The impact of leadership churn on quality management in Australian hospitals

Factors driving differences in the adoption of quality management practices among hospitals: A two-phase, sequential mixed-methods analysis

BACKGROUND

Although all hospitals aim to deliver high-quality care, there is considerable variation in their adoption of quality management (QM) practices. Organizational and environmental factors are known to drive strategic decision-making in hospitals, but their impact on the adoption of QM practices remains unclear.

PURPOSE

Our study aims to identify multiple organizational and environmental factors that explain variation in the adoption of QM practices among hospitals and to explore mechanisms underlying these relationships.

METHODOLOGY

We conducted a two-phase, sequential mixed-methods study of German acute care hospitals. The quantitative phase used between-effects regressions to identify factors explaining variation in the number of QM practices adopted by hospitals from 2015 to 2019. The qualitative phase used semistructured interviews with quality managers to gain in-depth insights.

RESULTS

The number of QM practices adopted by a hospital was significantly associated with factors like hospital size and the presence of an emergency department or QM steering committee. Our qualitative findings highlighted potential mechanisms such as the presence of an emergency department serving as a proxy for organizational complexity or urgency of case-mix.

CONCLUSION

We provide an overview of factors driving QM adoption in hospitals, extending beyond the focus on single factors in previous research. Future studies could explore additional factors highlighted by our interviewees.

PRACTICE IMPLICATIONS

Our results can inform interventions to strengthen QM in hospitals and guide future research on this topic.

Causes & Consequences of Health Care CEO Turnover in Australia and Retention Strategies: A Qualitative Study

It has been highlighted the increasing CEO turnover is a major issue for Australian and international health care organizations. Some of the negative consequences of CEO turnover includes organizational instability, high financial costs, and affecting patient care. On average, CEOs leave their role within 1 to 2 years after commencement, which can be detrimental to the hospital's overall functioning. Therefore, this study aims to identify the causes and consequences of increasing CEO turnover in health care, so retention strategies could be devised. Fourteen hospital CEOs across Australia were interviewed online to answer 5 open ended questions related to qualities of a CEO, challenges of the CEO role, Causes and consequences of increasing CEO turnover and recommendation for CEOs retention. Interviews followed a semi-structured schedule to prompt discussion in relation to the above. The study has identified that CEOs possess certain qualities such as self-awareness, leadership style, resilience that enable them to perform their role well. Challenges of this role such as COVID-19, managing organizational change staff management has been found and discussed. Broadly, causes have been divided into 5 major categories such as Organization, Performance, Pressure, Personal and Health reform. It was found that increasing CEO turnover can be damaging to the hospital, not just the staff and patients suffer but the surrounding community gets adversely affected. To minimize CEO turnover, it was suggested that the board needs to support their CEO by advocating and investing in organizational culture and leadership programs. The findings of this study aid, the board with certain strategies through which CEO can be supported. CEOs made certain recommendations in this study to minimize the turnover which can make such a big impact on health care as this may lead to better functioning hospitals in Australia. Moreover, these strategies could be used internationally to help them CEOs retain in their position.

Ten-year tenure as a physician CEO at a Nordic university hospital: five lessons learnt

Background

I was a 42-year-old neurosurgeon with experience as department head when I took chair as chief executive officer (CEO) at the University Hospital of North Norway to lead a comprehensive organisational and financial restructuring. This article aims to develop lessons learnt during my 10-year tenure.

Methods

I restructured the organisation and hired a new executive team. We developed a new strategy and measures to implement it. I describe the results, a strategic disagreement that developed and my resignment, and reflect critically over my actions as a leader.

Results

Measures of safety and quality in clinical processes, cost-effectiveness and financial equity improved. We expedited investments in medical equipment, information technology and hospital facilities. Patient satisfaction was stable, but employees’ job satisfaction decreased. After 9 years, a politicised strategic disagreement with superior authorities developed. I was criticised for attempting to influence inappropriately, and resigned.

Lessons learnt

(1) Data-driven improvement works, but comes at a cost. Healthcare organisations should consider to prioritise resilience over efficiency. (2) It is inherently difficult to recognise when and how an issue changes from a professional to a political logic. I should have used contacts in politics and surveilled local media better. (3) During conflict, role clarity is crucial. (4) CEOs should be prepared to resign when strategically unaligned with superior authorities. (5) A CEO tenure should not last more than 10 years.

Conclusion

My experiences as a physician CEO was intense and immensely interesting, but some of the lessons were painfully learnt.

Sustainable Quality Management Systems in the Current Paradigm: The Role of Leadership

This study supports the proposition that sustainability’s integration into Quality Management Systems (QMS) could be a viable pathway to the development of the Emergency paradigm, in which leadership plays a crucial role. A Systematic Literature Review (SLR) was performed in order to deepen leadership’s relationship with Quality Management (QM) from an evolutionary perspective. An exploratory survey was then conducted to assess quality managers’ perceptions of sustainability’s integration into QMS and their leadership styles, using the 5X Short Leader Form MLQ instrument. The results indicate that leadership is a critical element of QMS performance, enhancing transformational leadership, which appears to be the dominant self-perceived style of the quality managers who participated. Nevertheless, these practitioners recognise the difficulties in committing all employees to the sustainability journey. The theoretical and managerial implications give rise to this work. The SLR results could be a useful database to support future QM and Leadership research. The organisations could follow the suggested pathway to evolve their QMS to support solutions to some of the current challenges. At the same time, quality managers could reflect on their future professional challenges. This work has taken a step forward, indicating sustainable quality management systems as a viable pathway to explore QM knowledge regarding the Emergency paradigm, and thus enhancing leadership’s role.