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Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service

BACKGROUND: Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis’ typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement interventio...

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Autores principales: Jones, Lorelei, Pomeroy, Linda, Robert, Glenn, Burnett, Susan, Anderson, Janet E, Morris, Stephen, Capelas Barbosa, Estela, Fulop, Naomi J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560458/
https://www.ncbi.nlm.nih.gov/pubmed/30381330
http://dx.doi.org/10.1136/bmjqs-2018-008291
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author Jones, Lorelei
Pomeroy, Linda
Robert, Glenn
Burnett, Susan
Anderson, Janet E
Morris, Stephen
Capelas Barbosa, Estela
Fulop, Naomi J
author_facet Jones, Lorelei
Pomeroy, Linda
Robert, Glenn
Burnett, Susan
Anderson, Janet E
Morris, Stephen
Capelas Barbosa, Estela
Fulop, Naomi J
author_sort Jones, Lorelei
collection PubMed
description BACKGROUND: Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis’ typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England. METHODS: We conducted fieldwork over a 30-month period as part of an evaluation in six healthcare provider organisations in England. Our data comprised board member interviews (n=54), board meeting observations (24 hours) and relevant documents. RESULTS: Two organisations transformed their processes in a way that was consistent with the objectives of the intervention, and one customised the intervention with positive effects. In two further organisations, the intervention was only loosely coupled with organisational processes, and participation in the intervention stopped when it competed with other initiatives. In the final case, the intervention was corrupted to reinforce existing organisational processes (a focus on external regulatory requirements). The organisational response was contingent on the availability of ‘slack’—expressed by participants as the ‘space to think’ and ‘someone to do the doing’—and the presence of a functioning board. CONCLUSIONS: Underperforming organisations, under pressure to improve, have little time or resources to devote to organisation-wide quality improvement initiatives. Our research highlights the need for policy-makers and regulators to extend their focus beyond the choice of intervention, to consider how the chosen intervention will be implemented in public sector hospitals, how this will vary between contexts and with what effects. We provide useful information on the necessary conditions for a board-level quality improvement intervention to have positive effects.
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spelling pubmed-65604582019-06-26 Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service Jones, Lorelei Pomeroy, Linda Robert, Glenn Burnett, Susan Anderson, Janet E Morris, Stephen Capelas Barbosa, Estela Fulop, Naomi J BMJ Qual Saf Original Research BACKGROUND: Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis’ typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England. METHODS: We conducted fieldwork over a 30-month period as part of an evaluation in six healthcare provider organisations in England. Our data comprised board member interviews (n=54), board meeting observations (24 hours) and relevant documents. RESULTS: Two organisations transformed their processes in a way that was consistent with the objectives of the intervention, and one customised the intervention with positive effects. In two further organisations, the intervention was only loosely coupled with organisational processes, and participation in the intervention stopped when it competed with other initiatives. In the final case, the intervention was corrupted to reinforce existing organisational processes (a focus on external regulatory requirements). The organisational response was contingent on the availability of ‘slack’—expressed by participants as the ‘space to think’ and ‘someone to do the doing’—and the presence of a functioning board. CONCLUSIONS: Underperforming organisations, under pressure to improve, have little time or resources to devote to organisation-wide quality improvement initiatives. Our research highlights the need for policy-makers and regulators to extend their focus beyond the choice of intervention, to consider how the chosen intervention will be implemented in public sector hospitals, how this will vary between contexts and with what effects. We provide useful information on the necessary conditions for a board-level quality improvement intervention to have positive effects. BMJ Publishing Group 2019-03 2018-10-31 /pmc/articles/PMC6560458/ /pubmed/30381330 http://dx.doi.org/10.1136/bmjqs-2018-008291 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/
spellingShingle Original Research
Jones, Lorelei
Pomeroy, Linda
Robert, Glenn
Burnett, Susan
Anderson, Janet E
Morris, Stephen
Capelas Barbosa, Estela
Fulop, Naomi J
Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service
title Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service
title_full Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service
title_fullStr Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service
title_full_unstemmed Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service
title_short Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service
title_sort explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the english national health service
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560458/
https://www.ncbi.nlm.nih.gov/pubmed/30381330
http://dx.doi.org/10.1136/bmjqs-2018-008291
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