Marie-Claire Richer

‘If we can't do more, let's do it differently!': using appreciative inquiry to promote innovative ideas for better health care work environments

AIM To examine the use of appreciative inquiry to promote the emergence of innovative ideas regarding the reorganization of health care services. BACKGROUND With persistent employee dissatisfaction with work environments, experts are calling for radical changes in health care organizations. Appreciative inquiry is a transformational change process based on the premise that nurses and health care workers are accumulators and producers of knowledge who are agents of change. METHODS A multiple embedded case study was conducted in two interdisciplinary groups in outpatient cancer care to better understand the emergence and implementation of innovative ideas. RESULTS The appreciative inquiry process and the diversity of the group promoted the emergence and adoption of innovative ideas. Nurses mostly proposed new ideas about work reorganization. Both groups adopted ideas related to interdisciplinary networks and collaboration. A forum was created to examine health care quality and efficiency issues in the delivery of cancer care. CONCLUSION This study makes a contribution to the literature that examines micro systems change processes and how ideas evolve in an interdisciplinary context. IMPLICATIONS FOR NURSING MANAGEMENT The appreciative inquiry process created an opportunity for team members to meet and share their successes while proposing innovative ideas about care delivery. Managers need to support the implementation of the proposed ideas to sustain the momentum engendered by the appreciative inquiry process.

The sustainability of healthcare innovations: a concept analysis

AIM To report on an analysis of the concept of the sustainability of healthcare innovations. BACKGROUND While there have been significant empirical, theoretical and practical contributions made towards the development and implementation of healthcare innovations, there has been less attention paid to their sustainability. Yet many desired healthcare innovations are not sustained over the long term. There is a need to increase clarity around the concept of innovation sustainability to guide the advancement of knowledge on this topic. DESIGN Concept analysis. DATA SOURCES We included literature reviews, theoretical and empirical articles, books and grey literature obtained through database searching (ABI/INFORM, Academic Search Complete, Business Source Complete, CINAHL, Embase, MEDLINE and Web of Science) from 1996-May 2014, reference harvesting and citation searching. METHODS We examined sources according to terms and definitions, characteristics, preconditions, outcomes and boundaries to evaluate the maturity of the concept. RESULTS This concept is partially mature. Healthcare innovation sustainability remains a multi-dimensional, multi-factorial notion that is used inconsistently or ambiguously and takes on different meanings at different times in different contexts. We propose a broad conceptualization that consists of three characteristics: benefits, routinization or institutionalization, and development. We also suggest that sustained innovations are influenced by a variety of preconditions or factors, which are innovation-, context-, leadership- and process-related. CONCLUSION Further conceptual development is essential to continue advancing our understanding of the sustainability of healthcare innovations, especially in nursing where this topic remains largely unexplored.

Pluralism in PMO performance: The case of a PMO dedicated to a major organizational transformation

The focus of this article is on the contribution made by the project management office (PMO) to organizational performance. It explores the particular case of a PMO dedicated to a major organizational transformation within a Canadian university hospital. The national government has asked hospitals to provide strict control over their budgets through implementing strong governance mechanisms. How can PMO performance be assessed within this context? Perception of two different groups has been analyzed within a competing values framework, allowing for a combination of four different performance conceptions. Results show certain similarities in the barriers to PMO performance but, most importantly, they reveal that between the two groups a paradox exists regarding what is valued in PMO performance. Results bring empirical evidence of the application of the competing values framework to the health care sector, but also to a wide variety of industries, public or private.

Implementation of Evidence-Based Practices in the Context of a Redevelopment Project in a Canadian Healthcare Organization

PURPOSE The recent introduction of a project management office (PMO) in a major healthcare center, led by a nurse, provides a unique opportunity to understand how a PMO facilitates successful implementation of evidence-based practices in care delivery. DESIGN A case study with embedded units (individuals, projects, and organization). In this study, the case is operationally defined as the PMO deployed in a Canadian healthcare center. METHODS The sources of evidence used in this study were diverse. They consisted of 38 individual interviews, internal documents, and administrative data. The data were collected from March 2009 to November 2011. Content analysis was used to analyze the qualitative data. FINDINGS PMO experts help improve practices, and the patients thus receive safer and better quality care. Several participants point out that they could not make the changes without the PMOs support. They mention that they succeeded in changing their practices based on the evidence and acquired knowledge of change management with the PMO members that can be transferred to their practice. CONCLUSIONS With the leadership of the nurse director of the PMO, members provide a range of expertise and fields in evidence-based change management, project management, and evaluation. CLINICAL RELEVANCE PMO facilitates the implementation of clinical and organizational practices based on evidence to improve the quality and safety of care provided to patients.

Exploring Perceptions of Healthcare Professionals in the Implementation of a New Professional Role of Clinical Telehealth Coordinator Within a University Integrated Healthcare Network

OBJECTIVE As telehealth networks develop across Canada, new professional roles start to emerge. A university healthcare center part of an integrated health network has identified the need to introduce a clinical coordinator for specialized telehealth programs. However, very little is found in the current literature about the description or core competencies that such a professional should possess as well as the ways to implement this role. The objective of this study was to explore how healthcare professionals (HCPs) involved in a specialized teleoncology program perceive a new clinical telehealth coordinator (CTC) role within a university integrated healthcare network (UIHN) in a metropolitan area in Québec, Canada. MATERIALS AND METHODS A descriptive qualitative design was used and a purposive sample of nine HCPs, including physicians, nurses, and pharmacists who were members of a UIHN teleoncology committee, was recruited. RESULTS The HCPs identified that the CTC was a multifaceted role. The core competencies identified by the HCPs included knowledge, expertise, and experience. Participants identified three key factors in the implementation of this role, namely, the structural support, having a common language, and making the implementation of this role relevant. CONCLUSIONS The results suggest that this CTC role may be more complex than originally expected and that the diverse competencies suggest an expanded nature to this role. This has important implications for administrative strategies when addressing the key factors in the implementation of this role.

Project management office in health care: a key strategy to support evidence-based practice change.

This article describes the contribution of a Transition Support Office (TSO) in a health care center in Canada to supporting changes in practice based on evidence and organizational performance in the early phase of a major organizational change. Semistructured individual interviews were conducted with 11 members of the TSO and 13 managers and clinicians from an ambulatory sector in the organization who received support from the TSO. The main themes addressed in the interviews were the description of the TSO, the context of implementation, and the impact. Using the Competing Value Framework by Quinn and Rohrbaugh [Public Product Rev. 1981;5(2):122-140], results revealed that the TSO is a source of expertise that facilitates innovation and implementation of change. It provides material support and human expertise for evidence-based projects. As a single organizational entity responsible for managing change, it gives a sense of cohesiveness. It also facilitates communication among human resources of the entire organization. The TSO is seen as an expertise provider that promotes competency development, training, and evidence-based practices. The impact of a TSO on change in practices and organizational performance in a health care system is discussed.

From Multi-professional to Trans-professional Healthcare Teams: The Critical Role of Innovation Projects

This chapter addresses change and interprofessional collaboration in health care by contrasting two forms of collaborations. The first occurs in ongoing service delivery while the other takes place in project teams that are by definition temporary. Most practitioners and scholars discuss the many challenges of interprofessional collaboration in the context of continuous change efforts. However, collaboration differs when the need for change is more radical and innovative. The chapter explains why, and offers insight on how to manage projects interprofessionally.

The project management office: Transforming healthcare in the context of a hospital redevelopment project

It has been shown that classifying projects into a typology allows improved allocation of resources and promotes project success. However, a typology of healthcare projects has yet to be developed. The projects encountered by the Transition Support Office at the McGill University Health Centre in Montreal, Quebec, where a major redevelopment project is under way, were classified into a typology unique to the healthcare context. Examples of the 3 project types, Process, People, and Practice, are provided to clarify the specific support strategies and context-adapted interventions that were instrumental to their success.

Bringing knowledge to action in the context of a major organizational transition.

In the context of organizational transitions in health care institutions, the decisions taken by leaders and clinicians are informed by multiple sources and by a multitude of actors at all levels of the organization. A study was conducted in the context of a major organizational transition at the McGill University Health Centre in Montreal, Quebec, Canada. The purpose was to examine the body of literature around the notions of “evidence” in decision-making processes in health care. Key informants who had a strategic decision-making role linked to the transition activities were interviewed to explore their perceptions of the types of evidence used to support changes in the organization. Results revealed that managers and clinicians relied on multiple sources of evidence and shared similar concerns about reliability and validity of scant evidence.

Dealing with Uncertainty and Ambiguity in a Complex Project: The Case of Intravenous (IV) Pumps in a Healthcare Center

A University Hospital for the 21st Century In 2008, the Quebec government approved a CAD