Guest editorial

Citation

Sinha, M.N. (2018), "Guest editorial", Leadership in Health Services, Vol. 31 No. 3, pp. 266-268. https://doi.org/10.1108/LHS-07-2018-083

This Special Issue of Leadership in Health Services Journal contains selected papers that were presented at the 9th Canadian Quality Congress held at the University of Toronto, in Toronto, Ontario, Canada, September 7-8, 2017. The theme of the congress was Quality and Innovation in the 21st Century: Challenges and Opportunities.

The special issue contains papers on many interesting topics. Quality and innovation is the central theme. It has a mixture of theoretical, practical and those that are rooted in conceptual framework thinking for improving health-care organizations.

Leadership is at the core of all issues discussed. The papers represent very timely topics that are currently hotly debated and discussed throughout North America and in other parts of the world, that is, the quality and patient satisfaction must improve and costs must go down.

The first paper discusses how leveraging supply chain infrastructure can advance patient safety in community-based health-care settings. The authors argue that while the majority of patient safety studies in Canada and abroad have focused on safety in hospital settings, deaths and harm experienced by patients in the community settings (home care, long-term care, complex care and rehabilitation) are less well understood. The authors suggest that improving system infrastructure would reduce the occurrence of adverse events. According to them, the visibility across the continuum of care holds the potential to transform health care in Canada rather than a fragmented system where information is inadequately captured and transferred from provider to provider, to a system that would provide complete, accurate and up-to-date information of patient care, procedures, medications and outcomes to inform the best and safest care possible.

The second paper presents a comprehensive approach for studying organizational culture using “soft measures” to facilitate sustainable quality development. The author’s work consists of a number of different methods to collect soft data that influences the culture and the leadership within three organizations that were shown statistically significant with positive changes in organizational work culture only after a short period of one year.

The next paper is about improving patient flow in an emergency department of hospital using lean methodologies. The emergency department overcrowding (EDOC) and increased length of stay (LOS) have been key global issues for more than 20 years with many serious repercussions. Guided by the Lean management concepts, the author proposes solutions that fall under three themes: ensuring effective triaging of all patients, reducing the total number of patients referred to observation room and reducing maximum LOS and wait times in observation room. The solutions address the vital few causes of the EDOC and prolonged EDLOS that are critical to solving ED problems.

The fourth paper is about developing a model for measuring effectiveness of quality management practices in health-care organizations. Health care is the example where the needs of potential clients often exceeds the capabilities of the service delivery system. The authors use mathematical analyses in four major areas of quality assurance that describe conditions for the implementation of tasks, namely, the scheduling (as a methodology for allocating resources to perform tasks), capacity planning (for assigning values to each resources) queueing theory (for application for analyzing waiting times in hospitals) and overall examination covering total quality management principles to ensure appropriate conditions for completing tasks (called, CCT), where CCT is a mathematical representation of casual relationships between variables.

The fifth paper is a study of factors that influences doctors’ involvement in Lean management initiatives in public health-care organizations with a case study of Canadian hospitals. In total, 54 interviews of 18 lean-managed health-care organizations were conducted to identify ten factors found influencing the commitment of doctors toward change management. These factors are categorized into pre-change antecedents and change antecedents. The level of transformational leadership demonstrated was found to have potentially high to moderate influence on medical staff behavioral support for change outcomes.

The final paper addresses problems in patient flow. It identifies the reasons behind extensive wait time in a public-sector Liver Transplant Clinic which is an educational and research hospital facility. Lean management theories and practices were used. Data were collected through personal observations, interviews and brainstorming. A Value Stream Map was developed, non-value-added activities were removed affecting waiting time, all significant problems were identified, changes were made, improvements implemented and their success was measured. Scheduling, flow chart and a Kanban visual guide system were used together with software applications and Gemba Walk allowing interaction with people and processes in a kaizen spirit.

The 9th Canadian Quality Congress in Toronto was once again too good an opportunity to be missed.

I look forward welcoming everyone at the 10th Canadian Quality Congress, September 24-25, 2018, at the campus of the Simon Fraser University in Vancouver, British Columbia, Canada.