Cultural change that would affect all levels of staff in healthcare

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Leaders who can scan the situation and the needs of the individual staff is a necessary skill to identify and bridge possible gaps in work implementation. Aligning the members to the direction of the organization sets the tone of the work for every member.

When each staff at every level of the organization becomes fully aware of the situation, it will then become more natural for the leaders to mobilize the whole team and to delegate appropriate tasks in carrying out individual functions. Lastly, a leader who can inspire his colleagues in the organization will develop a positive work culture for all. Emphasis on these essential roles must be well taught to healthcare managers since every organization or team is unique on its own.

When members of the organization have established a harmonious relationship with its leaders and vice versa, performance and satisfaction at work will be enhanced. Aside from leadership abilities, management skills require emphasis for all persons who are tasked to manage a unit, a section, a department or the administrative body of any healthcare organization.

Managers must be well skilled in developing plans for the organization, organizing staff and attending to their needs at work. They should be able to have control of the organization especially to the implementation of the organization's mandate as a whole. Furthermore, managers who always monitor the progress of work implementation, and those who evaluate the organizational impact of its work on patients, do always have a more accurate view of the status of any healthcare institution.

Managers and leaders can be two different things, but real leaders who strongly influence positive work culture always demonstrate both sets of skills. No employee could ever be more motivated and empowered to do the work when there are elements of trust and supportive supervision of one's performance and welfare at work. Another critical aspect that mediates the positive culture at work is the value of teamwork. Teamwork is the union of individual members to achieve a specific goal.

Every healthcare organization, just like in other business entities, usually conduct activities that will enhance teamwork in the organization. Regularly, team building activities can help with the primary goal of uniting the members and not for rest and recreation. Healthcare managers should be able to come up with strategies that will engage the participation of all members that would soon break barriers to a good relationship at work.

Additionally, teamwork in healthcare settings should not include only healthcare professionals but also all other staff ancillary services, administrative services, and the like that are part of the organization.

Successful teams sustain a positive work culture. Excessive and prolonged stress among healthcare staff leads to burnout. Work shifts among staff are in place, however, cannot still cope up with the demands required by each unit or department especially in government healthcare institutions and large healthcare private institutions as well.

When these burnouts continue to inflict our healthcare teams who provide direct patient care and services, it will later impact negatively on the quality of care that they provide. Individual patients themselves can feel these changes.

Recommendations may include the formulation of strategies that will determine the source of the stress and to apply interventions that will aid in minimizing if not eliminating stress and burnout at healthcare settings.

Another aspect related to the negative culture at work is absenteeism. Aside from the demands from work, the staff sees going to work as a burden when they feel dissatisfied with leadership, experience blame, confusion, and discrimination, as well as incivility among colleagues. As both leaders and managers of a healthcare organization, it is imperative that these concerns receive proper attention other than just focusing on how to increase work output and profit.

Leadership must remember that all healthcare staff, encompassing administrators, doctors, nurses, laboratory staff, pharmacists, technicians, hospital engineers, clerks, and housekeeping service personnel and other parts of the workforce are the essential resource of the healthcare system.

Applying strategies that will work out a solution to sustain and continuously improve the positive work culture should always be a priority. Work culture whether positive or negative significantly impacts the quality of care and delivery of health services to patients. It will build patient trust and gain confidence among staff who provide patient care.

It will allow them to feel that other than the goal of working to cure their diseases, they receive care. When patients see doctors and nurses who are satisfied in doing their work and providing services, it enables them to follow instructions given to them e. When they feel teamwork is active among staff and stable leadership exists from their managers, these patients may be more than willing to allow themselves to seek medical advice and treatment.

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StatPearls [Internet]. Search term. Work Culture Marlon L. Issues of Concern The following factors have been described to be associated work culture of specific health care organization, dichotomized into positive and negative work cultures. Clinical Significance Work culture whether positive or negative significantly impacts the quality of care and delivery of health services to patients.

Review Questions Access free multiple choice questions on this topic. Comment on this article. References 1. Positive and negative behaviours in workplace relationships: a scoping review protocol.

BMJ Open. In hospitals that demonstrated positive changes, coalitions showed distinct patterns in membership diversity, authentic participation eg, clear about expectations and performance of members and capacity for management of the challenges of conflict, waning motivation and improvement fatigue. Despite the potential impact of complex interventions such as LSL, reports in the peer-reviewed literature often lack description of the intervention design process, and omit the detail required to allow for replication of the intervention for further testing, adoption and adaptation of the intervention for broader impact, or synthesis of evidence across studies.

Given the success of the intervention to improve organisational culture in ways associated with patient outcomes, 6 a clear description of the method of intervention adds to the literature on quality improvement and healthcare leadership.

This in-depth description may be useful for healthcare practitioners seeking to promote organisational culture change in their own contexts, researchers seeking to compare the results of the intervention with other leadership development and organisational culture change efforts, and healthcare professionals interested into understanding complex interventions across healthcare settings.

As previously described, the LSL intervention was designed to foster reductions in AMI mortality by supporting the implementation of evidence-based strategies and fostering improvements in domains of organisational culture related to hospital performance. Each of these activities is described in more detail below.

Additional ad hoc experts were invited to present on specific topics such as options for the web-based platform described below. The group met in four 2-hour sessions over a 4-month period to foster dynamic, critical and creative discussion on intervention design, and to ensure all aspects of the intervention were grounded in the latest and most robust scientific evidence and knowledge of the broader context of AMI care delivery such as trends in RSMRs and reimbursement issues.

In each session, a discussion lead would compile the most relevant scientific and practice-based evidence on a given topic, create and share a two to three-page summary with the group and foster conversation and synthesis relevant to LSL intervention design.

We developed a draft plan for the intervention based on our prior experience in leadership development programming 19 as well as relevant empirical literature, proposing three main components described further below : annual convenings of all hospitals, on-site workshops and remote support. We conducted pressure tests with three panels: 1 experts in cardiology attending the American College of Cardiology Scientific Meeting in Washington DC, 2 diverse clinicians and administrators working in cardiovascular care at a large health system in New England, and 3 diverse clinicians and administrators working in cardiovascular care from a large hospital system on Long Island, NY.

We asked participants for their thoughts on a wide range of topics including how best to pitch the study to hospital leaders, feasibility of specific features such as the workshops and comfort with the research aspects such as being observed see box 2. The sessions generated highly useful information about how to tailor the intervention activities to fit the hospital environment.

We made several substantive modifications to the intervention including the plan to have flexible modules and schedule formats to accommodate workflow at each hospital, and strategies for gaining support from intervention participants.

Illustrative feedback from a pressure testing session is presented in box 3. Engagement of stakeholders began very early in the design phase, when we reached out to MCCN to partner in the project. We hypothesised that MCCN member hospitals would be likely to be receptive to the intervention, to the extent that membership in MCCN represented significant prioritisation of and investment in quality improvement. We used random sampling with a purposeful component 20 to select a sample of 10 hospitals from within MCCN.

We approached the first 10 hospitals to determine receptivity; one declined due to reorganisation, and one declined as a competing initiative was underway. We replaced these two hospitals with similar receptive sites. We approached the senior leadership team to obtain explicit support; engagement involved paying close attention to how to align with their interests, using deliberate framing and language, anticipating and responding promptly to any requests and cultivating trusting relationships.

Recruitment of each hospital followed these steps. A succinct overview of the project was forwarded to the hospital as background material for the call online supplementary file 1. Second, we held invitational meetings via telephone that included senior executives as well as, at the discretion of each hospital, lead cardiologists, quality improvement experts and risk management.

In these meetings, the rationale and objectives for the intervention were briefly described, as well as the investment required for participation protecting time of staff time for involvement on the guiding coalition and the research components, commitment to improvement projects, access to hospital leadership.

Because the discussions were driven by the hospitals, the majority of the meetings consisted of the research team responding to questions and concerns from the hospital leadership. In some instances, follow-up materials or additional meetings were requested and provided.

We developed, piloted and revised an FAQ document to support them in their communications. Finally, once hospitals agreed to participate in the study, the CEO provided a signed letter of commitment to participate in the project in order to convey political will and support for the intervention online supplementary file 2.

Of note, we did not require any type of binding contract for participation in the study, and hospitals were advised that they could withdraw from the study at any time. We maintained direct communication with the CEO at least annually throughout the study, providing updates about study progress and accomplishments. All 10 hospitals continued participation throughout the intervention period.

The final design of the intervention included three core 21 components: 1 a series of three annual convenings attended by four key members of each guiding coalition; 2 a series of four 1-day workshops on-site with the full coalition at each hospital; and 3 a web-based platform that allowed hospitals to share experiences and served as a repository for programme resources figure 1.

The intervention period was 24 months in duration; we recognised this was ambitious, as prior literature suggests that measurable changes in organisational culture typically require up to a decade to observe.

Component 1: Annual convenings occurred every summer for a 3-day period in a major city convenient to the participants from the 10 hospitals. Each hospital was asked to send four senior champions for the project representing administrative, physician, nurse and quality improvement leadership.

Travel costs were covered by the project grant, and time for participation was committed by the participating hospitals. The convenings were designed to cultivate a community of peers that could rely on one another for advice and mentoring on culture change and quality improvement. Sessions included educational content, cross-hospital round tables and presentations, and opportunities for networking and healthy competition. In the first convening, hospitals were introduced to the concept of organisational culture and the evidence regarding building effective teams to lead improvements.

Each hospital also prepared to establish a guiding coalition 7 tasked with reducing AMI mortality rates. Hospitals were given guidance around coalition membership and structure, followed by facilitated work sessions to tailor the approach to their unique context.

They were asked to engage approximately 15 key staff involved in care of patients with AMI, including staff from multiple departments ie, cardiology, emergency medicine, pharmacy, quality improvement, cardiac rehabilitation , professions ie, physicians, nurses, technologists, administrators, physician assistants and levels of the organisation from senior executives to front-line staff.

They determined how best to organise themselves, and met as frequently as once per month or once per quarter. Some coalitions developed subgroups focused on specific tasks while others functioned best as a full group. In the second convening, hospitals had been engaged in the intervention for almost 12 months. Hospitals delivered formal presentations to each other, describing progress over the past year, highlighting challenges and successes. In addition, a series of facilitated breakout sessions focused on each of the five evidence-based strategies, 16 summarising the latest empirical evidence on each and allowing participants to share and brainstorm approaches to implementation in their particular settings.

The third and final convening focused on in-depth, practical discussions across institutions. Hospitals again reported on their progress towards reducing AMI mortality and associated lessons learnt. They also packaged and shared the tools and approaches they had created or adapted in efforts to reduce AMI mortality.

At the end of each convening, participants provided evaluative feedback via paper-based survey, including the extent to which they believed the learning objectives had been met, reflections on aspects of the convening that were most valuable and suggestions for improvement. Agendas for each annual convening are included as online supplementary file 3. Component 2: On-site workshops were intended to build leadership capacity within the guiding coalition and to catalyse progress towards improved organisational culture and uptake of the evidence-based strategies.

Each workshop included approximately one full day of content, which could be broken up over multiple days depending on the preferences of the guiding coalition. The core curriculum for the workshops addressed both how to work building an effective organisational culture and what to work on strategic problem solving 23 to address root causes of mortality.

In the first workshop, the primary objectives were to orient the guiding coalition members to the intervention and the evidence base, promote reflection on baseline measures of culture and practice, identify a problem statement and objective on which the group would focus their root cause analysis process and build effective working relationships and processes among coalition members, including representation and role clarity, 24 decision-making 25 and accountability.

Between workshops, the coalitions were tasked with making and measuring progress towards addressing their priority root causes of AMI mortality using a strategic problem-solving approach. Table 1 provides an illustrative example of a hospital project.

At subsequent workshops, members reported out on their progress on strategy implementation and AMI mortality rates, with the goal of addressing implementation challenges and further developing their individual and group leadership capacity.

Facilitators shared feedback on uptake of evidence-based practices, changes in organisational culture based on surveys administered at three time points during the intervention and hospital-specific measures of AMI mortality see online supplementary file 4. Of note, each hospital developed a measure of AMI mortality that was feasible for them to measure in a timely way to drive improvement.

Additional core workshop 2 content included diagnosing and shaping organisational culture, engaging conflict productively, 27 using levels of analysis to diagnose organisational challenges 28 29 and working with power and hierarchy. In workshop 4, coalitions used the AIDED model 17 to both promote uptake and sustainability of their strategic problem-solving project results and to inform potential application of LSL ways of working to other complex challenges in the hospital.

All coalitions covered the full curriculum over the course of the four in-hospital workshops. At the end of each workshop, participants provided evaluative feedback via paper-based survey, including the extent to which they believed the learning objectives had been met, reflections on aspects of the workshops that were most valuable and suggestions for improvement.

The workshop facilitation team included expert facilitators from across the USA, with backgrounds in organisational development, leadership education and quality improvement. Facilitators worked in teams of two, sometimes joined by a third facilitator with a clinical background relevant to the priority challenges of the guiding coalition. To allow for facilitators to become deeply familiar with each hospital, as well as for continuity of relationships with members of the guiding coalitions, a lead facilitator was assigned to each hospital for the duration of the intervention.

The secondary facilitator role was filled based on scheduling availability. Prior to each round of workshops, facilitators came together for a full-day, in-person orientation to the workshop objectives, design, and teaching and learning materials. To promote standardisation of the intervention across sites while allowing for adaptation to local context, facilitators referred to a fidelity checklist for each workshop online supplementary file 5. These checklists enumerated the outputs or milestones that each coalition was expected to reach in the workshop, and served as a record in case sessions were missed due to scheduling challenges or remedial work.

During the delivery of each round of workshops, the full group of facilitators met two to three times via teleconference to debrief on the workshops delivered so far and adjust as needed for upcoming hospital site visits. At the end of each workshop, the lead facilitator prepared a structured written summary of decisions and action items for report back to the guiding coalition and to the full facilitation team as a summary of progress.

Each individual facilitator also completed the fidelity checklist based on their experiences of the workshop. Component 3: Web-based information-sharing platform. The online platform had two primary functions. Second, to support direct communication across hospital teams and between hospitals and the research team for sharing of successes, barriers and project updates. We researched four possible platforms, and selected a password-protected platform called Basecamp based on several priority features: 1 ease of use, 2 integration with email communication, and 3 ability to create project spaces with discrete access.

One space was dedicated for annual convenings, and included a repository for presentations, round-table summaries, agendas and contact lists. This space was open to all members of all 10 guiding coalitions. A second space housed each of the evidence-based practices and included evidence briefs, peer-reviewed papers and other reference materials.

This space was also open to all members of all 10 coalitions. On a weekly basis, a member of the research team sent an update to all LSL participants to share tools and new scientific evidence related to AMI mortality, address questions from participants and promote sharing of experiences across participating hospitals.

For example, some updates included resources related to a specific strategy such as online sites for emergency medical services training and e-learning , while others were curated responses to participant questions that we compiled with input from national experts.

In many cases, questions posed by participants were addressed directly by other participants, promoting peer-to-peer connections and learning. The level of participation in Basecamp was uneven and sporadic; it was the component of the intervention that received the most mixed feedback. These three components of the intervention were considered core 21 to the intervention; however, within them, there were opportunities for adaptation to fit the needs and context of each hospital.

Second, in terms of convenings, the objectives and broad content were core, while specific sessions were tailored to hospital innovations and led by participants. Finally, Basecamp was a core communication platform, while questions and content were participant driven.

We hypothesise that several defining features of the intervention may have contributed to its effectiveness. First, expert facilitation from a well-regarded academic partner allowed for coalitions to address tensions, challenges and various impediments with the benefit of a credible, external, neutral party.

Second, the intervention was not purely focused on the technical implementation of evidence-based strategies in AMI care, but rather focused primarily on the relational aspects of work within the coalitions and the integration of the evidence-based practices into broader strategic problem-solving efforts. Third, the combination of externally facilitated workshops and cross-hospital practical experiences of peers allowed hospitals to integrate the latest science, as well as to develop organic solutions.

Such solutions were highly credible because they were developed by peers, a principle core to positive deviance. Participants emphasised this reflective time was powerful in order to allow teams to invest in new ways of working. This provided adequate time for teams to reflect, learn and adjust, and required significant commitment from the senior leadership of the hospital.

The delivery of the intervention as described was not without challenges. First, as with many complex outcome indicators, hospital access to the publicly reported day RSMR for patients with AMI from CMS lagged by approximately 18 months, limiting usefulness for improvement efforts in real time.

In response, while the overarching LSL study design used day RSMR as a primary outcome, we worked with each coalition to identify a meaningful and feasible measure of AMI mortality in their context to drive problem solving, including in-hospital mortality for many, and risk adjustment for some that had access to proprietary software. Second, several hospitals underwent large-scale transitions ie, changes in ownership or leadership that generated uncertainty among coalition members.

In response, for teams facing major barriers and transitions, we emphasised and revisited workshop curriculum related to engaging key stakeholders, creating and recreating shared commitment to the objective and aligning with organisational events and priorities with attention to identification of concrete action plans to promote progress despite turbulent context. Third, at the start of the intervention, we experienced mixed buy-in from senior clinical staff on the relevance of organisational culture and especially the domain of psychological safety.

Several limitations in the design and implementation of the intervention are worth noting. First, this is the first to our knowledge prospective intervention to attempt to shift organisational culture across diverse sites as a driver of complex patient outcome, we designed a large and resource-intensive model of intervention that we believed had the best chance of showing impact. The cost of replication of this intervention may be prohibitive for many hospital networks.

Second, our mixed methods longitudinal evaluation was not designed to show which components of the intervention were most effective. Finally, selection bias may have occurred as a result of our sampling approach. However, there was a high degree of receptivity across all levels of hospitals from the senior executive offices to front-line caregivers , and all but two hospitals that we approached enrolled and remained active for the entire study period.

Because we relied on a carefully selected network, it is not clear how recruitment and retention would have fared in a broader recruitment effort. In summary, LSL is, to our knowledge, the first successful longitudinal intervention to prospectively change aspects of hospital organisational culture associated with patient outcomes.

This in-depth, practical description of the development and delivery of the intervention may be useful for healthcare practitioners seeking to promote organisational culture change in their own contexts, researchers seeking to compare the results of the intervention with other leadership development and organisational culture change efforts and healthcare professionals committed to understanding complex interventions across healthcare settings.

Twitter: erika. EL and LC conceived and drafted the manuscript. KB participated in the delivery of the intervention. All authors made substantive contributions to the manuscript and reviewed and approved the final submission. Funding: This study was funded by The Medicines Company.

Competing interests: None declared. Provenance and peer review: Not commissioned; externally peer reviewed. BMJ Qual Saf. Published online Jul Author information Article notes Copyright and License information Disclaimer. Corresponding author. No commercial re-use. See rights and permissions. Published by BMJ. Associated Data Supplementary Materials Supplementary data. Supplementary data. Abstract Background Leadership Saves Lives LSL was a prospective, mixed methods intervention to promote positive change in organisational culture across 10 diverse hospitals in the USA and reduce mortality for patients with acute myocardial infarction AMI.

Methods of intervention development Hospitals were selected for participation from the membership of the Mayo Clinic Care Network using random sampling with a purposeful component. Results We provide in-depth descriptions of the design and delivery of the three intervention components three annual meetings of all hospitals, four rounds of in-hospital workshops and an online community , designed to equip a guiding coalition within each site to identify and address root causes of AMI mortality and improve organisational culture.

Conclusions This detailed practical description of the intervention may be useful for healthcare practitioners seeking to promote organisational culture change in their own contexts, researchers seeking to compare the results of the intervention with other leadership development and organisational culture change efforts, and healthcare professionals committed to understanding complex interventions across healthcare settings.

Keywords: healthcare quality improvement, health professions education, implementation science, leadership, teamwork. Background Hospital organisational culture is associated with patient outcomes 1—4 including mortality after acute myocardial infarction AMI ; however, little is known about whether and how culture can be influenced across diverse hospital settings.

Intervention goal and setting As previously described, the LSL intervention was designed to foster reductions in AMI mortality by supporting the implementation of evidence-based strategies and fostering improvements in domains of organisational culture related to hospital performance.

Box 1 Think tank topics. Intervention content Organisational culture change. Team-based leadership: How is it described in the literature? How do we want to conceptualise it for use in the intervention? How do we balance the need for individual coaching or development?

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Addressing the organizational problems plaguing Memorial Hermann Texas Medical Center requires an exhaustive assessment of the current situation and why it is important to introduce change. Memorial Hermann Texas Medical Center has recorded a dramatic reduction in employee engagement within the past three years. This particular issue also caught the attention of the HR manager who called for swift action to remedy the current situation.

It is worth noting that employees within Memorial Hermann Texas Medical Center painstakingly made certain that it functioned at its very best by aligning their goals with the organizational objectives. Their understanding of their role within the organization meant that they were now aware of their purpose and their influence in the decision-making process. Furthermore, employee engagement improved patient service which ultimately resulted in improved outcomes and experiences.

An engaged workforce is an invaluable asset to any organization since it is an integral element to consider when endeavoring to outperform any emerging competition Sharma et al. Employee engagement is also linked to cumulative gains within an organization and breeds innovation. It also results in higher earnings per share EPS which is fundamental to a health facility during periods of economic downturn. An employee engagement survey assesses the level of employee satisfaction at their current position and efforts that will promote high levels of commitment.

The following are proposed steps to improve employee engagement at Memorial Hermann Texas Medical Center;. Liked this paper? Hire one of our writers to write a unique hiqh quality for you! Order Unique Answer Now. You must be logged in to post a comment. Skip to content. Process Improvement at Memorial Hermann Texas Medical Center Process improvement is a practical approach which entails categorizing, evaluating and refining an existing method to achieve optimization within an organization while meeting quality standards.

The Importance of Process Improvement at Memorial Hermann Texas Medical Center Process improvement is integral, especially when seeking to introduce positive organizational change. Read also Appropriate Strategies for Administering the Quality Improvement and Risk-Management Processes within a Healthcare Delivery System Case Evaluation Addressing the organizational problems plaguing Memorial Hermann Texas Medical Center requires an exhaustive assessment of the current situation and why it is important to introduce change.

Proposed Steps to Improve Employee Engagement at MHT Medical Center The following are proposed steps to improve employee engagement at Memorial Hermann Texas Medical Center; Underscoring the Importance of Employee Engagement : Although employee engagement is an integral part of any organization aiming for success, numerous occasions exist where it is not highlighted suitably.

It is, therefore, integral for Memorial Hermann Texas Medical Center to start this process of change by elucidating and re-educating its employees on the crucial nature of employee engagement. They also need to gain an informed understanding of the significance of employee engagement and its impact on output. It also results in employees valuing the organization and averting any scenario that may be damaging to its overall standing.

It is also regarded as one of the most effective measures due to its high level of success Truss et al. While a lot of focus is understandably placed on physicians, the healthcare field and society at large can benefit from healthcare practitioners at all levels who better reflect the patients they serve.

The most effective healthcare professionals are those who maintain a steady commitment to continually learn and progress in their fields. Some impactful first steps toward more cultural diversity in healthcare have been taken, but the work has only just begun. It will take active participation from all involved to ensure the outcome is a diversified, more culturally competent team of caretakers and providers. It has since been updated to reflect information relevant to There are some errors in the form.

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