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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 the US, a growing number of organizations and industries are seeking to affirm their commitment to and efforts around diversity, equity, and inclusion (DEI) as recent events have increased attention to social inequities. As health care organizations are considering new ways to incorporate DEI initiatives within their workforce, the anticipated result of these efforts is a reduction in health inequities that have plagued our country for centuries. Unfortunately, there are few frameworks to guide these efforts because few successfully link organizational DEI initiatives with health equity outcomes. The purpose of this chapter is to review existing scholarship and evidence using an organizational lens to examine how health care organizations can advance DEI initiatives in the pursuit of reducing or eliminating health inequities. First, this chapter defines important terms of DEI and health equity in health care. Next, we describe the methods for our narrative review. We propose a model for understanding health care organizational activity and its impact on health inequities based in organizational learning that includes four interrelated parts: intention, action, outcomes, and learning. We summarize the existing scholarship in each of these areas and provide recommendations for enhancing future research. Across the body of knowledge in these areas, disciplinary and other silos may be the biggest barrier to knowledge creation and knowledge transfer. Moving forward, scholars and practitioners should seek to collaborate further in their respective efforts to achieve health equity by creating formalized initiatives with linkages between practice and research communities.

The COVID-19 pandemic and its related economic meltdown and social unrest severely challenged most countries, their societies, economies, organizations, and individual citizens. Focusing on both more and less successful country-specific initiatives to fight the pandemic and its multitude of related consequences, this chapter explores implications for leadership and effective action at the individual, organizational, and societal levels. As international management scholars and consultants, the authors document actions taken and their wide-ranging consequences in a diverse set of countries, including countries that have been more or less successful in fighting the pandemic, are geographically larger and smaller, are located in each region of the world, are economically advanced and economically developing, and that chose unique strategies versus strategies more similar to those of their neighbors. Cultural influences on leadership, strategy, and outcomes are described for 19 countries. Informed by a cross-cultural lens, the authors explore such urgent questions as: What is most important for leaders, scholars, and organizations to learn from critical, life-threatening, society-encompassing crises and grand challenges? How do leaders build and maintain trust? What types of communication are most effective at various stages of a crisis? How can we accelerate learning processes globally? How does cultural resilience emerge within rapidly changing environments of fear, shifting cultural norms, and profound challenges to core identity and meaning? This chapter invites readers and authors alike to learn from each other and to begin to discover novel and more successful approaches to tackling grand challenges. It is not definitive; we are all still learning.

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.

The importance of culture is often emphasized for continuous learning and quality improvement within health care organizations. Limited empirical evidence for cultivating a culture that supports continuous learning and quality improvement in health care settings is currently available.

The purpose of this report is to characterize the evolution of a large division of physical therapists and occupational therapists in a pediatric hospital setting from 2005 to 2018 to identify key facilitators and barriers for cultivating a culture empowered to engage in continuous learning and improvement.

An ethnographic methodology was used including participant observation, document review, and stakeholder interviews to acquire a deep understanding and develop a theoretical model to depict insights gained from the investigation.

A variety of individual, social, and structural enablers and motivators emerged as key influences toward a culture empowered to support continuous learning and improvement. Features of the system that helped create sustainable, positive momentum (e.g., systems thinking, leaders with grit, and mindful design) and factors that hindered momentum (e.g., system uncertainty, staff turnover, slow barrier resolution, and competing priorities) were also identified.

Individual-level, social-level, and structural-level elements all influenced the culture that emerged over a 12-year period. Several cultural catalysts and deterrents emerged as factors that supported and hindered progress and sustainability of the emergent culture.

Cultivating a culture of continuous learning and improvement is possible. Purposeful consideration of the proposed model and identified factors from this report may yield important insights to advance understanding of how to cultivate a culture that facilitates continuous learning and improvement within a health care setting.

The University of Tennessee Medical Center in Knoxville (UTMC) Preston Medical Library (PML) and Health Information Center (HIC) has provided a novel contribution to increasing consumer health literacy and reducing health disparities in a unique variety of ways. UTMC librarians have used qualitative, quantitative, and practice-based methodology and research to demonstrate what a regional medical library working with internal and community partners can accomplish. At UTMC, there has been a focus on the value of health literacy for the patient, the clinician, and the health care system itself. In 1993, the UTMC PML began a consumer and patient health information service, which was the foundation for increasing consumer health literacy. In 2014, UTMC took a leading role in advancing consumer health literacy through the opening of the HIC, a patient- and family-focused library inside of UTMC. This chapter will focus on the PML’s history as a reliable resource in providing patients, family members, and the community with accurate and trustworthy health information, as well as the librarians’ role related to health literacy and health disparities through various initiatives and projects. Additionally, this chapter will highlight specific suggestions for libraries interested in starting similar initiatives, such as obtaining support from leadership, opportunities for funding, and how to address roadblocks.

We provide a review of the research in this volume and suggest avenues for future research.

Review of the research in this volume and unstructured interviews with health care executives.

We identified the three central themes: (1) trust in leadership, (2) leading by example, and (3) multi-level leadership. For each of these themes, we highlight the shared concerns and findings, and provide commentary about the contribution to the literature on leadership.

While relation-oriented leadership is important in health care, there is a danger of too much emphasis on relations in an already caring profession. Moreover, in most health care organizations, leadership is distributed and scholars need to adopt the appropriate methods to investigate these multi-level phenomena.

In health care organizations, hands-on leadership, through role modeling, may be necessary to promote change. However, practicing what you preach is not as easy as it may seem.

We provide a framework for understanding current research on leadership in health care organizations.

Improving access and the quality of health services requires community health initiatives. However, in order for such efforts to be successful, there has to be some agreement at the community level as to which community initiatives ought to be pursued. With diversity of population, health disparities, limited resources, and competing needs, agreement is unlikely; instead a negotiated consensus among key stakeholders (community advocates, agency leaders, service providers, and consumers) must be developed. A negotiated consensus takes into account differences and allows for some kind of resolution of these differences in order to achieve a given end. A negotiated consensus is necessary for the identification of common goals, prioritizing these goals, and either seeking funding or utilizing available funding for selected community initiatives. The chapter examines efforts by a regional health care system which fostered community initiatives in four diverse sites. We develop a framework which can guide other community initiatives in health care.