Content area
Full Text
Introduction
Over a decade has passed since seminal reports including To Err is Human, Crossing the Quality Chasm, and the Canadian Adverse Events Study revealed significant areas for improvement in the quality of health care services delivered by health systems in the USA and Canada (Institute of Medicine, 1999, 2001; Baker et al., 2004). Substantial human and monetary capital has been invested to improve quality and while examples of success can be found in both countries, widespread improvement has yet to materialize (Baker et al., 2008; Institute of Medicine, 2013; Baker, 2015).
In order to facilitate widespread and sustained health care quality improvement, the Institute of Medicine (2013) stresses the need to establish continuously learning health care systems. Essential to learning health care systems are organizational cultures of continuous learning (Institute of Medicine, 2013). It is suggested that continuous learning cultures are ideally instilled by both formal and informal leaders, and supported by organizational competencies and structures that enable constant information development, process/systems analysis, and feedback loops for learning and quality improvement (Institute of Medicine, 2013). These characteristics of learning health care systems are fundamental elements of management philosophies such as total quality management (Bloor, 1999; Mosadeghrad, 2015; Peljhan and Marc, 2016).
Work processes on the “frontlines” of health care, or within what some refer to as “clinical microsystems of care,” have garnered considerable focus for health system quality improvement (Baker et al., 2008). Quality improvement approaches typically involve: methods by which system and process performance can be evaluated; methods for collecting information from key stakeholders like patients and employees in order to understand the root causes of suboptimal performance; methods for integrating this information within the change design process and; methods in which changes can be tested, implemented, and revaluated in an iterative manner (Juran, 1998; Grol et al., 2007; Baker et al., 2008). Improving performance at the microsystem level depends on teams having methods and access to supports for analyzing performance then subsequently undertaking improvement efforts (Baker et al., 2008). An infrastructure is thus necessary for exchanging information, mobilizing organizational resources, and aligning improvement efforts with strategic objectives across organizational levels (Juran, 1998; Ferlie and Shortell, 2001; Berwick et al., 2003). Herein lies an important...