Designing Effective Governance for Quality and Safety in Canadian Healthcare
Governing boards of healthcare organizations in Canada are accountable for the performance of their organization and provide oversight on their decisions. Traditionally, many healthcare boards have focused on finances and community relations and have deferred responsibility for quality of care to the medical or professional staff. This deferral reflects not only recognition of the expertise of clinical leaders on these issues but also the historical separation of responsibilities between the administration and the medical staff, the former being responsible for financial and operational issues, and the latter for quality of care.
[Show abstract] [Hide abstract] ABSTRACT: The importance of leadership to influence nurses’ use of clinical guidelines has been well documented. However, little is known about how to develop and evaluate leadership interventions for guideline use. The purpose of this study was to pilot a leadership intervention designed to influence nurses’ use of guideline recommendations when caring for patients with diabetic foot ulcers in home care nursing. This paper reports on the feasibility of implementing the study protocol, the trial findings related to nursing process outcomes, and leadership behaviors. A mixed methods pilot study was conducted with a post-only cluster randomized controlled trial and descriptive qualitative interviews. Four units were randomized to control or experimental groups. Clinical and management leadership teams participated in a 12-week leadership intervention (workshop, teleconferences). Participants received summarized chart audit data, identified goals for change, and created a team leadership action. Criteria to assess feasibility of the protocol included: design, intervention, measures, and data collection procedures. For the trial, chart audits compared differences in nursing process outcomes. Primary outcome: 8-item nursing assessments score. Secondary outcome: 5-item score of nursing care based on goals for change identified by intervention participants. Qualitative interviews described leadership behaviors that influenced guideline use. Conducting this pilot showed some aspects of the study protocol were feasible, while others require further development. Trial findings observed no significant difference in the primary outcome. A significant increase was observed in the 5-item score chosen by intervention participants (p = 0.02). In the experimental group more relations-oriented leadership behaviors, audit and feedback and reminders were described as leadership strategies. Findings suggest that a leadership intervention has the potential to influence nurses’ use of guideline recommendations, but further work is required to refine the intervention and outcome measures. A taxonomy of leadership behaviors is proposed to inform future research.0Comments 19Citations
- "The concept of monitoring is consistent with components of the PARIHS framework that suggests implementation of research evidence will be most successful when routine evaluation at both individual and organizational levels is part of the context (Kitson et al. 1998; Estabrooks et al. 2009 ). Within this study setting, monitoring of clinical indicators for guideline-based care was not routinely conducted by managers or clinical leaders, despite recommendations as a quality assurance initiative (Baker et al. 2010). Qualitative interview data from this study suggested that the behaviors and priorities of the manager successfully blocked implementation efforts of the diabetic foot ulcer guideline at one control site. "
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- [Show abstract] [Hide abstract] ABSTRACT: Par le passé, les médecins étaient seuls responsables des soins aux patients, tandis que les hôpitaux se contentaient de fournir le matériel et le personnel infirmier. Malgré d'importants changements à la relation entre le médecin et l'hôpital, les tribunaux canadiens maintiennent que les médecins sont des entrepreneurs indépendants. On explore si les propositions en vue de lier la rémunération au rendement, d'accroître la participation des conseils d'administration ou de la direction à l'attribution de privilèges et de partager la responsabilité de la qualité entre les médecins, les conseils d'administration et d'autres intervenants inciteront les tribunaux à transférer aux hôpitaux la responsabilité du fait d'autrui en cas de négligence de la part d'un médecin.0Comments 0Citations