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Aim: To investigate health care improvement team coaching activities from the perspectives of coachees, coaches and unit leaders in two national improvement collaboratives., Background: Despite numerous methods to improve health care, inconsistencies in success have been attributed to factors that include unengaged staff, absence of supportive improvement resources and organisational inertia., Methods: Mixed methods sequential exploratory study design, including quantitative and qualitative data from interprofessional improvement teams who received team coaching. The coachees (n = 382), coaches (n = 9) and leaders (n = 30) completed three different data collection tools identifying coaching actions perceived to support improvement activities., Results: Coachees, coaches and unit leaders in both collaboratives reported generally positive perceptions about team coaching. Four categories of coaching actions were perceived to support improvement work: context, relationships, helping and technical support., Conclusions: All participants agreed that regardless of who the coach is, emphasis should include the four categories of team coaching actions., Implications for Nursing Management: Leaders should reflect on their efforts to support improvement teams and consider the four categories of team coaching actions. A structured team coaching model that offers needed encouragement to keep the team energized, seems to support health care improvement., (© 2013 John Wiley & Sons Ltd.)

Background: Leading and leadership by formal and informal leaders goes on at all levels of microsystems--the essential building blocks of all health systems--and between them. It goes on between microsystems and other levels of the systems in health care. This series on high-performing clinical microsystems is based on interviews and site visits to 20 clinical microsystems in the United States. This fifth article in the series describes how leaders contribute to the performance of those microsystems., Analysis of Interviews: Interviews of leaders and staff members offer a rich understanding of the three core processes of leading. Building knowledge requires many behaviors of leaders and has many manifestations as leaders seek to build knowledge about the structure, processes, and patterns of work in their clinical microsystems. Taking action covers many different behaviors--making things happen, executing plans, making good on intentions. It focuses action on the way people are hired and developed and involves the way the work gets done. Reviewing and reflecting provides insight as to how the microsystem's patterns, processes, and structure enable the desired work to get done; what success looks like; and what will be next after that "success" is created., Conclusion: The focus on the processes of leading is intended to enable more people to develop into leaders and more people to share the roles of leading.

Background: Health systems worldwide are experiencing increasing cost-cutting pressures with more intense competition and rising customer requirements. We aimed to find out and compare the characteristics and successes of two different sustainable business cases in healthcare delivery from an innovation-driven, organizational perspective. Subject and methods: The data for the two cases were collected through structured literature research as well as personal interviews with the founders of the two healthcare business models. Data were analyzed using the business model canvas as a structured framework, as well as by cross-case analysis. Results: The two business models operate successfully, but pursue different approaches to healthcare innovation. We were able to show that one model pursues a very complex, network-based approach that is focused on one specific rural region, while the structure of the other is characterized by a scalable concept. In addition, we observed that the founders had a decisive influence on the development and success of the healthcare business models. Conclusion: Our study highlights the multitude of complex relationships required to build and establish innovative and successful business models for providing high-quality and cost-effective services in two of the world's largest healthcare systems. Moreover, it could be shown that the business model canvas offers a suitable methodological framework to compare and analyze in a structured manner the extent to which innovative care approaches also require an economically successful and sustainable business model. Results give a holistic, structured description of specific organizational features and environments, whch can then serve decision-makers in health and health economics as lessons learned and aid them in decision-making. [ABSTRACT FROM AUTHOR]

Background: There is a distinct difference between what we know and what we do in healthcare: a gap that is impairing the quality of the care and increasing the costs. Quality improvement efforts have been made worldwide by learning collaboratives, based on recognized continual improvement theory with limited scientific evidence. The present study of 132 quality improvement projects in Norway explores the conditions for improvement from the perspectives of the frontline healthcare professionals, and evaluates the effectiveness of the continual improvement method.Methods: An instrument with 25 questions was developed on prior focus group interviews with improvement project members who identified features that may promote or inhibit improvement. The questionnaire was sent to 189 improvement projects initiated by the Norwegian Medical Association, and responded by 70% (132) of the improvement teams. A sub study of their final reports by a validated instrument, made us able to identify the successful projects and compare their assessments with the assessments of the other projects. A factor analysis with Varimax rotation of the 25 questions identified five domains. A multivariate regression analysis was used to evaluate the association with successful quality improvements.Results: Two of the five domains were associated with success: Measurement and Guidance (p = 0.011), and Professional environment (p = 0.015). The organizational leadership domain was not associated with successful quality improvements (p = 0.26).Conclusion: Our findings suggest that quality improvement projects with good guidance and focus on measurement for improvement have increased likelihood of success. The variables in these two domains are aligned with improvement theory and confirm the effectiveness of the continual improvement method provided by the learning collaborative. High performing professional environments successfully engaged in patient-centered quality improvement if they had access to: (a) knowledge of best practice provided by professional subject matter experts, (b) knowledge of current practice provided by simple measurement methods, assisted by (c) improvement knowledge experts who provided useful guidance on measurement, and made the team able to organize the improvement efforts well in spite of the difficult resource situation (time and personnel). Our findings may be used by healthcare organizations to develop effective infrastructure to support improvement and to create the conditions for making quality and safety improvement a part of everyone's job. [ABSTRACT FROM AUTHOR]

Introduction The objectives of the Breakthrough Series Collaborative are to close the gap between what we know and what we do, and to contribute to continuous quality improvement (CQI) of healthcare through collaborative learning. The improvement efforts are guided by a systematic approach, combining professional and improvement knowledge. Objectives To explore what the improvement teams have learnt from participating in the collaborative and from dealing with promoting and inhibiting factors encountered. Method Qualitative interviews with 19 team members were conducted in four focus groups, using the Critical Incident Technique. A critical incident is one that makes significant contributions, either positively or negatively, to an activity. Results The elements of a culture of improvement are revealed by the critical incidents, and reflect the eight domains of knowledge, as a product of collaborative learning. The improvement knowledge and skills of individuals are important elements, but not enough to achieve sustainable changes. 90% of the material reflects the need for a system of CQI to solve the problems that organisations experience in trying to make lasting improvements. Conclusion A pattern of three success factors for CQI emerges: (1) continuous and reliable information, including measurement, about best and current practice; (2) engagement of everybody in all phases of the improvement work: the patient and family, the leadership, the professional environment and the staff; and (3) an infrastructure based on improvement knowledge, with multidisciplinary teams, available coaching, learning systems and sustainability systems. [ABSTRACT FROM PUBLISHER]

Purpose Our purpose is to describe how coaches who are clinical faculty help in the developmental process of residents to become better physicians and to lead the improvement of quality and safety in the Dartmouth-Hitchcock Leadership Preventive Medicine Residency Program (DHLPMR). Methods Using a semi-structured interview guide, eight coaches were interviewed and two focus groups were held with a total of nine residents. The qualitative data were content analysed to understand how both the coaches and residents perceive coaches' work and their role. Results The interviews with the coaches suggest that they take great pride in their work: they find it to be challenging and meaningful. The coaches use various skills and techniques - asking questions, listening deeply, observing the resident in action, offering encouragement and challenging the resident to think or act differently. The residents also perceive the work of the coach to help them progress on their learning journey. The role of the coach tends to go beyond coaching residents relative to improving an aspect of health care performance to creating the conditions for transformation and growth for the residents and the coaches. Conclusion The DHLPMR program is a unique residency program that has the intention to foster the development of future physician leaders who have the ability to both practise medicine and improve the clinical practices in which they work. The coaches are a vital ingredient in this program as they convey the residents/fellows on their leadership learning journey. [ABSTRACT FROM AUTHOR]

This cross-site comparison of the early experience of four provider organizations participating in the Brookings-Dartmouth Accountable Care Organization Collaborative identifies factors that sites perceived as enablers of successful ACO formation and performance. The four pilots varied in size, with between 7,000 and 50,000 attributed patients and 90 to 2,700 participating physicians. The sites had varying degrees of experience with performance-based payments; however, all formed collaborative new relationships with payers and created shared savings agreements linked to performance on quality measures. Each organization devoted major efforts to physician engagement. Policy makers now need to consider how to support and provide incentives for the successful formation of multipayer ACOs, and how to align private- sector and CMS performance measures. Linking providers to learning networks where payers and providers can address common technical issues could help. These sites' transitions to the new payment model constitutes an ongoing journey that will require continual adaptation in the structure of contracts and organizational attributes. [ABSTRACT FROM AUTHOR]