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ABSTRACT: BACKGROUND:: In response to increasing recognition of the importance of quality health care work environments, the Alberta Cancer Board initiated a province-wide leadership development program to plan for organizational change through a series of stages. In 2004, the Leadership Development Initiative (LDI) was implemented to facilitate organizational learning using a cohort-based leadership intervention based on a communities of practice framework. PURPOSES:: The aim of the Worklife Improvement and Leadership Development study was to examine both the outcomes and experiences of participants of the LDI program to better understand leadership development, implementation, and its impact on worklife quality among 5 cohorts of health care managers and staff at the Alberta Cancer Board. METHODOLOGY/APPROACH:: This study used both structured survey and interview methods, using a pretest-intervention-posttest quasi-experiment without a control group design, to assess the effects of LDI on worklife of leaders and staff. Surveys included the Leadership Practices Inventory and Areas of Worklife Scale, which looked at meaningfulness of work and organizational engagement. Interviews and focus group data provided a more detailed description of the experience of leadership development and perceptions of organizational worklife. FINDINGS:: The study revealed layers of information about the complexity of individual and collective leadership in a cohort-based design, perceptions of leadership initiatives, organizational worklife, and planned organizational change. Our findings suggest that early changes in how leaders reflected on their own skills and practices (Leading Self) were positive; however, growing disengagement as the LDI continued was evident in the focus group data, particularly when change in behavior of others was not perceived to be evident. PRACTICE IMPLICATIONS:: To support the effectiveness and success of a leadership initiative, managers and administrators need to implement strategies designed to help leaders grow and cope with ongoing flux of organizational change and stagnation.
Health care management review 01/2012; · 1.30 Impact Factor
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ABSTRACT: Healthcare leaders need evidence-based information on nursing medication administration technologies to guide the design of improvements to patient safety.
The aim of this study was to evaluate the research evidence on relationships between the use of medication administration technologies and incidence of medication administration incidents and preventable adverse drug events to inform decision-making about existing technology options.
Thirteen electronic databases and seven relevant patient safety websites were searched for the years 1980-2009.
A mixed-method systematic literature review of research on medication administration technologies and associated links to patient safety, operationalized as medication administration incidents and preventable adverse drug events, was conducted.
Twelve studies (two qualitative, five pre- and postinterventions and five correlational) met the inclusion criteria. All were assessed as medium quality with low generalizability of study findings. Only two studies sampled more than one hospital and none of the studies was driven by an explicit theoretical framework. The studies included in this review are generally positive towards medication administration technologies and their potential benefits, yet the level of evidence overall is equivocal. The majority of studies pointed to the development of workarounds by nurses following medication administration technology implementation that could compromise patient safety.
More theoretically driven research is needed to determine which medication administration technologies should be implemented in what ways to most effectively reduce medication administration incidents and preventable adverse drug events and minimize the development of potentially unsafe workarounds. Further evidence is required to accurately assess the actual contribution of medication administration technologies for improving patient safety.
Journal of Advanced Nursing 05/2011; 67(10):2080-95. · 1.48 Impact Factor
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ABSTRACT: Cancer pain is prevalent, yet patients do not receive best care despite widely available evidence. Although national cancer control policies call for education, effectiveness of such programs is unclear and best practices are not well defined.
To examine existing evidence on whether knowledge translation (KT) interventions targeting health care providers, patients, and caregivers improve cancer pain outcomes.
A systematic review and meta-analysis were undertaken to evaluate primary studies that examined effects of KT interventions on providers and patients.
Twenty-six studies met the inclusion criteria. Five studies reported interventions targeting health care providers, four focused on patients or their families, one study examined patients and their significant others, and 16 studies examined patients only. Seven quantitative comparisons measured the statistical effects of interventions. A significant difference favoring the treatment group in least pain intensity (95% confidence interval [CI]: 0.44, 1.42) and in usual pain/average pain (95% CI: 0.13, 0.74) was observed. No other statistical differences were observed. However, most studies were assessed as having high risk of bias and failed to report sufficient information about the intervention dose, quality of educational material, fidelity, and other key factors required to evaluate effectiveness of intervention design.
Trials that used a higher dose of KT intervention (characterized by extensive follow-up, comprehensive educational program, and higher resource allocation) were significantly more likely to have positive results than trials that did not use this approach. Further attention to methodological issues to improve educational interventions and research to clarify factors that lead to better pain control are urgently needed.
Journal of pain and symptom management 03/2011; 41(5):915-39. · 2.42 Impact Factor
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ABSTRACT: To examine the effects of a Leadership Development Initiative (LDI) on the emotional health and well-being among five levels of healthcare managers.
Increasingly dynamic, demanding healthcare environments result in highly stressful work atmospheres.
Using quasi-experimental and mixed methods, we used regression on pre- and post-LDI survey data with 86 managers, and individual/focus group interview data for focused ethnographic analysis.
An increasing trend was observed in self-assessed leadership practices after the LDI with a significant increase in 'inspiring a shared vision' (P<0.01). However, a non-significant decreasing trend in areas of work life and a non-significant increase in cynicism (P=0.14) was observed. Before the LDI, participants' self-assessment of their practice to 'enable others to act' was negatively related to emotional exhaustion (P<0.01). Both before and after the LDI, 'modelling the way' was significantly related to professional efficacy (P<0.01 pre; P<0.05 post). Post-LDI, 'inspiring a shared vision' was negatively (P<0.01) and 'enabling others to act' was positively (P<0.05) related to cynicism.
The LDI provided opportunities for healthcare managers to connect, strengthen leadership and social support networks and manage burnout.
Transformational leadership practices may influence managers' emotional health. Senior administrative support and communicating the structure and vision of developmental initiatives may help to achieve realistic expectations.
Journal of Nursing Management 11/2010; 18(8):1027-39. · 1.18 Impact Factor
