Making time for learning-oriented leadership in multidisciplinary hospital management groups.

BACKGROUND: Although the clinical requirements of health care delivery imply the need for interdisciplinary management teams to work together to promote frontline learning, such interdisciplinary, learning-oriented leadership is atypical. PURPOSE: We designed this study to identify behaviors enabling groups of diverse managers to perform as learning-oriented leadership teams on behalf of quality and safety. APPROACH: We randomly selected 12 of 24 intact groups of hospital managers from one hospital to participate in a Safety Leadership Team Training program. We collected primary data from March 2008 to February 2010 including pre- and post-staff surveys, multiple interviews, observations, and archival data from management groups. We examined the level and trend in frontline perceptions of managers' learning-oriented leadership following the intervention and ability of management groups to achieve objectives on targeted improvement projects. Among the 12 intervention groups, we identified higher- and lower-performing intervention groups and behaviors that enabled higher performers to work together more successfully. FINDINGS: Management groups that achieved more of their performance goals and whose staff perceived more and greater improvement in their learning-oriented leadership after participation in Safety Leadership Team Training invested in structures that created learning capacity and conscientiously practiced prescribed learning-oriented management and problem-solving behaviors. They made the time to do these things because they envisioned the benefits of learning, valued the opportunity to learn, and maintained an environment of mutual respect and psychological safety within their group. PRACTICE IMPLICATIONS: Learning in management groups requires vision of what learning can accomplish; will to explore, practice, and build learning capacity; and mutual respect that sustains a learning environment.

Governing inside the organization: interpreting regulation and compliance.

Looking inside organizations at the different positions, expertise, and autonomy of the actors, the authors use multisite ethnographic data on safety practices to develop a typology of how the regulator, as the focal actor in the regulatory process, is interpreted within organizations. The findings show that organizational actors express constructions of the regulator as an ally, threat, and obstacle that vary with organizational expertise, authority, and continuity of relationship between the organizational member and the regulator. The article makes three contributions to the current understandings of organizational governance and regulatory compliance, thereby extending both institutional and ecological accounts of organizations' behavior with respect to their environments. First, the authors document not only variation across organizations but variable compliance within an organization. Second, the variations described do not derive from alternative institutional logics, but from variations in positions, autonomy, and expertise within each organization. From their grounded theory, the authors hypothesize that these constructions carry differential normative interpretations of regulation and probabilities for compliance, and thus the third contribution, the typology, when correlated with organizational hierarchy provides the link between microlevel action and discourse and organizational performance.

The ethics of pharmaceutical research funding: a social organization approach.

This paper advances a social organization approach to examining unethical behavior. While unethical behaviors may stem in part from failures in individual morality or psychological blind spots, they are both generated and performed through social interactions among individuals and groups. To illustrate the value of a social organization approach, a case study of a medical school professor's first experience with pharmaceutical-company-sponsored research is provided in order to examine how funding arrangements can constrain research integrity. The case illustrates three significant ways that institutional corruption can occur in the research process. First, conflicts of norms between pharmaceutical companies, universities, and affiliated teaching hospitals can result in compromises and self-censorship. Second, normal behavior is shaped through routine interactions. Unethical behaviors can be (or can become) normal behaviors when they are produced and reproduced through a network of social interactions. Third, funding arrangements can create networks of dependency that structurally distort the independence of the academic researcher in favor of the funder's interests. More broadly, the case study demonstrates how the social organization approach deepens our understanding of the practice of ethics.

A case for safety leadership team training of hospital managers.

BACKGROUND: Delivering safe patient care remains an elusive goal. Resolving problems in complex organizations like hospitals requires managers to work together. Safety leadership training that encourages managers to exercise learning-oriented, team-based leadership behaviors could promote systemic problem solving and enhance patient safety. Despite the need for such training, few programs teach multidisciplinary groups of managers about specific behaviors that can enhance their role as leadership teams in the realm of patient safety. PURPOSE: The aims of this study were to describe a learning-oriented, team-based, safety leadership training program composed of reinforcing exercises and to provide evidence confirming the need for such training and demonstrating behavior change among management groups after training. METHODS: Twelve groups of managers from an academic medical center based in the Northeast United States were randomly selected to participate in the program and exposed to its customized, experience-based, integrated, multimodal curriculum. We extracted data from transcripts of four training sessions over 15 months with groups of managers about the need for the training in these groups and change in participants' awareness, professional behaviors, and group activity. FINDINGS: Training transcripts confirmed the need for safety leadership team training and provided evidence of the potential for training to increase targeted behaviors. The training increased awareness and use of leadership behaviors among many managers and led to new routines and coordinated effort among most management groups. Enhanced learning-oriented leadership often helped promote a learning orientation in managers' work areas. PRACTICE IMPLICATIONS: Team-based training that promotes specific learning-oriented leader behaviors can promote behavioral change among multidisciplinary groups of hospital managers.

Something might be missing from occupational health and safety audits: findings from a content validity analysis of five audit instruments.

OBJECTIVE: The objective was to examine the content validity of occupational health and safety (OHS) management audit methods. METHODS: The documentation used by five broader public sector service organizations to audit OHS management in workplaces was analyzed with reference to a recent OHS management standard (CSA Z1000). RESULTS: A relatively high proportion of CSA Z1000's content (74%) was partially or fully represented on average in the audit methods. However, six management elements were found to be incompletely represented in three or more of the methods. The most extreme example is the Internal Audits element whose content was completely missing for three of the audit methods. CONCLUSION: Some OHS management audit instruments in current use are incomplete relative to a recent OHS management standard. It may be that some instruments warrant revision to better reflect current expert consensus.