Journal of Healthcare Management - March/April 2014 - (Page 149)

w Hy H ospital i Mprove Ment e fforts f ail : a v iew f roM plans can be half baked, and there is usually a gap between what our top administrators want to have happen and what we are up against on the floor. . . . We spend a lot of time going backwards to try and make changes and fix things when we could have done it better the first time. f ront l ine in that it did not produce the results/ outcomes that were desired by your organization. Please describe in specific detail why this effort was ineffective. METHODS To explore the barriers to effective organizational change and improvement in the healthcare industry, we conducted focus groups with 167 frontline leaders from four Midwest community hospitals as part of a formal leadership development experience that we led. The four participating organizations were nonprofit entities; ranged in size from 197 to 294 beds, with an average of 238 beds; and were secondary care hospitals. For purposes of this study, a frontline leader is defined as a member of the organization's management team with direct supervisory responsibility over employees who deliver the organization's services (Longenecker & Simonetti, 2001). The frontline leader participants in this study were 61% female and 39% male, with an average age of 37.9 years. They represented 11 functional areas of their hospitals: 68.3% were from clinical operations (nursing, respiratory therapy, physical therapy, pharmacy, labs, and transportation), and 31.7% were from business operations (front office services, information systems, facilities, security, and food services). In Part 1 of the study, participants were asked the following question individually: Based on your experience, please identify a recent organizational change/ improvement effort that was ineffective tH e Upon completion of this task, participants were assigned to four-person focus groups to discuss and compare their individual observations and experiences as a team. All members of a particular focus group were from the same hospital, and every effort was made to ensure that each group represented a cross-section of frontline leaders from different parts of the organization to offer a variety of perspectives on each failed organizational change effort discussed. Once assigned, each team was given written guidelines instructing each person to share his or her individual findings with the group, encourage equal participation, and encourage each group to work toward consensus around the top 10 factors that caused the target improvement efforts to fail. Following these discussions, each team was asked to provide the facilitator with the group's top 10 list. The 42 focus groups generated, on average, 9.85 factors, which were then contentanalyzed using a three-judge review panel to review and assign each focus group's factors to an appropriate causeof-failure category. The three judges were seasoned organizational development professionals with previous experience in this type of qualitative research analysis. It is important to note that these categories were not predetermined but rather emerged as the content analysis proceeded. For a factor to be assigned to a specific category, two out of three judges had to independently 149

Table of Contents for the Digital Edition of Journal of Healthcare Management - March/April 2014

Journal of Healthcare Management - March/April 2014
Contents
Interview With Marna P. Borgstrom, FACHE, President and Chief Executive Officer, Yale New Haven Health System, and Chief Executive Officer, Yale-New Haven Hospital, Connecticut
Specialties: Missing in Our Healthcare Reform Strategies?
Costs and Benefits of Transforming Primary Care Practices: A Qualitative Study of North Carolina’s Improving Performance in Practice
Governing Board, C-suite, and Clinical Management Perceptions of Quality and Safety Structures, Processes, and Priorities in U.S. Hospitals
Use of Electronic Health Record Documentation by Healthcare Workers in an Acute Care Hospital System
Why Hospital Improvement Efforts Fail: A View From the Front Line

Journal of Healthcare Management - March/April 2014