The role of organizational factors in how efficiency-thoroughness trade-offs potentially affect clinical quality dimensions – a review of the literature

Glette, Malin Knutsen; Wiig, Siri

doi:10.1108/ijhg-12-2020-0134

Cited by 12 publications

(12 citation statements)

References 34 publications

(58 reference statements)

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“…The findings in this thesis (Papers II, III) support the research of Glette and Wiig (2021) arguing that quality and safety would slip off the agenda in the organisation when financial restrictions are pressing. There was a struggle with long-term quality and safety strategies when short-term financial challenges got priority.…”

Section: Multiple Challenges In Quality and Safety Worksupporting

confidence: 70%

“…The OQ framework (Bates et al, 2008) (Fernholm et al, 2020;. Moreover, a recent review illustrates how organisational factors such as heavy workload, time constraints, understaffing and lack of competence forced trade-offs on both managers and healthcare professionals (Glette & Wiig, 2021). These daily adaptations and resource restrictions affected the way that managers prioritise the ordinary operations of services and integrate quality and safety improvement activities.…”

Section: Multiple Challenges In Quality and Safety Workmentioning

confidence: 99%

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Exploring the role of managers in quality and safety work in nursing homes and homecare services; A multiple case study

Johannessen¹

2022

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Introduction: Working on quality and safety in nursing home and homecare services is difficult. Ever-increasing demands from an ageing population and political pressure to keep patients at home are among the challenges facing nursing homes and homecare. There is less knowledge of patient safety risks and adverse events in primary care than in specialised healthcare. Aim: This thesis explores the role of managers in quality and safety work in nursing homes and homecare services. Moreover, the thesis designs, implements, and evaluates a leadership intervention in nursing homes and homecare services to support managers’ quality and safety work. Methods: This study was designed as a two-phase longitudinal multiple case study consisting of design and pilot testing; and implementation and evaluation of the SAFE LEAD intervention. The intervention is based on a leadership guide and includes several workshops and learning activities facilitated by researchers. In phase 1, the intervention was designed with researchers, co-researchers and managers from two nursing homes and one homecare service. The pilot test of the leadership intervention was conducted in one nursing home and one homecare service. Data collection consisted of focus group interviews and observation of managers. Phase 2 started by exploring quality and safety challenges as perceived by managers and employees in two nursing homes and two homecare services prior to participation in the leadership intervention. The study then continued with a longitudinal study of the implementation and evaluation of the leadership intervention and its influence on managers quality and safety work. Data collection in phase 2 included focus group interviews, observations, workshops and site visits with managers and employees. Data analyses in phases 1 and 2 included deductive content analysis and interweaving of observation and interview data. Results: The results describe all activities from development to evaluation of a leadership intervention and its influence on managers’ quality and safety improvement work in nursing homes and homecare services. Paper I detailed the involvement of stakeholders and demonstrated how a participatory approach was important for adaptations of a leadership guide to nursing home and homecare contexts. An intervention that managers could use in their work practice was developed and pilot tested in one nursing home and one homecare service. A key finding in Paper I is the role of context and the need to tailor intervention material (web and booklet) to the context and to the needs, time constraints, language, and interests of managers. Paper II explored managers’ and employees’ perceptions of quality and safety challenges in two nursing homes and two homecare services before the intervention took place. Managers and employees found that quality and safety challenges depended on several factors and implied multiple trade-offs. Managers struggled with external change processes, budget cuts that affected common understanding of and commitment to quality and safety improvement at managerial and staff levels. Paper III showed that the intervention workshops and leadership guide contributed to a common understanding and commitment to quality and safety in the management teams. The leadership intervention influenced managers’ work practice in different ways depending on capacity and needs in the organisations. The leadership guide and the workshops created a social and reflexive arena for quality and safety work in which managers could focus on these topics. Moreover, it provided the managers with a tool for clearer sense of quality and safety work in different settings. Managers found it important that someone established a structure and took responsibility for scheduling and organising quality meetings. However, management continuity and the establishment of structures were crucial for the intervention to be adopted. Conclusion: The longitudinal insight in this thesis broadens the understanding of contextual impact on quality and safety work in nursing homes and homecare services and showed the comprehensive work with translating knowledge into practice. The thesis demonstrates the importance of participatory approach and involvement of stakeholders when designing a leadership intervention. Managers and employees perceived interrelated quality and safety challenges and found context work to be time consuming to make quality and safety improvement common efforts in the organisations. The leadership intervention created a place for reflection for managers and brought a more structured process and commitment to organisational quality and safety work.

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Section: Multiple Challenges In Quality and Safety Worksupporting

confidence: 70%

Section: Multiple Challenges In Quality and Safety Workmentioning

confidence: 99%

Exploring the role of managers in quality and safety work in nursing homes and homecare services; A multiple case study

Johannessen¹

2022

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“…First the umbrella perspective of the overall situation and future needs (long term perspective and planning), and second, to be aware of the immediate ongoing situation (short term planning and response), taking into account all facets in their decision-makings, and reorganising to support adaptive capacity in teams. However, leaders were clear about the consequences of common trade-offs, such as sacrificing scheduled competence development for staff to respond to acute patient situations or a sudden and unexpectedly high flow of incoming patients [28][29][30]. Such trade-offs reduced the overall resilience of the teams in the longterm and was a constant struggle for the team leaders to manage.…”

Section: Leading Through Contextual Understandingmentioning

confidence: 99%

Exploring the role of leaders in enabling adaptive capacity in hospital teams – a multiple case study

Fagerdal

Lyng

Guise

et al. 2022

BMC Health Serv Res

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Background Resilient healthcare research studies how healthcare systems and stakeholders adapt and cope with challenges and changes to enable high quality care. Team leaders are seen as central in coordinating clinical care, but research detailing their contributions in supporting adaptive capacity has been limited. This study aims to explore and describe how leaders enable adaptive capacity in hospital teams. Methods This article reports from a multiple embedded case study in two Norwegian hospitals. A case was defined as one hospital containing four different types of teams in a hospital setting. Data collection used triangulation of observation and interviews with leaders, followed by a qualitative content analysis. Results Leaders contribute in several ways to enhance their teams’ adaptive capacity. This study identified four key enablers; (1) building sufficient competence in the teams; (2) balancing workload, risk, and staff needs; (3) relational leadership; and (4) emphasising situational understanding and awareness through timely and relevant information. Conclusion Team leaders are key actors in everyday healthcare systems and facilitate organisational resilience by supporting adaptive capacity in hospital teams. We have developed a new framework of key leadership enablers that need to be integrated into leadership activities and approaches along with a strong relational and contextual understanding.

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“…1.1.2 Tradeoffs in decision making. Several safety science theorists have outlined tradeoffs as an inevitable balancing act among all kinds of pressures and safety in hazardous systems [16][17][18], including healthcare [19]. Tradeoffs involve ambiguity over what constitutes the right answer.…”

Section: Competing Interestsmentioning

confidence: 99%

Key topics in pandemic health risk communication: A qualitative study of expert opinions and knowledge

et al. 2022

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Background Science communication can provide people with more accurate information on pandemic health risks by translating complex scientific topics into language that helps people make more informed choices on how to protect themselves and others. During pandemics, experts in medicine, science, public health, and communication are important sources of knowledge for science communication. This study uses the COVID-19 pandemic to explore these experts’ opinions and knowledge of what to communicate to the public during a pandemic. The research question is: What are the key topics to communicate to the public about health risks during a pandemic? Method We purposively sampled 13 experts in medicine, science, public health, and communication for individual interviews, with a range of different types of knowledge of COVID-19 risk and communication at the national, regional and hospital levels in Norway. The interview transcripts were coded and analysed inductively in a qualitative thematic analysis. Results The study’s findings emphasise three central topics pertaining to communication about pandemic health risk during the first year of the COVID-19 pandemic in Norway: 1) how the virus enters the human body and generates disease; 2) how to protect oneself and others from being infected; and 3) pandemic health risk for the individual and the society. Conclusion The key topics emerging from the expert interviews relate to concepts originating from multiple disciplinary fields, and can inform frameworks for interprofessional communication about health risks during a pandemic. The study highlights the complexity of communicating pandemic messages, due to scientific uncertainty, fear of risk amplification, and heterogeneity in public health and scientific literacy. The study contributes with insight into the complex communication processes of pandemic health risk communication.

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The role of organizational factors in how efficiency-thoroughness trade-offs potentially affect clinical quality dimensions – a review of the literature

Cited by 12 publications

References 34 publications

Exploring the role of managers in quality and safety work in nursing homes and homecare services; A multiple case study

Exploring the role of managers in quality and safety work in nursing homes and homecare services; A multiple case study

Exploring the role of leaders in enabling adaptive capacity in hospital teams – a multiple case study

Key topics in pandemic health risk communication: A qualitative study of expert opinions and knowledge

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