A frequently neglected area-patient complaints-may be a valid measure to consider when assessing leadership and quality in a health-care context.

Cited by 77 publications

References 12 publications

Implementation of Lean and Six Sigma quality initiatives in hospitals: A goal theoretic perspective

Implementation of Lean and Six Sigma quality initiatives in hospitals: A goal theoretic perspective

Healthcare professional perspectives on quality and safety in New Zealand public hospitals: findings from a national survey

Measuring a caring culture in hospitals: a systematic review of instruments

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