Quality Improvement Leadership in Academic Children’s Hospitals
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Quality Improvement Leadership in Academic Children’s Hospitals
Hospitals meant for children are influenced by a health care environment, which has changed over time. Hospital leaders are obliged to take the necessary measures to foster quality health care and ensure patient safety. The policies and legal stipulations in place are meant to ensure that universal healthcare is achieved. Quality improvement is critical and has been the main agenda calling for hospital management, nursing leadership, and physicians to work together towards this target. Additionally, the business nature of the health care services delivery demand efficiency and productivity at higher levels compared to the traditional setting (Tagge, et al., 2017, p. 1040-1044). Stakeholders and those in hospital managerial positions should incorporate the renewed academia.
It is seamless and faster to implement changes to improve health care services through explicitly involving those in leadership positions. Leaders are essential for handling and managing the approaches intended for quality improvement. They are a source of energy and motivation required to scale up the organization. It has been argued that leaders are born, but, everybody has the capacity to act as a leader driven towards positive changes. Therefore, it is integral to empower leaders to improve healthcare quality and motivate the rest of the team to share in the vision and the strategic plans in place. To spark a revolution towards improving every health sector, leaders should have key qualities and competencies which help them perform their administrative duties. These leadership competencies can be defined as the characteristics which allow for excellent performance in assigned tasks. In other words, they are the set of traits and expertise needed to make someone a successful leader. The competencies needed for promoting excellent leadership stretch beyond academic and technical training blended with experience in the line of work (Ranji, et al., 2006, 72-e1). They include having a well formulated framework for evaluating and fostering personal skills needed to move the masses towards a certain target. Nonetheless, health practitioners can develop these skills as people are not fixed.
Problem Statement
Work personnel in every sector and industry get a positive experience when quality improvement starts with the leadership. Consequently, it is rational to argue that the conditions fundamental to achieving quality improvement by large depend on the management practices in place. Quality improvement can only be integrated in healthcare by changing management and leadership. In most cases, employees are motivated when they are treated with value and respect. The managerial team is tasked with steering the workforce to meet organizational targets and goals. For the health sector, this involves both elective and emergency targets. For example, standards on cancer and diagnostic while having the emergency up to speed with the demands in place (Mohammadi, et al., 2007, pp. 237-243). In most cases, health care workers consider interaction with the management as extremely authoritarian which lacks a patient-centric approach. However, quality improvement is perceived as a way of engaging every member of the organization. It can be argued that healthcare staff prefer non-hierarchical approaches to their tasks.
In this context, the reforms implemented in the healthcare sector for the past two decades have focused on quality improvement. Thus, actions like downsizing healthcare structures and decentralization of services have been taken. The key target is to bring these services closer to the community in question. Local managers are being allowed to exercise a larger extent of decisional powers. The move is expected to enhance equity, efficacy, and involve the community in delivering healthcare services especially for the case of academic children’s hospitals. The environment in the healthcare setting is complex and dynamic which calls for having a management system in place characterized by strong leadership (Tagge, et al., 2017, p. 1040-1044). Effective management and leadership should be inculcated at every level especially for the case of a decentralized health system.
The management is tasked with achieving organization goals and objectives. For the cases of NHS, it entails meeting elective and emergency targets like making referrals for outpatient treatment, meeting diagnostic and emergency department standards. The demand for quality healthcare is fast rising with an approximate of 8% vacancy rates in the health human resource department makes it hard to make time and efforts for quality improvement. Some leaders in the sector are making dedicated efforts for quality improvement as it has returns like enhanced productivity and quality. But this is not evident across the health sector (McAlearney, et al., 2005, p. 11). Strategic commitment is key as it motivates people to put efforts in their second job which requires an improvement on their current performance. The study is centered on the need for change which is being recognized by many stakeholders in academic children hospitals.
Significance of the Study
Clinical leadership is considered a key element in strengthening the health care system and policies in place. But, there is still a lot to be done to achieve widespread effective administration of children academic hospitals. Besides, most of the focus has been on those in high-level position ignoring the role played by middle-level administrators in the provision of healthcare. Prevalently, healthcare delivery is influenced by the context in place. On the contrary, little research has been conducted on the topic leadership in the clinical setting especially for academic children health organizations. Poor leadership and weak managerial systems have been a significant threat against care delivery to the vulnerable targeted population. Nonetheless, leadership in the health institutions meant for strengthening and quality improvement are hardly addressed in a fashion informed by effective leadership theory. As a result, there exists a knowledge gap in comprehending the poor leadership practices which are evident. Leadership has prevalently been conceptualized as a top-down structure whereas it involves various parties such as skilled medical personnel tasked with making vital clinical choices (Ranji, et al., 2006, 72-e1). The decisions made at every level of offering nursing interventions is affected by the collegial frameworks which make up management structures. Therefore, the study intends to bridge the knowledge gap which exists in the need for good leadership to achieve quality improvement goals in the United States pediatric health sector. The lens of distributed leadership will be used to evaluate the faulty leadership practices in academic hospitals meant for children.
Leadership, management, and quality improvement endeavors are different but inter-related. Not everyone in a managerial position is a leader and vice versa. Additionally, stakeholders should understand that not every manager and leader will embrace quality improvement which can be done separately from management and leadership. Nonetheless, a blend between the three entities is a way of achieving the best results. By large, management involves controlling a certain team for the accomplishment of a common goal. It calls for maintaining an administrative grip by giving instructions or orders, making quick interventions for guidance, and being on top of every detail. On the other hand, leadership involves motivating the teams to attain success (Mohammadi, et al., 2007, pp. 237-243). Quality improvement call for deliberately being lenient and loosen the grip which could result in a conflict unless QI has been adopted as the primary principle.
It is logical to argue that QI demands more health workers to act like leaders and few like managers. Most of the strict forms of QI meant to reinvent organizations involve sharing the management roles and responsibilities among skilled frontline teams. Consequently, cohesion can be achieved as the management and juniors work in unison. Incorporating QI in children academic hospitals involves strategic planning, approval from boards and regulators, and funding of training activities for both staff and leaders. Besides, a distributed leadership framework should be enacted to empower frontline teams. Patients also play a key role and their contribution should be considered to tailor improvement activities to meet their needs and values. Senior leaders and managers should be resilient, courageous, and patient in their commitment to adopting new management practices (Tagge, et al., 2017, p. 1040-1044). The benefits offered to employees such as incentives should not only rely on the achievement of hierarchical targets but also on the contribution towards creating a culture which fosters quality improvement over time. This has the potential to be conflict with individual beliefs for the case of senior management.
The rise in transparency and regulations has increased demand for healthcare especially in academic children hospitals which are publicly funded. This increases the pressure on leaders and managers in these institutions. Regulators prevalently call for quick development and implementation of improvement plans which makes it hard to meaningfully involve frontline health workers. Changes like job planning, variations in employment contracts, and taxation policies in the nation has over got health workers considering their jobs as transactional (Ranji, et al., 2006, 72-e1). The targets also take a top-down setting with a grip and control approach to management which makes the staff feel more insignificant and left out. The study is crucial as it covers a fundamental topic and the concepts presented can be incorporated in driving health organizations towards effective distributed leadership.
Background
Health care is characterized by a complex relationship between expected performance, contextual situations, professionals, and the leadership in place. Therefore, the leadership style adopted should be beyond the hierarchical constructs. Health care leadership should be conceptualized at a broader perspective which accounts for seamless interactions among the leaders, junior staff, and situations. Consequently, distributed leadership creates a framework for comprehending how a leader and followers can collaborate to come up with a shared comprehension of their interactions in the course of efficient health care delivery. It involves an arrangement where every member plays a different role towards a common target. A holistic approach to handling hospital activities can be created when followers and leaders perform in a united group context which offers a framework for interaction between events and people. Distributed leadership is used to term the process of coming up with an attributive form of administration for shared meaning and corresponding actions to achieve common targets (Mohammadi, et al., 2007, pp. 237-243). Children are a vulnerable group in the population, which calls for making necessary efforts to safeguard that they receive the best form of healthcare. It requires dedication from every stakeholder in the journey towards shaping the health sector. The findings of this research are aimed at helping fashion the current setting to meet the modern-day requirements of an effective academic pediatric center.
Quality Improvement should be the foundation for managing and leading every health organization. The move will replace the traditional setting where incentives are the benefits and hierarchical structures are filled with authoritative managerial positions. Regulators in the health industry recognize the need for improving hospital trusts. For instance, a strong sense of shared purpose is created when administrators and employees work in collaboration. Every hospital in the National Health Sector should adopt the culture of effectively managing people as it will increase operational and financial performance. In the turn the workplace culture in hospitals would improve alongside patient outcomes (Ranji, et al., 2006, 72-e1).
Framework
The distributed leadership framework will be used as the backbone of the study. The framework is inclusive as leadership is the association between, power and relationships between every party involved and the context at hand. Hence, social processes for example fostering team work by enhancing inter-personal relationships within the workplace are key. Consequently, leadership changes to motivating and influencing others by changing the notion of who is on top of the structure to creating and accomplishing leadership. The proposed leadership techniques can also be termed as the process of driving social influence where coordinated change is constructed by the team for quality improvement. The collective practices embed a scope of relationship between every party involved such as parents, leaders, and followers in the context (McAlearney, et al., 2005, p. 11).
Distributed leadership has two primary dimensions which include: Concertive action and conjoint agency. The former is concerned with assigning leadership among the employees to create a cooperative environment where leadership is shared across departments. Conjoint agency is focused on the form and quality relationships between the leaders and followers. Distributed leadership acts such as personal plans, peer influence, and mutual influence across teams are the drivers of change. Distributed leadership is the overall process for involving groups of health workers who can switch between leadership and followership according to the situation. Both the leaders and followers influence each other to achieve the best results. The mutual relationship has a positive impact on the leadership compared to the traditional authoritarian approaches. The academic children hospital context incorporates organizational elements such as: political, socio-cultural, routines, historical and the structures in place. These are the primary dynamics which apply between productive leadership and followership. The situational context either facilitates or limits the leadership practices. Hence, leadership can be considered as the interplay between contextual factors to develop meaning, unity, productivity, and teamwork to serve patients leading to better practice (Ferris, et al., pp. 143-155).
There has been an increase in the application of distributed leadership as the benchmark for analyzing the efficiency of the administration in academic children hospitals. Those in senior leadership positions have the biggest challenge and responsibility as they have to be flexible. Leadership roles call for being able to delegate duties to create a model that is inclusive, collective, and compassionate. Nonetheless, these leaders are accountable for the teams’ aggregate performance. Implementing quality improvement strategies through distributed leadership might have challenge the traditional beliefs and practices adopted by experienced senior leaders. The safety of healthcare relies on the definitions of standards and abiding by them. However, frontline workers have over time been left out in development, improvement and evaluation of these standards (Malloy, et al., 2010, pp. 1-19). Hospitals have been implementing these standards authoritatively down the chain of command in a non-negotiable manner. The fundamentals of quality improvement relate the health institutions to the nature as the ecosystem should be safeguarded and utilized instead of maximum optimization of its productivity. Human factors like disciplinary teams, trust, and relationships should be fashioned to promote talent management to achieve patient goals. The senior leadership should act as role models as their behavior is imitated across the entire organization. The staff members tend to be keen on the points leaders consider important and address besides what they say.
The secretary of state for health and social care launched the Virginia Mason Institute partnership in 2015 to inculcate lean management which is a strategy adopted by Toyota to minimize waste (Barnard, & Davis, 2017, p. 44). NHS can adopt the business strategy as it has proven useful in reducing the costs involved and maximizes productivity. An evaluation is being done on the trust’s progress which indicates that the thread of quality improvement has been achieved as staff engagement and CQC ratings are improving. It takes time for QI efforts to be realized in terms of financial and operational success. Thus, health practitioners and providers, caregivers, and regulators ought to be patient to witness improved children academic hospitals. Some health institutions have embraced quality enhancement individually without help from international health organizations and have reaped considerable gains. Emphasis have been laid on the need of coaching senior administrators and leaders. For instance, expertise from other business industries are being used by healthcare consultants to help them comprehend the required changes to foster lean productivity. The case of Toyota forms an excellent model for health organizations.
Research Questions
The study targets to answer various questions fundamental to the topic. This helped form the backbone to the study thus giving it a sense of direction. The concise list below holds the questions pertaining the research.
- What are the leadership strategies in place to promote effective health care delivery?
- How does leadership influence the achievement of quality improvement objectives?
- What is the impact of poor leadership on academic children hospitals?
- What are the main factors contributing to weak leadership systems in the health sector?
Research Hypotheses
The research will test the following hypotheses.
H1: The leadership strategies in place have an impact on the quality of healthcare offered.
H2: The business management aspect in academic children hospitals have an impact on the quality of services offered.
H3: A distributed approach to hospital leadership is integral in not only attaining effective administration but also promote service delivery.
H4: The traditional approach to hospital leadership contributes to a weak administration.
Secondary Data Types and Sources of Information
Agency for Healthcare Research and Quality – AHRQ provides research and data for a variety of healthcare topics such as Healthcare Cost and Utilization, Medical Expenditure Panel Survey, and U.S. Health Information Knowledgebase. National Information Center on Health Services Research and Health Care Technology -This group of sites provides links to a wide variety of data tools and statistics, including research datasets, data repositories, health statistics, survey instruments, and more. The National Library of Medicine sponsors it. Directory of Health and Human Services Data Resources- This site provides brief information. It links to almost all datasets from the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), Food and Drug Administration (FDA), and other agencies of the U.S. Department of Health and Human Services. These databases are a good source of information related to the leadership and management of children academic hospitals.
References
Barnard, J. A., & Davis, J. T. (2017). Quality Improvement Leadership in Academic Children’s Hospitals. Pediatric Quality & Safety, 2(4).
Ferris, T. G., Dougherty, D., Blumenthal, D., & Perrin, J. M. (2001). A report card on quality improvement for children’s health care. Pediatrics, 107(1), 143-155.
Malloy, E., Butt, S., & Sorter, M. (2010). Physician leadership and quality improvement in the acute child and adolescent psychiatric care setting. Child and Adolescent Psychiatric Clinics, 19(1), 1-19.
McAlearney, A. S., Fisher, D., Heiser, K., Robbins, D., & Kelleher, K. (2005). Developing effective physician leaders: changing cultures and transforming organizations. Hospital topics, 83(2), 11.
Mohammadi, S. M., Mohammadi, S. F., Hedges, J. R., Zohrabi, M., & Ameli, O. (2007). Introduction of a quality improvement program in a children’s hospital in Tehran: design, implementation, evaluation and lessons learned. International Journal for Quality in Health Care, 19(4), 237-243.
Ranji, S. R., Rosenman, D. J., Amin, A. N., & Kripalani, S. (2006). Hospital medicine fellowships: works in progress. The American Journal of Medicine, 119(1), 72-e1.
Tagge, E. P., Thirumoorthi, A. S., Lenart, J., Garberoglio, C., & Mitchell, K. W. (2017). Improving operating room efficiency in academic children’s hospital using Lean Six Sigma methodology. Journal of pediatric surgery, 52(6), 1040-1044.