Distributed leadership in health quality improvement collaboratives.

IF 1.7 3区医学 Q3 HEALTH POLICY & SERVICES

Health Care Management Review Pub Date : 2023-10-31 DOI:10.1097/HMR.0000000000000385

Kathrine Carstensen, Anne Mette Kjeldsen, Camilla Palmhøj Nielsen

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Abstract

Background and purpose: Distributed leadership has been suggested for describing patterns of influence in collaborative settings where public services are performed across professions and organizations. This study explores how leadership in health quality improvement collaboratives (QICs) is characterized by aligned distributed leadership practices, and how these practices relate with experienced progress and achievements in the quality improvement (QI) work.

Methods: The analysis relied on a qualitative, multicase study of two nationwide Danish QICs. Data consisted of 12 single-person and 21 group interviews with local QI teams and local and regional QIC coordinators (85 informants in total), participant observations of 34 meetings within the QICs, and a collection of documentary material. The collected data were analyzed thematically with NVivo.

Results: Leadership practices in local QI teams are characterized by aligned distributed leadership, with leadership activities being widely distributed based on negotiated, emergent practices regarding the aims, roles, and scope of the QI work. However, local quality coordinators play a pivotal role in driving the QI activities, and hierarchical support from hospital/municipal management is a precondition for the contribution of aligned distributed leadership to experienced progress and QIs.

Practice implications: Emergent distributed leadership should be balanced by thorough consolidation of the practices to provide the best circumstances for robust QI. The active participation of formal managers and local coordinators plays a pivotal role in this consolidation and is decisive for the increased potential for long-term success and sustainability of the QI work, particularly within complex QICs.

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健康质量改进协作的分布式领导。

背景和目的：有人建议分布式领导来描述跨专业和组织提供公共服务的协作环境中的影响力模式。本研究探讨了健康质量改进协作（QIC）中的领导力如何以一致的分布式领导力实践为特征，以及这些实践如何与质量改进（QI）工作中的经验进步和成就相关。方法：该分析依赖于对两个丹麦全国性QIC的定性、多播研究。数据包括对当地合格中介机构团队、当地和地区合格中介机构协调员（共85名线人）的12次单人和21次小组访谈，合格中介机构内34次会议的参与者观察，以及一组文件材料。使用NVivo对收集的数据进行了主题分析。结果：当地QI团队的领导实践以一致的分布式领导为特征，领导活动基于协商的、关于QI工作目标、角色和范围的紧急实践而广泛分布。然而，当地质量协调员在推动QI活动方面发挥着关键作用，医院/市政管理层的层级支持是一致的分布式领导对经验进步和合格中介机构做出贡献的先决条件。实践意义：应通过彻底整合实践来平衡紧急分布式领导，为强大的合格中介机构提供最佳环境。正式管理人员和当地协调员的积极参与在这一整合中发挥着关键作用，对提高QI工作的长期成功和可持续性的潜力具有决定性作用，尤其是在复杂的QI中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Care Management Review HEALTH POLICY & SERVICES-

CiteScore

4.70

自引率

8.00%

发文量

期刊介绍： Health Care Management Review (HCMR) disseminates state-of-the-art knowledge about management, leadership, and administration of health care systems, organizations, and agencies. Multidisciplinary and international in scope, articles present completed research relevant to health care management, leadership, and administration, as well report on rigorous evaluations of health care management innovations, or provide a synthesis of prior research that results in evidence-based health care management practice recommendations. Articles are theory-driven and translate findings into implications and recommendations for health care administrators, researchers, and faculty.