How perceptions of time and place construct two stories concerning status and privilege for clinicians and administrators in healthcare organizations

Poor information quality (IQ) must be understood as a business problem rather than systems problem. In health care organization, what is required is an effective quality management that continuously manages and reviews the factors influencing IQ in health information systems (HIS) so as to achieve the desired outcomes. Hence, in order to understand the issues of information quality management (IQM) practices in health care organizations, a more holistic evaluation study should be undertaken to investigate the IQM practices in health care organizations. It is the aim of this paper to identify the significant evaluation criteria that influence the production of good IQ in HIS. Six selected frameworks and best practices both from health informatics and information systems literature have been reviewed to identify the evaluation criteria from the perspective of human, organizational and technological factors. From the review, it was found that human and organization factors are of greater significance in influencing HIS IQ. Our review depicts that there is still shortage in finding a comprehensive IQM evaluation framework. Thus, the criteria from the frameworks reviewed can be used in combination for more comprehensive evaluation criteria. Integrated IQM evaluation criteria for HIS are then proposed in this study. Poor IQ is the result of complex interdependency within sociotechnical factors in health care organization and lack of formal and structured IQM practices. Thus, a feedback mechanism such as evaluation is needed to understand the issues in depth in the future.

The aims of this scoping literature review are to examine and summarize the organizational-level factors, context, and processes that influence the use of evidence-based practice in healthcare organizations. A scoping literature review was done to answer the question: What is known from the existing empirical literature about factors, context, and processes that influence the uptake, implementation, and sustainability of evidence-based practice in healthcare organizations? This review used the Arksey and O'Malley framework to describe findings and to identify gaps in the existing research literature. Inclusion and exclusion criteria were developed to screen studies. Relevant studies published between January 1991 and March 2014 were identified using four electronic databases. Study abstracts were screened for eligibility by two reviewers. Following this screening process, full-text articles were reviewed to determine the eligibility of the studies by the primary author. Eligible studies were then analyzed by coding findings with descriptive labels to distinguish elements that appeared relevant to this literature review. Coding was used to form categories, and these categories led to the development of themes. Thirty studies met the eligibility criteria for this literature review. The themes identified were: the process organizations use to select evidence-based practices for adoption, use of a needs assessment, linkage to the organization's strategic direction, organizational culture, the organization's internal social networks, resources (including education and training, presence of information technology, financial resources, resources for patient care, and staff qualifications), leadership, the presence of champions, standardization of processes, role clarity of staff, and the presence of social capital. Several gaps were identified by this review. There is a lack of research on how evidence-based practices may be sustained by organizations. Most of the research done to date has been cross-sectional. Longitudinal research would give insight into the relationship between organizational characteristics and the uptake, implementation, and sustainability of evidence-based practice. In addition, although it is clear that financial resources are required to implement evidence-based practice, existing studies contain a lack of detail about the cost of adopting and using new practices. This scoping review contains a number of implications for healthcare administrators, managers, and providers to consider when adopting and implementing evidence-based practices in healthcare organizations.

Leadership style and specific organizational climates have emerged as critical mechanisms to implement targeted practices in organizations. Drawing from leadership and organizational climate theories, we propose that climate for implementation of cultural competence reflects how transformational leadership may enhance the organizational implementation of culturally responsive practices in health care organizations. Using multilevel data from 427 employees embedded in 112 treatment programs collected in 2013 from addiction health services, confirmatory factor analysis showed adequate fit statistics for our measure of climate for implementation of cultural competence and the three outcomes – knowledge (Cronbach’s alpha = .88), service (Cronbach’s alpha = .86) and personnel (Cronbach’s alpha = .86) practices. Results from multilevel path analyses indicate a positive relationship between employee perceptions of transformational leadership and climate for implementation of cultural competence (standardized indirect effect = .057, bootstrap p < .001). We also found a positive and indirect effect between transformational leadership and each of the culturally competent practices – knowledge (standardized indirect effect = .006, bootstrap p < .004), services (standardized indirect effect = .019, bootstrap p < .001), and personnel (standardized indirect effect = .014, bootstrap p < .005). Findings contribute to leadership theory and offer evidence related to the implementation of cultural competence in health care organizations.

Paper aims This article aims at proposing a methodology for assessing lean practices in healthcare organizations that are undergoing a lean implementation. Originality The proposed methodology evaluates healthcare organizations and help managers identify the relationships intensities between their problems and lean practices. This application occurs in a case study in an Emergency Department from a Brazilian public hospital. Research method The proposed methodology provides a theoretical framework that addresses lean practices according to fundamental aspects of the organization, such as people, partnerships, results, processes and leadership, corroborating to a systemic view of lean implementation and facilitating its long-term sustainability. Main findings Our findings provide guidelines for the public hospital leadership, allowing a clear focus on the improvement efforts that can mitigate problems. Implications for theory and practice Due to contextual diversity, the understanding of the critical success factors for lean implementation under such conditions deserves attention. Hence, the proposed method allows practitioners and academics to better comprehend the lean implementation within healthcare organizations. Such enhanced comprehension allows to anticipate potential issues throughout the lean implementation, entailing more assertive efforts. Moreover, accounting for specific problems when designing the lean implementation avoids the utilization of a general and ineffective approach.

Best practices comprise recent, relevant, and helpful nursing practices, methods, interventions, procedures or techniques based on high-quality evidence. Best practices should be implemented to improve individual patients' health outcomes the overall quality of health care, and to strengthen the health system at large. Four facilitators (benefit levers) to effectively roll-out best practices in healthcare organizations were identified: alignment, permeation plans, leadership for change, as well as supporting and reinforcing structures. To develop and review a guide for an operational plan to facilitate the roll-out of best practices in healthcare organizations. The content of the guide was based on findings of an integrative literature review and interviews. This article discusses the development of the guide using the logic model as format (phase One) as well as its review including five key informants using the Delphi method (phase Two). The Logic Model provided a feasible format for the guide. Two Delphi rounds were required to review the guide's design and content. This guide addresses pre-roll-out resources; pre-roll-out activities, best practices (outcomes) during and after roll-outs; and impact. The guide should be tested in different healthcare organizations and adapted accordingly to have an impact on improved patient and health outcomes. The guide can be used by managers wishing to roll-out best practices in their healthcare organizations to achieve improved health outcomes for individual patients.

ObjetivoEste artículo explora el estado actual de las prácticas logísticas en los hospitales de Bogotá, Colombia.Diseño/metodología/enfoqueLa evaluación se basa en la investigación de un estudio de caso utilizando entrevistas abiertas, entrevistas centradas, un cuestionario y observaciones directas como fuentes de evidencia. Se analizan siete establecimientos de salud colombianos: cuatro hospitales públicos y tres clínicas privadas. El análisis cruzado de casos permite la identificación de patrones relacionados con la gestión del abastecimiento, la gestión de inventarios, la reposición y el uso de las tecnologías de la información y la comunicación (TIC).ResultadosLos procedimientos manuales, la mala planificación, el escaso reconocimiento de la alta dirección y la falta de personal especializado caracterizan la situación actual. Las prácticas innovadoras con un potencial para mejorar la eficacia de las actividades logísticas son raras, particularmente en los hospitales públicos.Investigación futuraEste estudio se podría replicar en otras ciudades colombianas, con el fin de generalizar los resultados a todo el país. También podría ser interesante documentar implementaciones exitosas y menos exitosas de prácticas logísticas innovadoras en hospitales colombianos para guiar y promover su adopción.Limitaciones de la investigación/implicacionesEl pequeño número de casos considerados, y el hecho de que la investigación se concentra en una ciudad, limita la generalización de nuestros resultados.Originalidad/valorSegún nuestro conocimiento, esta investigación es la primera en explorar el estado de las prácticas de logística hospitalaria en Colombia.

Position statement: Reducing fatigue associated with sleep deficiency and work hours in nurses

PurposeTo improve understanding of mentoring and other leadership development practices in health care organizations, focusing on three questions: What has been done? What is being done? What should be done?Design/methodology/approachFirst, 160 key informant interviews explored mentoring and leadership development practices in health care between September 2003 and December 2004. Second, all US hospital chief executives were surveyed between August‐December 2004 (844 respondents) and asked about mentoring and leadership development.FindingsNo interviewed executives and fewer than one‐quarter of chief executive respondents reported participating in formal mentoring programs as a protégé. Nearly one in three executives surveyed reported that a formal mentoring program was available within their organizations; however, only three key informants described programs in existence longer than five years. Issues such as assuring senior leadership support, sustaining budgetary commitment, and dedicating qualified personnel were all reportedly important for health care organizations striving to design and implement mentoring and other leadership development practices.Research limitations/implicationsWhile limited by a modest response rate within a chief executive population, survey results highlight the importance of mentoring in framing perceptions about leadership development. Future research should attempt to better understand how perspectives guide program development decisions.Practical implicationsBy considering opportunities to use mentoring to help employees advance, organizations can build investments in leadership development, ideally helping under‐represented groups to attain higher management ranks.Originality/valueThis paper is among the first to combine qualitative and quantitative methods to explore mentoring and leadership development in health care organizations.

Protection of patients' rights is critical in improving healthcare quality, and hence this study aimed at reviewing patient rights’ practices in healthcare organizations of Iran.Using systematic search, this review was conducted based on Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Several keywords, including "patient rights", "patient bills of rights" and "patients rights’ charter" were searched bilingually in the databases of SID, Magiran, PubMed, Scopus, and Web of Science from 2010 to 2021, and then, following a three-tier screening using the Critical Appraisal Skills Program (CASP) checklists, 76 articles were extracted. The degree of compliance with the Patients' Rights Charter (PRC) in healthcare organizations was 60.88% on average. As to the observance of the PRC dimensions, respectively, the highest and lowest scores were related to the "right to privacy and confidentiality" (70.16%) and "right to access an efficient complaining system" (53.01 %).Respect for patients' rights in organizations was assessed at a moderate level, and some aspects of patients' rights should be attended to immediately. Therefore, discrepancies in the dimensions of patients' rights and their implementation by organizations should be on the agenda of healthcare managers and policymakers.

Medical errors are a recurring fact in health care organizations. The importance of mitigating and learning from these errors is incontrovertible. Prevailing practices in health care organizations convincingly argue for a “both-and” approach to this goal, meaning that, in a perfect world, heath care professionals may simultaneously eliminate and welcome (and thus learn from) errors. Yet health care organizations that do well on both accounts are extraordinarily rare. Some health care policymakers, administrators, caregivers, and researchers believe that this problem stems from a lack of commitment to patient safety or insufficient implementation of such “both-and” practices. We challenge this reasoning and suggest that both organizational goodwill and implementation difficulties constitute simplistic explanations. In our opinion, health care challenges are strongly grounded in the current state of the error literature that promotes a “both-and” approach.

BackgroundKazakhstan inherited the Semashko health system model, known for the centralized adoption of rules at the Ministry of Health (MoH) level that regulate the healthcare system. In 2019 MoH established a national framework with indicators aimed at collecting qualitative and quantitative data from healthcare organizations as part of their annual self-evaluation, and biannual external evaluation by the National Research Center for Health Development (NRCHD). The purpose of this study was to pilot the MoH framework on rational use of medicines and evaluate its effects on medicine use practices in health care organizations and at the national level.Materials and methodsThis cross-sectional study was conducted from October to December 2019 at 22 state-owned primary health care organizations (polyclinics) serving adults and children in Astana, Kazakhstan. Data were collected by trained surveyors visiting each organization. Data were converted to numeric values to arrive at compliance scores for each organization and analyzed to assess each organization’s compliance with set indicators.ResultsThe evaluation showed the rational use of medicines was assessed as “excellent” (90% < compliant) in 2 organizations (9% of the sample), “good” (75–89% compliant) in 7 organizations (32%), and “satisfactory” (50–74% compliant) in 13 organizations (59%), with an average compliance rate of 71% across the sample. 22 organization-specific evaluation reports were developed by the evaluator (NRCHD) and sent to health care organizations for corrective actions. Evaluation data triggered two improvements at the national level: correction of the default setting for trade names to international nonproprietary names within the physician ordering feature of the national health information system for medicines, and adoption of a national policy that allowed the exchange of unused stocks of medicines between polyclinics.ConclusionsUsing the national framework allowed the evaluator agency and healthcare organizations to identify organization-specific gaps and triggered improvements in the use of medicines.

Many hospitals are unable to successfully implement "evidence-based practices" at the unit level. For example, consistent implementation of the central line bundle (CLB), proven to prevent catheter-related bloodstream infections (CRBSIs) is often difficult. This problem has been broadly characterized as "change implementation failure" in health care organizations. Several studies have used retrospective designs to examine the problem; however, there are few prospective studies examining communication dynamics underlying successful implementation of change (eg, evidence-based practices). This prospective study will be set in 2 intensive care units at an academic medical center. At baseline, both units have low compliance with CLB and higher-than-expected CRBSIs. Periodic quality improvement (QI) interventions will be conducted over a 52-week period to promote implementation of CLB in both units. Simultaneously, the following parameters will be examined: (1) Structure and content of communication related to CLB in both units through "communication logs" completed weekly by nurses, physicians, and managers; and (2) outcomes, that is, CLB adherence in both units through weekly chart review. Catheter utilization and CRBSI (infection) rates will serve as additional unit-level outcome measures. The aim is 2-fold: (1) to examine associations between QI interventions and structure and content of communication at the unit level; and (2) to examine associations between structure and content of communication and outcomes at the unit level. The periodic QI interventions are expected to increase CLB adherence and reduce CRBSIs through their influence on structure and content of communication. The prospective design would help examine dynamics in unit-level communication structure and content related to CLB, as well as unit-level outcomes. The study has potential to make significant contributions to theory and practice, particularly if interventions are found to be effective in enabling successful practice change at the unit level. To this effect, the study has potential to provide insights into communication structure and content associated with collective learning and culture change at the unit level. Results and insights are expected to lay a foundation for generating context-sensitive "evidence-based management" strategies for successful practice change at the unit level. An ultimate expected deliverable is the development of an "action-learning framework" for successful implementation of evidence-based practices in health care organizations.

Making organizations helpful in health care generally means ensuring the delivery of cost-effective approaches to reduce human suffering. Strong leadership can facilitate implementation of innovations and evidence-based health care by fostering an organizational context that is supportive of change, encouraging buy-in from staff, and increasing both implementation fidelity (fidelity to the implementation strategy) and intervention fidelity (fidelity to the clinical intervention). In the current era of health care reform, in which provider accountability for cost-effective intervention is paramount, examining the role of transformational leadership in the implementation process of evidence-based care is critical. Transformational leadership has great potential to support the enactment of changes in health care organizations. In addition, although there has been some criticism, transformational leadership has a great deal of empirical support across settings, cultures, and countries. Despite a growing body of support, there is limited knowledge regarding how organizational culture and climate embedding mechanisms are utilized and how these are a function of or relate to transformational leaders’ influence on followers’ implementation behaviors. Each of the four different studies included in this symposium addresses one or more of these issues related to embedding factors associated with the implementation context. Together, the papers help to advance knowledge about the role of leadership in shaping followers’ attitudes and behaviors about implementation of evidence-based treatment practices in mental health and addiction health service organizations. Each of the four papers relies on unique samples and advanced quantitative and qualitative methods to provide a multifaceted perspective on leadership and implementation, an underresearched area in health care. Together, the papers in this symposium advance implementation science by providing concrete understanding of leadership in real-world health care settings. Implications for methods, theory, and translation of findings into practice are discussed. Leadership and Climates for Implementation of Culturally Responsive and Evidence-Based Practices Presenter: Erick Guerrero; U. of Southern California Presenter: Yinfei Kong; U. of Southern California Presenter: Gina Rosen; U. of Southern California Leadership Intervention to Improve the Implementation of Evidence-Based Health Care Practices Presenter: Howard Padwa; U. of California, Los Angeles Presenter: Lesley Harris; U. of Louisville Organizational Support Moderates the Effect of Leadership on Organizational Citizenship Behavior Presenter: Gregory A. Aarons; U. of California, San Diego Presenter: Mark G. Ehrhart; San Diego State U. Presenter: Elisa Maria Torres; UC San Diego The Effects of Transformational Leadership and Leader-Member Exchange on Attitudes toward Feedback Presenter: Karissa Fenwick; U. of Southern California, School of Social Work Presenter: Kim Brimhall; U. of Southern California

: Difficult economic conditions and powerful workforce trends pose significant challenges to managing talent in health care organizations. Although robust research evidence supports the many benefits of maintaining a strong commitment to talent management practices despite these challenges, many organizations compound the problem by resorting to workforce reductions and limiting or eliminating investments in talent management. : This study examines how nationwide health care systems address these challenges through best practice talent management systems. Addressing important gaps in talent management theory and practice, this study develops a best practice model of talent management that is grounded in the contextual challenges facing health care practitioners. : Utilizing a qualitative case study that examined 15 nationwide health care systems, data were collected through semistructured interviews with 30 executives and document analysis of talent management program materials submitted by each organization. : Exemplary health care organizations employ a multiphased talent management system composed of six sequential phases and associated success factors that drive effective implementation. Based on these findings, a model of talent management best practices in health care organizations is presented. : Health care practitioners may utilize the best practice model to assess and enhance their respective talent management systems by establishing the business case for talent management, defining, identifying, and developing high-potential leaders, carefully communicating high-potential designations, and evaluating talent management outcomes.

Quality management in healthcare organizations: Empirical evidence from the baldrige data