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1 – 10 of over 24000Medical errors have become the third leading cause of death in the USA. Two million deaths from preventable medical errors will occur annually worldwide each year. The purpose of…
Abstract
Purpose
Medical errors have become the third leading cause of death in the USA. Two million deaths from preventable medical errors will occur annually worldwide each year. The purpose of this paper is to find themes from the literature relating leadership styles – leadership approaches in practice – with success in reducing medical errors and patient safety.
Design/methodology/approach
This review analyzed primary and secondary sources based on a search for the terms leadership OR leadership style AND medical errors OR patient safety using five high-quality health-care-specific databases: Healthcare Administration Database from Proquest, LLC, Emerald Insight from Emerald Publishing Limited, ScienceDirect from Elsevier, Ovid from Ovid Technologies and MEDLINE with Full-Text from Elton B. Stevens Company. After narrowing, the review considered 21 sources that met the criteria.
Findings
The review found three leadership approaches and four leadership actions connected to successfully reducing medical errors and improving patient safety. Transformational, authentic and shared leadership produced successful outcomes. The review also found four leadership actions – regular checks on the front line and promoting teamwork, psychological safety and open communication – associated with successful outcomes. The review concluded that leadership appeared to be the preeminent factor in reducing medical errors and improving patient safety. It also found that positive leadership approaches, regardless of the safety intervention, led to improving results and outcomes.
Research limitations/implications
This review was limited in three ways. First, the review only included sources from the USA, the UK, Canada and Australia. While those countries have similar public-private health-care systems and similar socioeconomics, the problem of medical errors is global (Rodziewicz and Hipskind, 2019). Other leadership approaches or actions may have correlated to reducing medical errors by broadening the geographic selection parameters. Future research could remove geographic restrictions for selection. Second, the author has a bias toward leadership as distinctive from management. There may be additional insights gleaned from expanding the search terms to include management concepts. Third, the author is a management consultant to organizations seeking to improve health-care safety. The author’s bias against limited action as opposed to strategic leadership interventions is profound and significant. This bias may generalize the problem more than necessary.
Practical implications
There are three direct practical implications from this review. The limitations of this review bound these implications. First, organizations might assess strategic and operational leaders to determine their competencies for positive leadership. Second, organizations just beginning to frame or reframe a safety strategy can perhaps combine safety and leadership interventions for better outcomes. Third, organizations could screen applicants to assess team membership and team leadership orientation and competencies.
Originality/value
This review is valuable to practitioners who are interested in conceptual relationships between leadership approaches, safety culture and reducing medical errors. The originality of this research is limited to that of any literature review. It summarizes the main themes in the selected literature. The review provides a basis for future considerations centered on dual organizational interventions for leadership and safety.
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Saligrama Agnihothri and Raghav Agnihothri
The purpose of this paper is to develop a framework for the application of evidence-based management to chronic disease healthcare.
Abstract
Purpose
The purpose of this paper is to develop a framework for the application of evidence-based management to chronic disease healthcare.
Design/methodology/approach
Chronic healthcare is specially characterized by recursive patient-physician interactions in which evidence-based medicine (EBM) is applied. However, implementing evidence-based solutions to improve healthcare quality requires managers to effect changes in many different areas: organizational structure, procedures, technology and in physician/provider behaviors. To complicate matters further, they must achieve these changes using the tools of resource allocation or incentives. The literature contains many systematic reviews evaluating the question of physician and patient behavior under various types and structures of incentives. Similarly, systematic reviews have also been done regarding specific changes to the healthcare process and their effectiveness in improving patient outcomes. Yet, these reviews uniformly lament a lack of appropriate data from well-organized studies on the question of “Why?” solutions may work in one instance while not in another. The authors present a new theoretical framework that aids in answering this question.
Findings
This paper presents a new theoretical framework (Influence Model of Chronic Healthcare) that identifies: the critical areas in which managers can effect changes that improve patient outcomes; the influence these areas can have on each other, as well as on patient and physician behavior; and the mechanisms by which these influences are exerted. For each, the authors draw upon, and present the evidence in the literature. Ultimately, the authors recognize that this is a complex question that has not yet been fully researched. The contribution of this model is twofold: first, the authors hope to focus future research efforts, and second, provide a useful heuristic to managers who must make decisions with only the lesser-quality evidence the literature contains today.
Originality/value
This model can be used by managers as a heuristic either ex ante or ex post to determine the effectiveness of their decisions and strategies in improving healthcare quality. In addition, it can be used to analyze why actions or decisions taken achieved a given outcome, and how best to proceed to effect further improvements on patient outcomes. Last, the model serves to focus attention on specific questions for further research.
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Patrik Nordin, Anna-Aurora Kork and Inka Koskela
The purpose of this paper is to shed light on the potential of organizational learning for developing effectiveness of care. Value-based healthcare measurement recognizes patient…
Abstract
Purpose
The purpose of this paper is to shed light on the potential of organizational learning for developing effectiveness of care. Value-based healthcare measurement recognizes patient value as a driver for improving health outcomes at the societal and individual levels. By using the action learning method, this paper examines the phases of organizational learning in a private healthcare organization that has developed a novel Big Data screening tool for the treatment of patients with type 2 diabetes mellitus (DM2).
Design/methodology/approach
Relying on triple-loop learning as a conceptual framework and by applying the action learning method to case study design, this paper illustrates the phases of organizational learning and efforts to utilize value-based measurement in healthcare.
Findings
The case organization was able to identify patients at risk and to improve their care balance. Although the results for the measurement of patient outcomes led to questioning of previous care processes and practices in the organization, increasing value for all stakeholders by incorporating social needs to business opportunities remains under process.
Originality/value
With the focus on organizational learning and organizational value creation processes, this paper demonstrates incorporation of measuring patient outcomes in re-structuring care processes, enhancing organizational performance and improving effectiveness as well as quality of care.
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Soo-Hoon Lee, Thomas W. Lee and Phillip H. Phan
Workplace voice is well-established and encompasses behaviors such as prosocial voice, informal complaints, grievance filing, and whistleblowing, and it focuses on interactions…
Abstract
Workplace voice is well-established and encompasses behaviors such as prosocial voice, informal complaints, grievance filing, and whistleblowing, and it focuses on interactions between the employee and supervisor or the employee and the organizational collective. In contrast, our chapter focuses on employee prosocial advocacy voice (PAV), which the authors define as prosocial voice behaviors aimed at preventing harm or promoting constructive changes by advocating on behalf of others. In the context of a healthcare organization, low quality and unsafe patient care are salient and objectionable states in which voice can motivate actions on behalf of the patient to improve information exchanges, governance, and outreach activities for safer outcomes. The authors draw from the theory and research on responsibility to intersect with theories on information processing, accountability, and stakeholders that operate through voice between the employee-patient, employee-coworker, and employee-profession, respectively, to propose a model of PAV in patient-centered healthcare. The authors complete the model by suggesting intervening influences and barriers to PAV that may affect patient-centered outcomes.
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Stanley J. Smits, Dawn Bowden, Judith A. Falconer and Dale C. Strasser
– This paper aims to present a two-decade effort to improve team functioning and patient outcomes in inpatient stroke rehabilitation settings.
Abstract
Purpose
This paper aims to present a two-decade effort to improve team functioning and patient outcomes in inpatient stroke rehabilitation settings.
Design/methodology/approach
The principal improvement effort was conducted over a nine-year period in 50 Veterans Administration Hospitals in the USA. A comprehensive team-based model was developed and tested in a series of empirical studies. A leadership development intervention was used to improve team functioning, and a follow-up cluster-randomized trial documented patient outcome improvements associated with the leadership training.
Findings
Iterative team and leadership improvements are presented in summary form, and a set of practice-proven development observations are derived from the results. Details are also provided on the leadership training intervention that improved teamwork processes and resulted in improvements in patient outcomes that could be linked to the intervention itself.
Research limitations/implications
The practice-proven development observations are connected to leadership development theory and applied in the form of suggestions to improve leadership development and teamwork in a broad array of medical treatment settings.
Practical implications
This paper includes suggestions for leadership improvement in medical treatment settings using interdisciplinary teams to meet the customized needs of the patient populations they serve.
Originality/value
The success of the team effectiveness model and the team-functioning domains provides a framework and best practice for other health care organizations seeking to improve teamwork effectiveness.
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Isaac S. Obeng and Ikedinachi K. Ogamba
This study identifies and synthesizes existing literature on the integration of diabetic and dental services and explores a service integration model for optimising diabetic…
Abstract
Purpose
This study identifies and synthesizes existing literature on the integration of diabetic and dental services and explores a service integration model for optimising diabetic patient health outcomes and improving healthcare systems in low and middle-income countries.
Design/methodology/approach
Peer-reviewed literature that analysed the integration of health services regarding dental and medical services were reviewed. The articles were identified using the Academic Search Complete, Business Source Complete, CINAHL Complete, Google Scholar and MEDLINE databases and screened using the PRISMA guidelines.
Findings
A total of 40 full-text articles were examined for eligibility out of which 26 were selected for analysis. Diabetes was shown to contribute significantly to the global disease burden and this is also reflected in most low and middle-income countries. It is found that the integration of medical and dental services could help alleviate this burden. Hence, locally adapted Rainbow-Modified Integrated Care model is proposed to fill this integration gap.
Originality
The integration of dental and medical services has been proven to be useful in improving diabetic patient outcomes. Hence, the need to facilitate cross-professional collaboration between dentists and physicians cannot be overemphasised and this can be extended and locally adapted by different health systems across the world.
Practice Implications
The integration of dental and diabetic services using models such as the Rainbow Model of Integrated Care is recommended to optimise health outcomes of diabetic patients and enhancing service delivery, especially in resource-poor healthcare systems.
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Public reports of provider-specific patient outcomes aim to help consumers select suppliers of medical services. Yet, in an environment of rapidly changing medical technology and…
Abstract
Public reports of provider-specific patient outcomes aim to help consumers select suppliers of medical services. Yet, in an environment of rapidly changing medical technology and increasingly heterogeneous patient populations, and because they necessarily reflect the experience of other patients who received care in the past, such reports may be of limited value in helping patients forecast the probability of an adverse outcome for each provider they are considering. I propose that providers underwrite insurance policies that promptly pay patients a predetermined sum after an adverse outcome. Patients can use such outcome warranties to infer quality differences among providers easily and reliably. In addition, outcome warranties efficiently reward both providers and patients for reducing the risk of adverse outcomes and thereby improve the safety and affordability of health care. As such, outcome warranties help advance four important goals of health care management: reduction of financial risk, recruitment and retention of physicians, remediation of adverse outcomes, and raising the provider's reputation.
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Bita A. Kash, Kayla M. Cline, Stephen Timmons, Rahil Roopani and Thomas R. Miller
Health care institutions in many Western countries have developed preoperative testing and assessment guidelines to improve surgical outcomes and reduce cost of surgical care. The…
Abstract
Purpose
Health care institutions in many Western countries have developed preoperative testing and assessment guidelines to improve surgical outcomes and reduce cost of surgical care. The aims of this chapter are to (1) summarize the literature on the effect of preoperative testing on clinical outcomes, efficiency, and cost; and (2) to compare preoperative testing guidelines developed in the United States, the United Kingdom, and Canada.
Design/methodology/approach
We reviewed the literature from 1975 to 2014 for studies and preoperative testing guidelines.
Findings
We identified 29 empirical studies and 8 country-specific guidelines for review. Most studies indicate that preoperative testing is overused and comes at a high cost. Guidelines are tied to payment only in one country studied. This is the most recent review of the literature on preoperative testing and assessment with a focus on quality of care, efficiency, and cost outcomes. In addition, this chapter provides an international comparison of preoperative guidelines.
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Marc Verschueren, Johan Kips and Martin Euwema
The purpose of the study was to explore in literature what different leadership styles and behaviors of head nurses have a positive influence on the outcomes of patient safety or…
Abstract
Purpose
The purpose of the study was to explore in literature what different leadership styles and behaviors of head nurses have a positive influence on the outcomes of patient safety or quality of care.
Design/methodology/approach
We reviewed the literature from January 2000 until September 2011. We searched Pubmed, Embase, Cinahl, Psychlit, and Econlit.
Findings
We found 10 studies addressing the relationship between head nurse leadership and safety and quality. A wide array of styles and practices were associated with different patient outcomes. Transformational leadership was the most used concept in the studies. A trend can be observed over these studies suggesting that a trustful relationship between the head nurse and subordinates is an important driving force for the achievement of positive patient outcomes. Furthermore, the effects of these trustful relationships seem to be amplified by supporting mechanisms, often objective conditions like clinical pathways and, especially, staffing level.
Value/originality
This study offers an up-to-date review of the limited number of studies on the relationship between nurse leadership and patient outcomes. Although mostly transformational leadership was found to be responsible for positive associations with outcomes, also contingent reward had positive influence on outcomes. We formulated some comments on the predominance of the transformational leadership concept and suggested the application of complexity theory and political leadership for the current context of care. We formulated some implications for practice and further research, mainly the need for more systematic empirical and cross cultural studies and the urgent need for the development of a validated set of nurse-sensitive patient outcome indicators.
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Gangaraju Vanteddu and Charles D. McAllister
The purpose of this paper is to propose an integrated framework to simultaneously identify and improve healthcare processes that are important from the healthcare provider's and…
Abstract
Purpose
The purpose of this paper is to propose an integrated framework to simultaneously identify and improve healthcare processes that are important from the healthcare provider's and patient's perspectives.
Design/methodology/approach
A modified quality function deployment (QFD) chart is introduced to the field of healthcare quality assurance. A healthcare service example is used to demonstrate the utility of the proposed chart.
Findings
The proposed framework is versatile and can be used in a wide variety of healthcare quality improvement contexts, wherein, two different perspectives are needed to be considered for identifying and improving critical healthcare processes.
Practical implications
The modified QFD chart used in conjunction with the stacked Pareto chart will facilitate the identification of key performance metrics from the patient's and the hospital's perspectives. Subsequently, the chief contributory factors at different levels are identified in a very efficient manner.
Originality/value
Healthcare quality improvement professionals will be able to use the proposed modified QFD chart in association with stacked Pareto chart for effective quality assurance.
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