Effects of Leader Tactics on the Creativity, Implementation, and Evolution of Ideas to Improve Healthcare Delivery
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Columbia University Mailman School of Public Health, New York, NY, USA; 2Yale School of Public Health, New Haven, CT, USA; 3The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
BACKGROUND: Slow progress in quality improvement (QI) has prompted calls to identify new QI ideas. Leaders guiding these efforts are advised to use evidence-based tactics, or specific approaches to address a goal, to promote clinician and staff engagement in the generation and implementation of QI ideas, but little evidence about effective tactics exists. OBJECTIVE: Examine the association between leader tactics and the creativity, implementation outcome, and evolution of QI ideas from clinicians and staff. DESIGN: Prospective panel analysis of 220 ideas generated by 12 leaders and teams (N = 72 members) from federally qualified community health practices in one center over 18 months. Measures were extracted from meeting minutes (note-taking by a member during meetings) and expert panel review. Multi-level models were used. MEASURES: Leader tactics, idea creativity, implementation outcome, evolution pathways, center, and ideasubmitter characteristics. RESULTS: Leaders used one of four approaches: no tactic, meeting ground rules, team brainstorming, or reflection on team process. Implemented ideas evolved in three pathways: Plug and Play, Slow Burn, and Iterate and Generate. Compared with no leader tactic, meeting ground rules resulted in ideas not significantly different in creativity, implementation outcome, or evolution pathway. Brainstorming was associated with greater idea creativity, idea implementation, and ideas following a Plug and Play path (low member engagement and implementation over 2 months or less). Reflection on team process was associated with idea implementation (versus not), and ideas following an Iterate and Generate path (high member engagement and implementation over 3 months or more). CONCLUSIONS: Two tactics, brainstorming and reflection, are helpful depending on goals. Brainstorming may aide leaders seeking disruptive change via more creative, rapidly implemented ideas. Reflection on team process may aide leaders seeking high-engagement ideas that may be implemented slowly. Both tactics may help leaders cultivate dynamics that increase implementation of ideas that improve healthcare. KEY WORDS: quality improvement; implementation; leader; ideas; primary care.
Received September 9, 2019 Accepted August 11, 2020
J Gen Intern Med DOI: 10.1007/s11606-020-06139-9 © Society of General Internal Medicine 2020
INTRODUCTION
To achieve the goal of a high-quality, learning healthcare system in the USA, many physicians and leaders endorse the use of quality improvement (QI) methods to assess changes in areas needing improvement.1, 2 Engaging primary care practices, described as system gatekeepers,3 is essential to successful QI efforts focused on improving population health, enhancing patient experiences, and reducing costs.1, 2 Slow progress in these efforts has prompted calls to identify new ideas for QI,
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