Abstract
As healthcare organizations examine how to design and adapt their management structures to ensure quality is being measured and improved, considerations around the functioning of systems and the management of change become crucial. The inherent financial and service-driven complexities of the healthcare industry and its systems require a mosaic approach to organizational structures and processes. Healthcare institutions must develop organizational structures in response to the requirements of dynamic external and internal stakeholders whose interests and motives do not categorically coincide. Organizations must be structured to embody the specific needs of their identity and mission. This chapter discusses the multiple structural approaches that have evolved to accommodate the explicit concerns of organizations whether a large academic medical center, large group practice, smaller community hospital, or an integrated healthcare system.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Kohn LT, Corrigan JM, Donaldson MS (eds) (2000) To err is human: building a safer health system. National Academies Press, Washington, DC
Institute of Medicine (2001) Crossing the quality chasm: a new health system for the 21st century. The National Academies Press, Washington, DC
Berwick DM (1996) A primer on leading the improvement of systems. BMJ 312:619. https://doi.org/10.1136/bmj.312.7031.619
Senge PM (1990) The fifth discipline: the art and practice of the learning organization. Random House, London
De Savigny D, Adam T (eds) (2009) Systems thinking for health systems strengthening. Alliance for Health Policy and Systems Research, World Health Organization, Geneva
Greene SM, Reid RJ, Larson EB (2012) Implementing the learning health system: from concept to action. Ann Intern Med 157:207–210. https://doi.org/10.7326/0003-4819-157-3-201208070-00012
Frankel AS, Leonard MW, Denham CR (2006) Fair and just culture, team behavior, and leadership engagement: the tools to achieve high reliability. Health Serv Res 41:1690–1709
Marx D (2001) Patient safety and the “just culture”: a primer for health care executives. Trustees of Columbia University in the City of New York. https://www.chpso.org/sites/main/files/file-attachments/marx_primer.pdf
Helmreich RL (2000) On error management: lessons from aviation. BMJ 320:781–785. https://doi.org/10.1136/bmj.320.7237.781
Cochrane BS, Hagins M, Picciano G et al (2017) High reliability in healthcare: creating the culture and mindset for patient safety. Health Manage Forum 30:61–68. https://doi.org/10.1177/0840470416689314
Baker DP, Day R, Salas E (2006) Teamwork as an essential component of high-reliability organizations. Health Serv Res 41:1576–1598
Weick KE, Sutcliffe KM (2001) Managing the unexpected: assuring high performance in an age of complexity, 1st edn. Jossey-Bass, San Francisco
Pronovost PJ, Berenholz SM, Goeschel CA et al (2006) Creating high reliability in health care organizations. Health Serv Res 41:1599–1617. https://doi.org/10.1111/j.1475-6773.2006.00567.x
Chassin MR, Loeb JM (2013) High-reliability health care: getting there from here. Milbank Q 91:459–490
Koron-Djakovic D, Canamucia A, Lempa M et al (2016) Organization complexity and primary care providers’ perceptions of quality improvement culture within the Veterans Health Administration. Am J Med Qual 31(2):139–146. https://doi.org/10.1177/1062860614559743
Gupta R, Moriates C (2017) Swimming upstream: creating a culture of high-value care. Acad Med 92(5):597–601. https://doi.org/10.1097/ACM.0000000000001485
Nelson EC, Godfrey MM, Batalden PB et al (2008) Clinical microsystems, part 1: the building blocks of health systems. Jt Comm J Qual Patient Saf 34(7):367–378
Monitor, Independent Regulator for NHS Foundation Trusts (2009) Service-line management: an overview. Monitor, London. https://www.gov.uk/government/publications/service-line-management-an-introduction-for-nhs-foundation-trusts
Nasrabad RR (2016) Service line management: a new paradigm in health care system. Int J Med Res Health Sci 5(12):208–211
Rangachari P (2010) Knowledge sharing and organizational learning in the context of hospital infection prevention. Q Manage Health Care 19(1):34–46. https://doi.org/10.1097/QMH.0b013e3181ccbd1d
Pronovost PJ, Marsteller JA (2014) Creating a fractal-based quality management infrastructure. J Health Organ Manage 28(4):576–586
Johns Hopkins Medicine (2017) Excellence and discovery: an overview. http://www.hopkinsmedicine.org/about/downloads/jhm-overview.pdf. Accessed 19 Mar 2017
Austin JM, Demski R, Callender T et al (2017) From board to bedside: how the application of financial structures to safety and quality can drive accountability in a large health system. Jt Comm J Qual Patient Saf 43(4):166–175. https://doi.org/10.1016/j.jcjq.2017.01.001
Kravet SJ, Bailey J, Demski R, Pronovost P (2016) Establishing an ambulatory medicine quality and safety oversight structure: leveraging the fractal model. Acad Med 91(7):962–966. https://doi.org/10.1097/ACM.0000000000001102
Interview with Johns Hopkins leaders, April 5–7, 2017
Nancarrow SA, Booth A, Ariss S et al (2013) Ten principles of good interdisciplinary team work. Hum Resour Health 11:19. https://doi.org/10.1186/1478-4491-11-19
Institute for Healthcare Improvement (2019) Science of improvement: forming the team. http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementFormingtheTeam.aspx. Accessed 14 May 2019
Agency for Healthcare Research and Quality (2019) About Team STEPPS. Rockville, MD. http://www.ahrq.gov/teamstepps/about-teamstepps/index.html
Shanafelt TD, Gorringe G, Menaker R et al (2015) Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc 90(4):432–440. https://doi.org/10.1016/j.mayocp.2015.01.012
Weiner BJ, Shortell SM, Alexander JA (1997) Promoting clinical involvement in the hospital quality improvement efforts: the effects of top management, board, and physician leadership. Health Serv Res 32:491–510
Berwick DM, Nolan TW, Whittington J (2008) The triple aim: care, health, and cost. Health Aff 27(3):759–769. https://doi.org/10.1377/hlthaff.27.3.759
Bodenheimer T, Sinsky C (2014) From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med 12:573–576
Ziegenfuss JT (1997) Five responsibilities of medical quality leaders. Am J Med Qual 12(4):175–176. https://doi.org/10.1177/0885713X9701200401
Ashkenas RN, Francis SC (2000) Integration managers: special leaders for special times. Harv Bus Rev 78(6):108–116
Nackel JG (1995) Breakthrough delivery systems: applying business process innovation. J Soc Health Syst 5(1):11–21
Hutchins D (2008) Hoshin kanri: the strategic approach to continuous improvement. Gower Publishing Co, Burlington. https://www.henryford.com/hcp/academic/pathology/production-system/wednesdays-words/2011-articles/march-9-2011
Goeschel CA, Wachter RM, Pronovost PJ (2010) Responsibility for quality improvement and patient safety: hospital board and medical staff leadership challenges. Chest 138(1):171–178. https://doi.org/10.1378/chest.09-2051
Alexander JA, Lee SY (2006) Does governance matter? Board configuration and performance in not-for-profit hospitals. Milbank Q 84(4):733–758. https://doi.org/10.1111/j.1468-0009.2006.00466.x
Orlikoff JE, Totten MK (2003) Trustee workbook 2: best practices in governance: what makes great boards great. Trustee 56(4):15–18
Prybil LD (2006) Size, composition, and culture of high-performing hospital boards. Am J Med Qual 21(4):224–229. https://doi.org/10.1177/1062860606289628
Prybil LD, Peterson R, Brezinski P et al (2010) Board oversight of patient care quality in community health systems. Am J Med Qual 25:34–41. https://doi.org/10.1177/1062860609352804
Jha AK, Epstein AM (2010) Hospital governance and the quality of care. Health Aff 29:182–187. https://doi.org/10.1377/hlthaff.2009.0297
Pronovost PJ, Sexton B (2005) Assessing safety culture: guidelines and recommendations. Qual Saf Health Care 14(4):231–233. https://doi.org/10.1136/qshc.2005.015180
Pross C, Geissler A, Busse R (2017) Measuring, reporting, and rewarding quality of care in 5 nations: 5 policy levers to enhance hospital quality accountability. Milbank Q 95(1):136–183. https://doi.org/10.1111/1468-0009.12248
Pronovost PJ, Miller M, Wachter RM (2007) The GAAP in quality measurement and reporting. JAMA 298(15):1800–1802. https://doi.org/10.1001/jama.298.15.1800-2
Reinertsen JL, Gosfield AG, Rupp W et al (2007) Engaging physicians in a shared quality agenda. IHI Innovation Series white paper. Institute for Healthcare Improvement, Cambridge
Shanafelt T, Goh J, Sinsky C (2017) The business case for investing in physician well-being. JAMA Intern Med 177(12):1826–1832. https://doi.org/10.1001/jamainternmed.2017.4340
Shanafelt TD, Noseworthy JH (2017) Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 92(1):129–146
Additional Reading
Agency for Healthcare Research and Quality (2013) Practice facilitation handbook: module 14. creating quality improvement teams and QI plans. http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod14.html. Accessed May 2013
Ziegenfuss JT (1991) Organizational barriers to quality improvement in medical and health care organizations. Qual Assur Util Rev 6(4):115–122
Ziegenfuss JT (1994) Toward a general procedure for quality improvement: the double track process. Am J Med Qual 9(2):90–97
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 American College of Medical Quality (ACMQ)
About this chapter
Cite this chapter
McLean, R., Hooks, J., Guttman, C. (2021). Organization Design and Management. In: Giardino, A., Riesenberg, L., Varkey, P. (eds) Medical Quality Management. Springer, Cham. https://doi.org/10.1007/978-3-030-48080-6_8
Download citation
DOI: https://doi.org/10.1007/978-3-030-48080-6_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-48079-0
Online ISBN: 978-3-030-48080-6
eBook Packages: MedicineMedicine (R0)