Learning to Improve Improved Learning

This thesis focuses on the connection between learning and quality improvement in health care. I explored this from the macro, meso and micro level perspectives. The central research question of this thesis is: Which issues support and hinder the development of healthcare professionals working in hospitals in their quality improvement work? To investigate how healthcare professionals can be supported in their quality improvement work, I employed a case study methodology. I studied three different cases over the course of five years. The first case was the national Dutch Faster Better programme. The second case was a number of different improvement projects in an academic hospital. For the third case I was intensively involved for a period of 18 months in a Dutch teaching hospital. In all three cases I used different methods for data collection and data analysis, varying from quantitative analyses of questionnaires to action research. By combining different research methods I gained more insight into the complexity associated with healthcare professionals’ learning to conduct improvement work

Transferring skills in quality collaboratives focused on improving patient logistics

Background: A quality improvement collaborative, often used by the Institute for Healthcare Improvement, is used to educate healthcare professionals and improve healthcare at the same time. However, no prior research has been done on the knowledge and skills healthcare professionals need to achieve improvements or the extent to which quality improvement collaboratives help enhance both knowledge and skills. Our research focused on quality improvement collaboratives aiming to improve patient logistics and tried to identify which knowledge and skills ar

Do quality improvement collaboratives’ educational components match the dominant learning style preferences of the participants?

Background: Quality improvement collaboratives are used to improve healthcare by various organizations. Despite their popularity literature shows mixed results o

Development of dashboards for Quality and Safety Management

Which challenges do hospitals face in the development process of hospital-wide Quality and Safety dashboards and how do they overcome them? Is it possible to learn from others and speed up the development process

Ontwikkeling is een uitdaging; Dashboards voor Kwaliteit en Veiligheid in ziekenhuizen

Externe partijen vragen in toenemende mate om inzicht en transparantie over de kwaliteit van zorg voor het uitvoeren van hun controlerende taak. Zorgprofessionals hebben behoefte aan cijfers over de geleverde zorg- en dienstverlening, zodat zij kunnen verbeteren. Wetenschappelijke verenigingen stimuleren het opzetten van ziektebeeld gebonden registraties. Al deze verzamelde informatie kunnen instellingen ook gebruiken voor interne sturing op basis van een kwaliteitsdashboard

Developing a hospital-wide quality and safety dashboard

__Background__ Several countries have national policies and programmes requiring hospitals to use quality and safety (QS) indicators. To present an overview of these indicators, hospital-wide QS (HWQS) dashboards are designed. There is little evidence how these dashboards are developed. The challenges faced to develop these dashboards in Dutch hospitals were retrospectively studied. __Methods__ 24 focus group interviews were conducted: 12 with hospital managers (n=25; 39.7%) and 12 support staff (n=38; 60.3%) in 12 of the largest Dutch hospitals. Open and axial codings were applied consecutively to analyse the data collected. __Results__ A heuristic tool for the general development process for HWQS dashboards containing five phases was identified. In phase 1, hospitals make inventories to determine the available data and focus too much on quantitative data relevant for accountability. In phase 2, hospitals develop dashboard content by translating data into meaningful indicators for different users, which is not easy due to differing demands. In phase 3, hospitals search for layouts that depict the dashboard content suited for users with different cognitive abilities and analytical skills. In phase 4, hospitals try to integrate dashboards into organisational structures to ensure that data are systematically reviewed and acted on. In phase 5, hospitals want to improve the flexibility of their dashboards to make this adaptable under differing circumstances. __Conclusion__ The literature on dashboards addresses the technical and content aspects of dashboards, but overlooks the organisational development process. This study shows how technical and organisational aspects are relevant in development processes

The balancing act of organizing professionals and managers: An ethnographic account of nursing role development and unfolding nurse-manager relationships

Scholars describe organizing professionalism as ‘the intertwinement of professional and organizational logics in one professional role’. Organizing professionalism bridges the gap between the often-described conflicting relationship between professionals and managers. However, the ways in which professionals shape this organizing role in daily practice, and how it impacts on their relationship with managers has gained little attention. This ethnographic study reveals how nurses shape and differentiate themselves in organizing roles. We show that developing a new nurse organizing role is a balancing act as it involves resolving various tensions concerning professional authority, task prioritization, alignment of both intra- and interprofessional interests, and internal versus external requirements. Managers play an important yet ambiguous role in this development process as they both cooperate with nurses in aligning organizational and nursing professional aims, and sometimes hamper the development of an independent organizing nursing role due to conflicting organizational concerns

A scoping review of rebel nurse leadership: Descriptions, competences and stimulating/hindering factors

Aims: To (1) give an overview of rebel nurse leadership by summarising descriptions of positive deviance, tempered radicals and healthcare rebels; (2) examine the competences of nurse rebel leadership; and (3) describe factors that stimulate or hinder the development of rebel nurse leadership. Background: Research shows nurses have lower intention to leave their jobs when they can control their work practices, show leadership and provide the best care. However, organisational rules and regulations do not always fit the provision of good care, which challenges nurses to show leadership and deviate from the rules and regulations to benefit the patient. Three concepts describe this practice: positive deviance, healthcare rebels and tempered radicals. Design: Scoping review using the Joanna Briggs Institute methodology and PRISMA-ScR checklist. Methods: Papers describing positive deviance, healthcare rebels and tempered radicals in nursing were identified by searching Scopus, CINAHL, PubMed and PsycINFO. After data extraction, these three concepts were analysed to study the content of descriptions and definitions, competences and stimulating and hindering factors. Results: Of 2705 identified papers, 25 were included. The concept descriptions yielded three aspects: (1) positive deviance approach, (2) unconventional and non-confirmative behaviour and (3) relevance of networks and relationships. The competences were the ability to: (1) collaborate in/outside the organisation, (2) gain and share expert (evidence-based) knowledge, (3) critically reflect on working habits/ problems in daily care and dare to challenge the status quo and (4) generate ideas to improve care. The factors that stimulate or hinder the development of rebel nurse leadership are as follows: (1) dialogue and reflection, (2) networking conditions and (3) the managers’ role. Conclusions: Based on our analysis, we summarise the descriptions given of rebel nurse leadership, the mentioned competences and provide an overview of the factors that stimulate or hinder rebel nurse leadership