Subject(s)
Patients , Safety , Accident Prevention , Aviation/standards , Humans , Industry/standards , Interpersonal RelationsABSTRACT
The purpose of this article is to explore some of the tools and technologies available in operations management in health care in general and in emergency medicine in particular. The intent is to stimulate the reader to explore some of these approaches and tools in further detail. Various theories are noted, but the intent of this article is to be eclectic so as to give the reader a feel for the rich variety of approaches available.
Subject(s)
Emergency Service, Hospital/organization & administration , Models, Organizational , Operations Research , Outcome and Process Assessment, Health Care/organization & administration , Total Quality Management/organization & administration , Cooperative Behavior , Emergency Medicine/organization & administration , Forecasting , Humans , Interprofessional Relations , Patient Care Team/organization & administration , Quality Control , United StatesABSTRACT
BACKGROUND: Leading and leadership by formal and informal leaders goes on at all levels of microsystems--the essential building blocks of all health systems--and between them. It goes on between microsystems and other levels of the systems in health care. This series on high-performing clinical microsystems is based on interviews and site visits to 20 clinical microsystems in the United States. This fifth article in the series describes how leaders contribute to the performance of those microsystems. ANALYSIS OF INTERVIEWS: Interviews of leaders and staff members offer a rich understanding of the three core processes of leading. Building knowledge requires many behaviors of leaders and has many manifestations as leaders seek to build knowledge about the structure, processes, and patterns of work in their clinical microsystems. Taking action covers many different behaviors--making things happen, executing plans, making good on intentions. It focuses action on the way people are hired and developed and involves the way the work gets done. Reviewing and reflecting provides insight as to how the microsystem's patterns, processes, and structure enable the desired work to get done; what success looks like; and what will be next after that "success" is created. CONCLUSION: The focus on the processes of leading is intended to enable more people to develop into leaders and more people to share the roles of leading.
Subject(s)
Hospital Units/standards , Leadership , Patient Care , Professional-Patient Relations , Systems Analysis , Canada , Data Interpretation, Statistical , Humans , Interdisciplinary Communication , Interviews as Topic , Knowledge , Motivation , Personnel Management , Process Assessment, Health Care , Qualitative Research , Software , United StatesABSTRACT
BACKGROUND: The microsystem, as agent for change, plays a critical and essential role in developing and deploying the macrosystem's strategic plan. STRATEGIC PLANNING AND MICROSYSTEM THINKING: To effectively deploy a strategic plan, the organization must align the plan's goals and objectives across all levels and to all functional units. The concepts of microsystem thinking were the foundation for the journey on which Overlook Hospital/Atlantic Health System (Summit, NJ) embarked in 1996. Six stages can be identified in the development of the relationship between macrosystems and microsystems. Five critical themes--trust making, mitigation of constraints and barriers among departments and units, creation of a common vocabulary, raising of microsystem awareness, and facilitation of reciprocal relationships--are associated with these stages. NOTES FROM A MICROSYSTEM JOURNEY: The emergency department (ED) experienced Stage 1--The Emergence of a Self-Aware Microsystem--as it created cultural and behavioral change, which included the actualization of staff-generated ideas and an ongoing theme of trust making. In Stage 3--Unlike Microsystems (Different Units) Learn to Collaborate--the ED's microsystems approach spread to other units in the hospital. Collaboratives addressed x-ray turnaround times, admission cycle times, and safety initiatives. SUMMARY AND CONCLUSIONS: The microsystem--the small, functional, front-line units--is where the strategic plans become operationalized.
Subject(s)
Hospital Departments/organization & administration , Interdepartmental Relations , Organizational Culture , Systems Analysis , Cooperative Behavior , Emergency Service, Hospital/organization & administration , Hospitals, Community/organization & administration , Humans , New Jersey , Organizational Innovation , Organizational Objectives , Planning Techniques , TrustSubject(s)
Emergency Service, Hospital/standards , Narration , Safety Management , Total Quality Management/methods , Video Recording/methods , Guidelines as Topic , Hospital-Patient Relations , Hospitals, Community/standards , Humans , Inservice Training , Medical Errors/prevention & control , New Jersey , Organizational Culture , Patient SatisfactionABSTRACT
The literature is replete with examples of collaborative studies and research from 1960 to about 1995, after which the movement seems to have lost momentum. With the emergence and focus on patient safety issues, the importance of collaboration and a team approach to patient care has become paramount. CRM is a communication methodology developed by the aviation industry, based on team-centered decision making systems. Once we have identified the key components of a successful collaborative model, it is imperative that we incorporate them into the health care providers' educational curriculum, both in training as well as in the practice setting. Effective communication must be identified as a necessary skill, and collaboration as a conscious, learned behavior. The dream of collaboration has been deferred long enough, and CRM shows promise for re-igniting the collaborative movement.