An intraorganizational model for developing and spreading quality improvement innovations
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An_intraorganizational_model_for_developing_and.99784.pdf
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Author(s)
Kellogg, Katherine C.
Gainer, Lindsay A.
Allen, Adrienne S.
OʼSullivan, Tatum
Singer, Sara J.
Date Issued
July 2016
Journal
Health Care Management Review
Publisher
Wolters Kluwer Health, Inc
Citation
Kellogg, Katherine C.; Gainer, Lindsay A.; Allen, Adrienne S.; OʼSullivan, Tatum and Singer, Sara J. “An Intraorganizational Model for Developing and Spreading Quality Improvement Innovations.” Health Care Management Review (July 2016): 1.
Version
Final published version
Abstract
BACKGROUND
Recent policy reforms encourage quality improvement (QI) innovations in primary care, but practitioners lack clear guidance regarding spread inside organizations.
PURPOSE
We designed this study to identify how large organizations can facilitate intraorganizational spread of QI innovations.
METHODOLOGY/APPROACH
We conducted ethnographic observation and interviews in a large, multispecialty, community-based medical group that implemented three QI innovations across 10 primary care sites using a new method for intraorganizational process development and spread. We compared quantitative outcomes achieved through the group's traditional versus new method, created a process model describing the steps in the new method, and identified barriers and facilitators at each step.
FINDINGS
The medical group achieved substantial improvement using its new method of intraorganizational process development and spread of QI innovations: standard work for rooming and depression screening, vaccine error rates and order compliance, and Pap smear error rates. Our model details nine critical steps for successful intraorganizational process development (set priorities, assess the current state, develop the new process, and measure and refine) and spread (develop support, disseminate information, facilitate peer-to-peer training, reinforce, and learn and adapt). Our results highlight the importance of utilizing preexisting organizational structures such as established communication channels, standardized roles, common workflows, formal authority, and performance measurement and feedback systems when developing and spreading QI processes inside an organization. In particular, we detail how formal process advocate positions in each site for each role can facilitate the spread of new processes.
PRACTICE IMPLICATIONS
Successful intraorganizational spread is possible and sustainable. Developing and spreading new QI processes across sites inside an organization requires creating a shared understanding of the necessary process steps, considering the barriers that may arise at each step, and leveraging preexisting organizational structures to facilitate intraorganizational process development and spread.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially.
MIT Department
Sloan School of Management
Terms of Use
Creative Commons Attribution-NonCommercial 4.0 International
Persistent DSpace Link
DOI of Published Version
https://doi.org/10.1097/hmr.0000000000000122
