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Leading quality care transformation through involving everyone in improving care

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Author	Melin, Craig N.
Title	Leading quality care transformation through involving everyone in improving care
Date	2012
Abstract	Background: With the science and transparency of quality measurement unfolding, and economic forces changing, hospital leaders seek to aggressively improve their systems' care quality. Successful organizational transformations will engage everyone in the work of continuously attaining better patient outcomes (health), better system performance (care) and better professional development (learning). While respected experts have written about how to lead organizations to high quality, use of the various theories has not been studiously evaluated. Methods: This thesis conducts a retrospective inquiry into successful improvement in four hospitals, using a grounded, structured format to prompt recollecting and noticing (with an additional brief case report of a prospective use of the same format in a community hospital). The format, which integrates concepts from business leadership, healthcare leadership, quality improvement and change theory, anticipates that leaders 1) recognize the adaptive challenge, 2) help everyone see they have two jobs: doing their work and improving it; and 3) in a path tailored to the organization's context, move the healthcare system through a Quality Transformation Framework of five mechanisms of change. Realist evaluation of interviews and focus groups was used to retrospectively assess use of the framework and its five mechanisms of change to effect specific outcomes, and how the mechanisms were adapted to the different site contexts; clarifying what worked, for whom, and under what circumstances. Results: All four sites identified the need for change; involved staff in doing and improving their work; and utilized all five mechanisms of change in different ways. Realist evaluation facilitated refinement of the framework by tying its change mechanisms more closely to system and patient goals, tightening assumptions about context, and providing insight into its application. Conclusion: This study yielded a refined Quality Transformation Framework of mechanisms of change, with additional information on what worked, for whom, and under what circumstances in four sites, inviting hospital leaders to use the framework as guidance in transforming a hospital system to achieve sustainable high quality care, as measured by whole system measures, through engaging everyone in the organization in improving care.
Description	xiii, 327 leaves : ill. ; 28 cm.
Format	application/pdf
Advisor	Nelson, Eugene C; Batalden, Paul B; Splaine, Mark E; Edmondson, Amy C
College	Dartmouth College -- Dartmouth Institute for Health Policy and Clinical Practice.
Issuing Body	Dartmouth Dissertations are made available through the Dartmouth Digital Library.
Degree	Thesis (Ph.D.)--Dartmouth College.
Copyright	All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means without permission in writing from the author.
DOI	http://dx.doi.org/10.1349/ddlp.436

Title	Page 1
Format	application/pdf
Issuing Body	Dartmouth Dissertations are made available through the Dartmouth Digital Library.
Degree	Thesis (Ph.D.)--Dartmouth College.
Full Text	LEADING QUALITY CARE TRANSFORMATION THROUGH INVOLVING EVERYONE IN IMPROVING CARE A Thesis Submitted to the Faculty In partial fulfillment of the requirements for the degree of Doctor of Philosophy in Health Policy & Clinical Practice By Craig N. Melin, MS MBA DARTMOUTH COLLEGE Hanover, New Hampshire May 31, 2012 Examining Committee: _____________________________________ (Chairperson) Eugene C. Nelson, D.Sc, MPH _____________________________________ Paul B. Batalden, MD _____________________________________ Mark E. Splaine, MD, MS _____________________________________ Amy C. Edmondson, PhD AM _________________________________ Brian W. Pogue, PhD Dean of Graduate Studies

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