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Clinical front-line staff are best positioned within the organizations to identify patient safety problems and craft solutions. However, in traditional models, safety committees are led by senior executives who are not clinically responsible for patients. This top-down approach can result in missed opportunities to address patient-centered challenges and better manage the health of the defined populations served by these organizations.

To foster teamwork, enhance empowerment, and improve the patient care environment, Operations Councils led by trained front-line staff were deployed in 15 clinical areas at the Ohio State University Wexner Medical Center (OSUWMC) as a performance improvement tool.

Standardized training of Council facilitators was designed and implemented to guide the performance improvement process. Balanced scorecards were developed in each Council based on the risks and concerns of that particular clinical area. After initial implementation of the Operations Councils, patient safety events declined and team engagement improved by over 34% across the medical center; the highest changes were seen in areas where Operations Councils had been deployed. Additionally, outcome metrics including area-specific and system-wide mortality and readmissions improved after implementation.

We suggest that this type of approach may be an appropriate strategy to consider in other health care organizations as such institutions are challenged to better manage the health of their defined patient populations.

Settlement services in Canada have only recently started offering support and programming for emotional wellness issues faced by newcomers to Canada (immigrants who have been in Canada for less than 5 years). Funding for such services has steadily increased over the past 5 years, particularly in the wake of the COVID-19 pandemic. Greater investment in ensuring the emotional wellness of immigrants is spurring new settlement services and programming. These include a wide array of configurations and approaches across the different geographies of Canada. This is evidence that providing such services for newcomers is in the early stages of implementation, characterised by experimentation and precarity. Mental and emotional wellness programming is in contrast with more established services, such as those meant to provide language learning, where common assessment tools, measures of proficiency and progress are well established. With funding from the Immigration, Refugees and Citizenship Canada (IRCC), this chapter features data from a 2-year project that examined emotional wellness services for immigrants offered in four cities in western Canada between 2018 and 2020. The study used surveys and interviews with clients and focus groups with front-line staff to understand client needs and discern the issues and impact of emotional wellness programming. Findings include apparent limitations in staff capacity and expertise to provide help when needed, the inappropriateness of service models meant for other contexts and complex funding requirements resulting in issues of access and the overall precarity of such programming.

Scholars of race and work have shown that social categories shape how individuals interact with coworkers and clients. Social categories also inform the creation of roles within an organization when nonwhites are hired to interact with other nonwhites. This study examines these roles, or racialized labor, and illustrates how racial categories govern organizational behavior. By studying immigrant-serving providers at a range of nonprofits, this chapter shows how the assumed relationship between racial category and knowledge is evidence of ethnoracial logics, or the practice of using racial categories to organize work because of assumptions about the inherent racial ethnic knowledge an employee possesses. To make the case for these logics, the chapter draws on ethnographic fieldwork and in-depth interviews with Latino, Latina, and White nonprofit professionals to show how expertise is developed and differentiated along racial lines.

This chapter describes two change efforts involving participatory action research within the pharmacy operations division of Kaiser Permanente. Focus is on a parallel learning mechanism that has been used to support communications and change during two large-scale information technology interventions. It begins with basic background information on participatory action research in organizations. Since the case setting is Kaiser Permanente, the chapter provides some information on the U.S. healthcare industry context and then shifts to Kaiser’s communication forum, a learning mechanism that has been in place for 35 years. Cognitive, structural, and procedural aspects of the learning mechanism are explored, and the chapter features interviews with some of the key forum players. Both in the forum’s infancy and in its current more institutionalized state, the pharmacy organization has been in crisis. Implications for the use of parallel learning structures on a long-term basis to support long-term participatory action research are explored along with contributions to theory on insider/outsider action research.

A primary impetus of the modern hospice movement was the disparity, during the later 20th century, between the care provided to persons with illnesses considered “curable” and the treatment – or lack of it – accorded the incurably or terminally ill. In its transformation from a reform-oriented, interdisciplinary response to the needs of the dying to an integrated component of the American healthcare system, hospice care's original mission, target population, and modality of service delivery were all significantly altered in ways that generated new disparities in access to “death with dignity.” This chapter attempts to trace the political, economic, and institutional dimensions of this transformation as reflected in the experiences of one Northeastern hospice during a 6-month period in 2001. Using an analytic approach known as institutional ethnography (IE), the authors focus on the work of the Hospice's Interdisciplinary Group (IDG) to uncover the linkages between local problems in the delivery of hospice care and extra-local sites of power and constraint at the mezzo- and macrolevels of the American healthcare system. The significance of these linkages for patients, frontline workers, and other stakeholders are interpreted from several perspectives. Implications for change are discussed.

Despite hospitals’ efforts to reduce health care-associated infections (HAIs), success rates vary. We studied how leadership practices might impact these efforts.

We conducted eight case studies at hospitals pursuing central line-associated blood stream infection (CLABSI)-prevention initiatives. At each hospital, we interviewed senior leaders, clinical leaders, and line clinicians (n=194) using a semi-structured interview protocol. All interviews were transcribed and iteratively analyzed.

We found that the presence of local clinical champions was perceived across organizations and interviewees as a key factor contributing to HAI-prevention efforts, with champions playing important roles as coordinators, cheerleaders, and advocates for the initiatives. Top-level support was also critical, with elements such as visibility, commitment, and clear expectations valued across interviewees.

Results suggest that leadership plays an important role in the successful implementation of HAI-prevention interventions. Improving our understanding of nonclinical differences across health systems may contribute to efforts to eliminate HAIs.

In December 1999, the UK Civil Service Management Board in Whitehall agreed upon a reform program focusing on six themes, all connected with improved managerial processes internal to the civil service and intended to complement the more externally oriented Modernising Government agenda set out in a white paper earlier that year. The purpose was to achieve major changes in the way in which the civil service was run – “step change” rather than continuous improvement. In May 2002, the Cabinet Office commissioned a research project to provide an evaluation of the Civil Service Reform program through four case studies. This chapter draws upon the findings of that study to discuss the extent to which cultural differences affected the outcomes of this ambitious reform program. In addition, it draws upon a set of interviews in 2005 which updated the findings of the research. The chapter suggests that four very different types of culture had important impacts on the way in which the case study organizations went about the process of addressing the Cabinet Office reform program, namely national cultures which differed greatly between the case studies, although they were all UK-based organizations; organizational cultures which differed greatly within each of the case study organizations; occupational cultures which crossed the four case studies, but usually with significant differences in each context; and sectoral cultures which in several cases provided particular barriers to change. The chapter shows how these different dimensions of culture were interwoven in the change programs of the four cases and explores the extent to which their progress on the reform agenda was affected by their particular cultural mix. It suggests that some “cultural stances” within these overall cultures were more difficult to change than others, so that reforms had to be re-activated on several occasions and through a variety of mechanisms. Finally, the chapter illustrates how, in the case study organizations which were most successful, a deliberate strategy was adopted by top management of highlighting the clashing internal cultures, in order to challenge the traditional positions of internal and external stakeholders, in spite of the risks involved.

This chapter evaluates a model of the organizational context of burnout with direct reference to a new measure, the Areas of Worklife Scale (AWS). The model proposes a structured framework for considering six areas of worklife – workload, control, reward, community, fairness, and values – that have resonated through the literature on burnout over the previous two decades. The chapter presents extensive data on the AWS, testing a model of the six areas’ interrelationships as well as their overall relationship to the three aspects of burnout. The results of these analyses are discussed in reference to the psychometric qualities of the measure and the implications of a structured approach to work environments for future development of research on burnout. Implications for developing workplace interventions are also considered.