Towards collective leadership in health care organisations: a practical approach to engaging and empowering frontline clinical staff in quality improvement.
Title: Towards collective leadership in health care organisations: a practical approach to engaging and empowering frontline clinical staff in quality improvement.
Authors: Philip Cohen, Annie Curtin, Vitas Anderson and Donna R. Cohen
The second edition of the National Safety and Quality Health Service (NSQHS) Standards (released by the Australian Commission on Safety and Quality in Health Care in November 2017) emphasises the important role that leaders play in influencing the quality of care within health care organisations. Leaders need to support their workforce, shape the culture, set direction, and monitor progress in safety and quality performance. Engaging managers and clinicians in governance and quality improvement activities is also identified as a foundation for aligning clinical and managerial priorities.
However, recent research from the United Kingdom suggests there may be only a tenuous link between “traditional leader-centric development programmes” and organisational outcomes (1). As a result, the concept of collective leadership has been developed that involves a broader practice of leadership by clinicians and other frontline staff. Such collective leadership is best achieved by a developmental focus on the collective, rather than on individual leaders alone.
Our research project involving frontline clinical teams at a Melbourne hospital offers some insights into the practicalities of achieving collective leadership. The teams are using an innovative approach for engaging frontline staff in quality improvement activities, termed map-enabled experiential review (MEER; see reference 2). This involves a novel technique for assessing current routine practice relevant to achieving the objectives of the NSQHS standards, using the assessment outcomes as the basis for identifying appropriate improvement actions and then implementing the planned activities. In addition to measuring whether demonstrable improvements in practice have been achieved, the project also seeks to determine whether an initiative that aims to develop collective leadership produces a sustainable impact on the attitudes and behaviours of frontline staff – and managers – with respect to quality improvement.
This paper will present initial findings from the research.
(1) West, M. et al. (2015) Leadership and Leadership Development in Health Care, Faculty of Medical Leadership and Management, London.
(2) Cohen, D.R. et al. (2018) Map-enabled experiential review: A novel approach to engaging healthcare staff in quality improvement. Manuscript submitted.
ACHSM / ACHS 2017 Congress
Making quality everyone’s business: A new approach to engaging staff in quality improvement
Title: Making quality everyone’s business: A new approach to engaging staff in quality improvement
Authors: Donna R. Cohen, Vitas Anderson, Annie Curtin and Philip J. Cohen
Indicator monitoring and accreditation regimes form the backbone of quality and safety in the health care sector and have contributed significantly to the quality movement in Australian hospitals. However, the goal of achieving zero avoidable patient harm remains elusive. Recent reviews – such as the 2016 Duckett Review of hospital safety and quality assurance in Victoria – have noted that quality and safety have become very compliance-focussed, with issues often going undetected until they become major problems. Of particular concern is a general lack of engagement of clinicians in quality improvement activities.
We have developed a novel approach to team-based self-assessment – termed map-enabled experiential review (MEER) – that has significant potential to address these persistent problems of undetected issues and disengaged clinicians.
The approach uses interactive, graphical tools that guide structured conversations amongst team members about their routine practices. The tools are engaging and educative and help to develop the collective competence of teams and encourage reflective practice by individuals. The tools link issue diagnosis to action planning, providing a complete platform for plan-do-review quality improvement cycles in the context of everyday practice.
The MEER concept originated in an organisational self-assessment tool commissioned in 2012 by the Victorian Department of Health and Human Services to assist hospitals and health services with quality improvement in their clinical learning environments. That tool is now used in all Victorian public health and registered community health services. The concept has now been extended to include a range of quality applications, including the NSQHS Standards and Clinical Care Standards.
Early trials of MEER tools in a hospital setting have been positive and suggest these tools complement current quality initiatives and offer a fresh approach to addressing persistent quality and safety issues in the health sector.
Australasian Evaluation Society International Conference, aes17
Map-enabled experiential review: Enhancing the relevance of evaluation at the program delivery coalface.
Title: Map-enabled experiential review: Enhancing the relevance of evaluation at the program delivery coalface
Authors: Donna R. Cohen, Vitas Anderson and Philip J. Cohen
Indicators form the centrepiece of most monitoring and evaluation frameworks and are a valuable evaluation tool. However, many important aspects of program delivery do not lend themselves to indicator measurement. Indeed, individuals involved in program delivery often find it difficult to relate indicators to their day-to-day activities and may struggle to engage with evaluation activities and outcomes as a consequence. This is a major impediment to achieving improved program implementation, which is one of the primary objectives of evaluation.
Map-enabled experiential review (MEER) is an innovative approach to data collection in the context of program evaluation that complements indicator measurement and actively engages individuals involved in program delivery. The approach uses interactive graphical tools to collect data about program activities. The data reflect the experiences of stakeholders involved in program delivery and therefore provide an additional evidence-base for interpreting indicator data.
In 2016–17, the MEER approach was included in the first round of evaluation of the Rural Community Intern Training (RCIT) Program run by the Victorian Department of Health and Human Services. The MEER tool was employed at each of the five RCIT program sites and engaged stakeholders in a series of structured conversations. The graphical nature of the tool revealed the relationship between various streams of activity within the program, which was educative for stakeholders and helpful in identifying root causes of issues. As similar conversations occurred at each of the five program sites, it was possible to distinguish ‘local’ issues from ‘global’ issues, which informed recommendations to the department following the evaluation.
This project demonstrates the value of the map-enabled experiential review approach in building evaluation capital. The approach is engaging for participants, provides structure to qualitative evaluation processes, captures data not accessible through indicator monitoring and assists stakeholders to develop ownership of the evaluation outcomes.
Australasian Evaluation Society International Conference, aes16
BPCLEtool: Demonstrating the power of map-enabled experiential review for statewide quality improvement projects
Title: BPCLEtool: Demonstrating the power of map-enabled experiential review for statewide quality improvement projects
Authors: Donna R. Cohen, Vitas Anderson, Philip J. Cohen, Laura Conroy and Kade Dillon
Map-enabled experiential review is a novel approach to organisational self-assessment that expands the utility of program logic/theory of change models as evaluation tools. Tools based on the map-enabled experiential review concept have outstanding potential to both facilitate and evaluate changing landscapes.
In 2012, the map-enabled experiential review concept was used to develop a tool to assist hospitals in self-assessing against Victoria’s Best Practice Clinical Learning Environments (BPCLE) Framework. Following favourable reviews for the prototype tool in a pilot project, an online version – BPCLEtool – was developed. The Victorian Department of Health & Human Services (DHHS) wished to use BPCLEtool to facilitate statewide implementation of the BPCLE Framework. Two key aims for BPCLEtool were:
- The tool should enable health services to work through the evaluation tasks autonomously.
- The tool should facilitate data collection by DHHS about the quality of Victorian clinical learning environments.
All 88 Victorian public health services have been implementing the BPCLE Framework using BPCLEtool since early 2014 and completed a second round of indicator reporting in February 2016.
Stakeholder feedback revealed a positive experience for organisations that used BPCLEtool. Staff were engaged by the map-enabled self-assessment process, which facilitated internal evaluation that was informative from a quality improvement perspective, educative for the participants and collegial. From the DHHS perspective, BPCLEtool ensured consistent and structured statewide implementation of the BPCLE Framework and permitted assessment of the ‘health’ of the Victorian clinical education system.
This project demonstrates the value of map-enabled experiential review tools in facilitating implementation and evaluation of programs across multiple settings. The tools are engaging for participants and provide structure to evaluation processes, enabling the collection of meaningful evaluation data across the program.
Australasian Evaluation Society International Conference, aes15
An innovative online tool for expanding the utility of program logic maps
Title: An innovative online tool for expanding the utility of program logic maps
Authors: Donna R. Cohen, Vitas Anderson and Philip J. Cohen
Program logic mapping is one of the core methods used in developing targeted program evaluation plans. This presentation outlines a novel application of program logic maps which, when implemented as an online tool, has significant potential for expanding the utility of these maps within the evaluation field.
The map-enabled experiential review tool provides an effective means for capturing staff experience of organisational processes (an important source of evaluation data in itself), as well as empowering staff to take ownership of those processes and quality improvement activities. The tool also enables users to utilise indicator measurement and other relevant performance data in the context of self-assessment.
The concept originated in a self-assessment tool – BPCLEtool – developed for use within the Victorian clinical education.
In 2014, BPCLEtool was implemented in 88 public health services by the Victorian Department of Health & Human Services. BPCLEtool was successfully used by those health services to engage staff in the self-assessment, action planning, indicator selection and indicator monitoring steps of a quality improvement cycle. User feedback was positive and many users recognised the broader applicability of the concept. Importantly, the tool provides the Department with de-identified assessment and indicator data to monitor the ‘health’ of the Victorian clinical education system.
Map-enabled experiential review is relevant to other key health service and general organisational processes and the tool is presently being further developed and implemented. Initial feedback on its practicality and usability has been very positive.
This concept offers a unique contribution to evaluation practice because it enables any program, project or process represented in a program logic map to be converted into an engaging, interactive self-assessment tool that captures the tacit knowledge of staff about real-world implementation of organisational processes.