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OB Citations - Conceptualizing, Measuring, and Evaluating Improvement Networks

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OB Citations - Conceptualizing, Measuring, and Evaluating Improvement Networks
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Conceptualizing, Measuring, and Evaluating Improvement Networks

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  • Implementing Educational Innovations at Scale: Transforming Researchers Into Continuous Improvement Scientists

    Cohen-Vogel, L., Tichnor-Wagner, A., Allen, D., Harrison, C., Kainz, K., Socol, A. R., & Wang, Q. (2015). Implementing Educational Innovations at Scale: Transforming Researchers Into Continuous Improvement Scientists. Educational Policy, 29(1), 257-277. PAIS Index; Research Library. https://doi.org/10.1177/0895904814560886

  • Continuous Improvement in the Public School Context: Understanding How Educators Respond to Plan–Do–Study–Act Cycles

    Tichnor-Wagner, A., Wachen, J., Cannata, M., & Cohen-Vogel, L. (2017). Continuous Improvement in the Public School Context: Understanding How Educators Respond to Plan–Do–Study–Act Cycles. Journal of Educational Change, 18(4), 465–494. https://doi.org/10.1007/s10833-017-9301-4

  • Learning to Improve: How America’s Schools Can Get Better at Getting Better

    Bryk, A. S., Gomez, L. M., Grunow, A., & LeMahieu, P. G. (2015). Learning to Improve: How America’s Schools Can Get Better at Getting Better. Harvard Education Press. https://www.hepg.org/hep-home/books/learning-to-improve

  • Innovating at the Nexus of Impact and Improvement: Leading Educational Improvement Networks

    Peurach, D. J. (2016). Innovating at the Nexus of Impact and Improvement: Leading Educational Improvement Networks. Educational Policy, 30(7), 606–648. https://doi.org/10.3102/0013189X16670898

  • The Developmental Evaluation of School Improvement Networks

    Peurach, D. J., Glazer, J. L., & Winchell Lenhoff, S. (2016). The Developmental Evaluation of School Improvement Networks. Educational Policy, 30(4), 606–648. https://doi.org/10.1177/0895904814557592

  • School Improvement Networks as a Strategy for Large-Scale Education Reform: The Role of Educational Environments

    Glazer, J. L., & Peurach, D. J. (2013). School Improvement Networks as a Strategy for Large-Scale Education Reform: The Role of Educational Environments. Educational Policy, 27(4), 676–710. https://doi.org/10.1177/0895904811429283

  • Evidence for Improvement: An Integrated Analytic Approach for Supporting Networks in Education

    Sherer, D., Norman, J., Bryk, A. S., Peurach, D. J., Vasudeva, A., & McMahon, K. (2020). Evidence for improvement: An Integrated Analytic Approach for Supporting Networks in Education. Carnegie Foundation for the Advancement of Teaching,

  • Inter-Organizational Networks in Education

    Wohlstetter, P., & Lyle, A. G. (2019). Inter-Organizational Networks in Education. In M. Connolly, D. Eddy-Spicer, C. James, & S. Kruse (Eds.), The SAGE Handbook of School Organization. SAGE Publications Ltd. https://doi.org/10.4135/9781526465542.n12

  • The Improvement Guide: A Practical Approach to Enhancing Organizational Performance

    Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. John Wiley & Sons.

  • Developmental Evaluation: Applying Complexity Concepts to Enhance Innovation and Use

    Patton, M. Q. (2010). Developmental Evaluation: Applying Complexity Concepts to Enhance Innovation and Use. Guilford Press.

  • Organizing Schools for Improvement: Lessons from Chicago

    Bryk, A. S., Sebring, P. B., Allensworth, E., Easton, J. Q., & Luppescu, S. (2010). Organizing Schools for Improvement: Lessons from Chicago. University of Chicago Press.

  • The Social Organization of Networked Improvement Communities

    Russell, J. L., Bryk, A. S., Dolle, J. R., Gomez, L. M., LeMahieu, P. G., & Grunow, A. (2019, April). The Social Organization of Networked Improvement Communities. American Educational Research Association Annual Meeting, Toronto, ON.

  • Assessing the First Two Years’ Effectiveness of Statway®: A Multilevel Model With Propensity Score Matching

    Yamada, H., & Bryk, A. S. (2016). Assessing the First Two Years’ Effectiveness of Statway®: A Multilevel Model With Propensity Score Matching. Community College Review, 44(3), 179–204. https://doi.org/10.1177/0091552116643162

  • Explanation and Elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: Examples of SQUIRE Elements in the Healthcare Improvement Literature

    Goodman, D., Ogrinc, G., Davies, L., Baker, G. R., Barnsteiner, J., Foster, T. C., Gali, K., Hilden, J., Horwitz, L., Kaplan, H. C., Leis, J., Matulis, J. C., Michie, S., Miltner, R., Neily, J., Nelson, W. A., Niedner, M., Oliver, B., Rutman, L., … Thor, J. (2016). Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: Examples of SQUIRE elements in the healthcare improvement literature. BMJ Quality & Safety, 25(12), e7–e7. https://doi.org/10.1136/bmjqs-2015-004480

  • Using Improvement Science to Better Support Beginning Teachers: The Case of the Building a Teaching Effectiveness Network

    Hannan, M., Russell, J. L., Takahashi, S., & Park, S. (2015). Using Improvement Science to Better Support Beginning Teachers: The Case of the Building a Teaching Effectiveness Network. Journal of Teacher Education, 66(5), 494–508. https://doi.org/10.1177/0022487115602126

  • Networked Improvement Communities: The Discipline of Improvement Science Meets the Power of Networks

    LeMahieu, P. G., Grunow, A., Baker, L., Nordstrum, L. E., & Gomez, L. M. (2017). Networked Improvement Communities: The Discipline of Improvement Science Meets the Power of Networks. Quality Assurance in Education, 25(1), 5–25. https://doi.org/10.1108/QAE-12-2016-0084

  • The Right Network for the Right Problem

    Gomez, L. M., Russell, J. L., Bryk, A. S., LeMahieu, P. G., & Mejia, E. M. (2016). The Right Network for the Right Problem. Phi Delta Kappan, 98(3), 8–15. https://doi.org/10.1177/0031721716677256

  • Generating a Networked Improvement Community to Improve Secondary Mathematics Teacher Preparation: Network Leadership, Organization, and Operation

    Martin, W. G., & Gobstein, H. (2015). Generating a Networked Improvement Community to Improve Secondary Mathematics Teacher Preparation: Network Leadership, Organization, and Operation. Journal of Teacher Education, 66(5), 482–493. https://doi.org/10.1177/0022487115602312

  • Establishing and Sustaining Networked Improvement Communities: Lessons From Michigan and Minnesota

    Proger, A., Bhatt, M., Cirks, V., & Gurke, D. (2017). Establishing and Sustaining Networked Improvement Communities: Lessons From Michigan and Minnesota (REL 2017-264; What’s Happening). Regional Educational Laboratory Midwest. https://ies.ed.gov/ncee/rel/Products/Publication/3853

  • Research on Data Use: A Framework and Analysis

    Coburn, C. E., & Turner, E. O. (2011). Research on Data Use: A Framework and Analysis. Measurement: Interdisciplinary Research and Perspectives, 9(4), 173–206. https://doi.org/10.1080/15366367.2011.626729

  • Assessing the Effectiveness of Quantway®: A Multilevel Model With Propensity Score Matching

    Yamada, H., Bohannon, A. X., Grunow, A., & Thorn, C. A. (2018). Assessing the Effectiveness of Quantway®: A Multilevel Model With Propensity Score Matching. Community College Review, 46(3), 257–287. https://doi.org/10.1177/0091552118771754

  • A Framework for the Initiation of Networked Improvement Communities

    Russell, J. L., Bryk, A. S., Dolle, J. R., Gomez, L. M., Lemahieu, P. G., & Grunow, A. (2017). A Framework for the Initiation of Networked Improvement Communities. Teachers College Record, 119(5), 1–36. https://doi.org/10.1177/016146811711900501

  • Communities of Practice: Learning, Meaning, and Identity

    Wenger, E. (1999). Communities of Practice: Learning, Meaning, and Identity. Cambridge University Press.

  • Brokerage and Closure: An Introduction to Social Capital

    Burt, R. S. (2005). Brokerage and Closure: An Introduction to Social Capital. Oxford University Press.

  • Toward High-Performance Organizations A Strategic Role for Groupware

    Achieving tomorrow's high-performance organizations will involve massive changes throughout their capability infrastructures. The complexity of implementing these changes will be daunting, and deserves a strategic approach. Groupware will support important, special new knowledge capabilities in these infrastructures, and also can play a key role in an evolutionary strategy.

  • Improving Our Ability to Improve: A Call for Investment in a New Future

    In the past fifty years we have seen enormous growth in computing capability – computing is everywhere and has impacted nearly everything. In this talk, Dr. Douglas Engelbart, who pioneered much of what we now take for granted as interactive computing, examines the forces that have shaped this growth. He argues that our criteria for investment in innovation are, in fact, short-sighted and focused on the wrong things. He proposes, instead, investment in an improvement infrastructure that can result in sustained, radical innovation capable of changing computing and expanding the kinds of problems that we can address through computing. In this talk, Dr. Engelbart describes both the processes that we need to put in place and the capabilities that we must support in order to stimulate this higher rate of innovation. The talk closes with a call to action for this World Library Summit audience, since this is a group that has both a stake in innovation and the ability to shape its direction.

  • Governing by Network: The New Shape of the Public Sector

    A fundamental, but mostly hidden, transformation is happening in the way public services are being delivered, and in the way local and national governments fulfill their policy goals. Government executives are redefining their core responsibilities away from managing workers and providing services directly to orchestrating networks of public, private, and nonprofit organizations to deliver the services that government once did itself. Authors Stephen Goldsmith and William D. Eggers call this new model "governing by network" and maintain that the new approach is a dramatically different type of endeavor that simply managing divisions of employees. Like any changes of such magnitude, it poses major challenges for those in charge. Faced by a web of relationships and partnerships that increasingly make up modern governance, public managers must grapple with skill-set issues (managing a contract to capture value); technology issues (incompatible information systems); communications issues (one partner in the network, for example, might possess more information than another); and cultural issues (how interplay among varied public, private, and nonprofit sector cultures can create unproductive dissonance). Governing by Network examines for the first time how managers on both sides of the aisle, public and private, are coping with the changes. Drawing from dozens of case studies, as well as established best practices, the authors tell us what works and what doesn't. Here is a clear roadmap for actually governing the networked state for elected officials, business executives, and the broader public.

  • From Networking to School Networks to “Networked Learning”: The Challenge for the Networked Learning Communities Programme

  • From Professional Learning Community to Networked Learning Community

    Drawing on research, this book offers a deeper understanding of topics such as distributed leadership, dialogue, organisational memory, trust, self-assessment and inquiry, and purpose linked to learning.

  • Learning Networks for Sustainable, Large-Scale Improvement

    Obstetric safety bundles, consisting of action steps shown to improve outcomes, have been developed to address the most common and preventable causes of maternal morbidity and mortality. Implementing these best practices across all birthing facilities remains an important and challenging clinical and public health priority. The California Maternal Quality Care Collaborative (CMQCC) developed an innovative external mentor model for large-scale collaborative improvement in which participating organizations were subdivided into small teams of six to eight hospitals, led by a paired dyad of physician and nurse leaders. The mentor model preserves the active sharing that enhances improvement across a large group of facilities working on the same project while enabling individualized attention to teams. The mentor model was tested by implementing the obstetric hemorrhage safety bundle (which consists of 17 key practices in four domains) in multiple California hospitals. A total of 126 hospitals were engaged to simultaneously implement the safety bundle. The adoption rates for the recommended practices in the four action domains were (1) Readiness, 78.9%; (2) Recognition and Prevention, 76.5%; (3) Response, 63.1%; and (4) Reporting and Systems Learning, 58.7%. Mentors (31/40) and participating teams (48 responses from 39/126 hospitals) provided feedback in an exit survey. Among the respondents, 64.5% of mentors and 72.9% of participants agreed that compared to a traditional collaborative structure, the mentor model was better suited for quality improvement at scale. The mentor model was successful in providing individualized support to teams and enabled implementation of the hemorrhage safety bundle across a diverse group of 126 hospitals. Health care systems struggle to scale-up and spread effective practices across diverse settings. Failures in scale-up and spread (SUS) are often attributed to a lack of consideration for variation in local contexts among different health care delivery settings. We argue that SUS occurs within complex systems and that self-organization plays an important role in the success, or failure, of SUS. Self-organization is a process whereby local interactions give rise to patterns of organizing. These patterns may be stable or unstable, and they evolve over time. Self-organization is a major contributor to local variations across health care delivery settings. Thus, better understanding of self-organization in the context of SUS is needed. We re-examine two cases of successful SUS: 1) the application of a mobile phone short message service intervention to improve adherence to medications during HIV treatment scale up in resource-limited settings, and 2) MRSA prevention in hospital inpatient settings in the United States. Based on insights from these cases, we discuss the role of interdependencies and sensemaking in leveraging self-organization in SUS initiatives. We argue that self-organization, while not completely controllable, can be influenced, and that improving interdependencies and sensemaking among SUS stakeholders is a strategy for facilitating self-organization processes that increase the probability of spreading effective practices across diverse settings. There is a large and persistent failure to achieve widespread dissemination of evidence-based practices in child health care. Too often studies demonstrating evidence for effective child health care practices are not brought to scale and across different settings and populations. This failure is not due to a lack of knowledge, but rather a failure to bring to bear proven methods in dissemination, diffusion, and implementation (DD&I) science that target the translation of evidence-based medicine to everyday practice. DD&I science offers a framework and a set of tools to identify innovations that are likely to be implemented, and provides methods to better understand the capabilities and preferences of individuals and organizations and the social networks within these organizations that help facilitate widespread adoption. Successful DD&I is dependent on making the intervention context sensitive without losing fidelity to the core components of the intervention. The achievement of these goals calls for new research methods such as pragmatic research trials that combine hypothesis testing with quality improvement, participatory research that engages the target community at the beginning of research design, and other quasi-experimental designs. With the advent of health care reform, it will be extremely important to ensure that the ensuing large demonstration projects that are designed to increase integrated care and better control costs can be rapidly brought to scale across different practices settings, and health plans and will be able to achieve effectiveness in diverse populations. The BC Patient Safety & Quality Council has a mandate to bring health system stakeholders together in a collaborative partnership to improve quality of care. Our experience has demonstrated the value of networks to provide a forum for individuals to “think like a system,” considering the perspectives of others in addressing system issues. This transition from silo-based thinking is important as we move to improve the quality of care at the pace that is required. Substantial innovation related to cancer prevention and treatment has occurred in recent decades. However, these innovations have often come at a significant cost. Cost-utility analysis provides a useful framework to assess if the benefits from innovation are worth the additional cost. This systematic review on published cost-utility analyses related to cancer care is from 1988 through 2013. Analyses were conducted in 2013–2015. This review analyzed data from the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org), a comprehensive registry with detailed information on 4,339 original cost-utility analyses published in the peer-reviewed medical and economic literature through 2013. There were 721 cancer-related cost-utility analyses published from 1998 through 2013, with roughly 12% of studies focused on primary prevention and 17% focused on secondary prevention. The most often studied cancers were breast cancer (29%); colorectal cancer (11%); and prostate cancer (8%). The median reported incremental cost-effectiveness ratios (in 2014 U.S. dollars) were $25,000 for breast cancer, $24,000 for colorectal cancer, and $34,000 for prostate cancer. The current evidence indicates that there are many interventions that are cost effective across cancer sites and levels of prevention. However, the results highlight the relatively small number of cancer cost-utility analyses devoted to primary prevention compared with secondary or tertiary prevention. The integration of Clinical Decision Support Systems (CDSS) in nowadays clinical environments has not been fully achieved yet. Although numerous approaches and technologies have been proposed since 1960, there are still open gaps that need to be bridged. In this work we present advances from the established state of the art, overcoming some of the most notorious reported difficulties in: (i) automating CDSS, (ii) clinical workflow integration, (iii) maintainability and extensibility of the system, (iv) timely advice, (v) evaluation of the costs and effects of clinical decision support, and (vi) the need of architectures that allow the sharing and reusing of CDSS modules and services. In order to do so, we introduce a new clinical task model oriented to clinical workflow integration, which follows a federated approach. Our work makes use of the reported benefits of semantics in order to fully take advantage of the knowledge present in every stage of clinical tasks and the experience acquired by physicians. In order to introduce a feasible extension of classical CDSS, we present a generic architecture that permits a semantic enhancement, namely Semantic CDSS (S-CDSS). A case study of the proposed architecture in the domain of breast cancer is also presented, pointing some highlights of our methodology. The objective of the study was to evaluate the intra- and interobserver agreement among obstetric experts in court regarding the retrospective review of abnormal fetal heart rate tracings and obstetrical management of patients with abnormal fetal heart rate during labor. A total of 22 French obstetric experts in court reviewed 30 cases of term deliveries of singleton pregnancies diagnosed with at least 1 hour of abnormal fetal heart rate, including 10 cases with adverse neonatal outcome. The experts reviewed all cases twice within a 3-month interval, with the first review being blinded to neonatal outcome. For each case reviewed, the experts were provided with the obstetric data and copies of the complete fetal heart rate recording and the partogram. The experts were asked to classify the abnormal fetal heart rate tracing and to express whether they agreed with the obstetrical management performed. When they disagreed, the experts were asked whether they concluded that an error had been made and whether they considered the obstetrical management as the cause of cerebral palsy in children if any. Compared with blinded review, the experts were significantly more likely to agree with the obstetric management performed (P < .001) and with the mode of delivery (P < .001) when informed about the neonatal outcome and were less likely to conclude that an error had been made (P < .001) or to establish a link with potential cerebral palsy (P = .003). The experts’ intraobserver agreement for the review of abnormal fetal heart rate tracing and obstetrical management were both mediocre (kappa = 0.46–0.51 and kappa = 0.48–0.53, respectively). The interobserver agreement for the review of abnormal fetal heart rate tracing was low and was not improved by knowledge of the neonatal outcome (kappa = 0.11–0.18). The interobserver agreement for the interpretation of obstetrical management was also low (kappa = 0.08–0.19) but appeared to be improved by knowledge of the neonatal outcome (kappa = 0.15–0.32). The intra- and interobserver agreement among obstetric experts in court for the review of abnormal fetal heart rate tracing and the appropriateness of obstetrical care is poor, suggesting a lack of objectivity of obstetrical expertise as currently performed in court. To assess the improvement of knowledge in cardiotocography (CTG) analysis, with the use of a dedicated e-learning program. Multicentre randomized controlled trial conducted in 5 maternity departments of Eastern-Paris Perinatal network. Midwives and obstetricians were recruited on a voluntary basis. At first log-in, they were tested on CTG interpretation and on labor management. They were then randomly allocated to a “training” group (n = 57) with the e-learning program, or to a “no-training” group (n = 56). After three months, a second test was performed. Mean scores at first and second tests, rate of participants in the bottom quartile, and mean scores between doctors and midwives were compared between “training” and “no-training” groups. Seventy-five midwives and 38 obstetricians participated in the study. The mean scores at first test were similar in both groups (32.4 ± 5.2 out of 50 and 32.5 ± 4.6, p = 0.989). After e-learning, the results were significantly higher in the “training” group than in the “no-training” group (mean 37.1 ± 5.5 vs. 32.6 ± 5.7, respectively; p = 0.0026). The number of participants in the bottom quartile reached 36.0% in the “no-training” group, while it decreased to 12.6% in the “training” group (p = 0.032). Doctors had higher results than midwives in the first test (34.9 ± 5.9 vs. 32.4 ± 4.3; p = 0.0048), but not in the second test in the group with training (37.7 ± 6.7 vs. 36.8 ± 4.8; p = 0.64). Training in CTG interpretation using an e-learning program improves the performance of obstetric staff. The possibility of logging-in from any place at any time may favor the use of an e-learning program in maternity staff.

  • Analyzing the Functional Dynamics of Technological Innovation Systems: A Scheme of Analysis

    Various researchers and policy analysts have made empirical studies of innovation systems in order to understand their current structure and trace their dynamics. However, policy makers often experience difficulties in extracting practical guidelines from studies of this kind. In this paper, we operationalize our previous work on a functional approach to analyzing innovation system dynamics into a practical scheme of analysis for policy makers. The scheme is based on previous literature and our own experience in developing and applying functional thinking. It can be used by policy makers not only to identify the key policy issues but also to set policy goals.

  • From Sectoral Systems of Innovation to Socio-Technical Systems: Insights About Dynamics and Change from Sociology and Institutional Theory

    In the last decade ‘sectoral systems of innovation’ have emerged as a new approach in innovation studies. This article makes four contributions to the approach by addressing some open issues. The first contribution is to explicitly incorporate the user side in the analysis. Hence, the unit of analysis is widened from sectoral systems of innovation to socio-technical systems. The second contribution is to suggest an analytical distinction between systems, actors involved in them, and the institutions which guide actor’s perceptions and activities. Thirdly, the article opens up the black box of institutions, making them an integral part of the analysis. Institutions should not just be used to explain inertia and stability. They can also be used to conceptualise the dynamic interplay between actors and structures. The fourth contribution is to address issues of change from one system to another. The article provides a coherent conceptual multi-level perspective, using insights from sociology, institutional theory and innovation studies. The perspective is particularly useful to analyse long-term dynamics, shifts from one socio-technical system to another and the co-evolution of technology and society.

  • Micro-Foundations of the Multi-Level Perspective on Socio-Technical Transitions: Developing a Multi-Dimensional Model of Agency Through Crossovers Between Social Constructivism, Evolutionary Economics and Neo-Institutional Theory

    The Multi-Level Perspective (MLP) is a prominent framework to understand socio-technical transitions, but its micro-foundations have remained under-developed. The paper's first aim is therefore to develop the MLP's theoretical micro-foundations, which are rooted in Social Construction of Technology, evolutionary economics and neoinstitutional theory. The second aim is to further identify crossovers between these theories. To achieve these goals, the paper analytically reviews the three theories, focusing on: (1) the relevance of each theory for transitions and the MLP, (2) the theory's conceptualisation of agency, (3) criticisms of each theory and subsequent conceptual elaborations (which prepare the ground for potential crossovers between them). Mobilizing insights from the analytical reviews, the paper articulates a multi-dimensional model of agency, which also provides a relational and processual conceptualization of ongoing trajectories in which actors are embedded. Specific conceptual linking points between the three theories are identified, leading to an understanding of socio-technical transitions as evolutionary, interpretive and conflictual processes.

  • Leveraging Social Capital and School Improvement: The Case of a School Network and a Comprehensive Community Initiative in Chicago

    This study assesses the first 4.5 years of an effort by a foundation in Chicago to promote children and adolescents? social and academic development as part of a comprehensive community initiative. The authors examine the potential and challenges associated with the foundation?s strategy of developing social capital within a network of schools and community organizations.

  • Reform through School Networks: A New Kind of Authority and Accountability

    Many educational reforms are implemented on a school-by-school basis where the individual or the school is often the target of the effort. But the problems of education transcend the capacity of one school working alone. Networking schools with each other or with partner organizations works to develop social capital; this can be an effective alternative to market-type or hierarchical approaches to reform. In the network model of organizing, authority and accountability are based on the social relationships between network participants. Focusing on new management roles within school networks, the authors' findings suggest that networks promote community-based collaboration, cost sharing, knowledge sharing, and the involvement of external partners. In contrast, challenges to the network strategy include the need for extensive training in group process skills and the need for quality information. The intent of this article is to make the language and discourse of networks more accessible to education reformers.

  • Improving Schools through Networks: A New Approach to Urban School Reform

    Research suggests that decentralized management reforms have produced changes in classroom practice and higher student achievement in some schools. However, many schools simply do not have the capacity to improve on their own. A few school districts are experimenting with a new approach to school reform?school networks?that relies on collaboration between schools. This article draws on data from an evaluation of the Annenberg Challenge in Los Angeles, a reform effort that experimented with school networks as a vehicle for improving schools. As a theoretical framework, the authors applied Lawler's (1991) high-involvement model, which suggests that in order for an organization's improvement efforts to be successful, resources must be decentralized, and stakeholders must be actively collaborating on the reform process. The authors found that when school networks created structures that decentralized power and distributed organizational resources throughout the network, they also enhanced school capacity for reform.

  • Improvement, Trust, and the Healthcare Workforce

    Although major defects in the performance of healthcare systems are well documented, progress toward remedy remains slow. Accelerating improvement will require large shifts in attitudes toward and strategies for developing the healthcare workforce. At present, prevailing strategies rely largely on outmoded theories of control and standardisation of work. More modern, and much more effective, theories of production seek to harness the imagination and participation of the workforce in reinventing the system. This requires a workforce capable of setting bold aims, measuring progress, finding alternative designs for the work itself, and testing changes rapidly and informatively. It also requires a high degree of trust in many forms, a bias toward teamwork, and a predilection toward shouldering the burden of improvement, rather than blaming external factors. A new healthcare workforce strategy, founded on these principles, will yield much faster improvement than at present.

  • Total Quality Management: Empirical, Conceptual, and Practical Issues

    In recent years, total quality management (TQM) has become something of a social movement in the United States. This commentary returns to the writings of the movement's founders-W. Edwards Deming, Joseph Juran, and Kaoru Ishikawa-to assess the coherence, distinctiveness, and likely perseverance of this provocative management philosophy. We identify a number of gaps in what is known about TQM processes and outcomes and explore the congruence between TQM practices and behavioral science knowledge about motivation, learning, and change in social systems. The commentary concludes with a prognosis about the future of TQM-including some speculations about what will be needed if TQM is to take root and prosper in the years to come.

  • What Is a “Good” Social Network for Policy Implementation? The Flow of Know-How for Organizational Change

    This study concerns how intraorganizational networks affect the implementation of policies and practices in organizations. In particular, we attend to the role of the informal subgroup or clique in cultivating and distributing locally adapted and integrated knowledge, or know-how. We develop two hypotheses based on the importance of intraorganizational coordination for an organization's capacity for change. The first emphasizes the importance of distributing know-how evenly to potential recipient subgroups. The second emphasizes the importance of restricting know-how to flow from high know-how subgroups. We test our hypotheses with longitudinal network data in 21 schools, finding stronger support for the second hypothesis than the first. Our findings can help managers cultivate know-how flows to contribute to organizational change.

  • The State of Network Research in Public Administration

    The wide use of networks warrants a closer examination of network research in public administration. This article focuses on the methodological issues of network research and examines how social network analysis has been used and can be used to advance network research in public administration. Through a content analysis of 81 network articles, we found that the topics examined through network analysis have become more diverse in recent years. Yet relatively few articles have examined the intersection of policy networks, governance networks, and collaborative networks. The field needs more mixed-methods research designs and more research on the substructures of networks and multilevel networks.

  • Core Concepts and Key Ideas for Understanding Public Sector Organizational Networks: Using Research to Inform Scholarship and Practice

    This article provides an overview of the key research findings and core concepts on the topic of organizational networks. The primary focus is on goal-directed “whole” service delivery networks, which are prevalent in the public and nonprofit sectors. The findings and ideas presented are especially salient for helping public managers build, maintain, operate, and govern multiorganizational networks in ways that will enhance their effectiveness. Because research and theory on networks extend well beyond the boundaries of public management and administration, the authors draw on thinking from a number of fields, providing a broad understanding of public networks and network functioning. The article is intended to provide usable information on networks for both practitioners and students, as well as to suggest directions for future research for the many public management scholars who now study organizational networks.

  • A Preliminary Theory of Interorganizational Network Effectiveness: A Comparative Study of Four Community Mental Health Systems

    This paper presents the results of a comparative study of interorganizational networks, or systems, of mental health delivery in four U.S. cities, leading to a preliminary theory of network effectiveness. Extensive data were collected from surveys, interviews, documents, and observations. Network effectiveness was assessed by collecting and aggregating data on outcomes from samples of clients, their families, and their case managers at each site. Results of analyses of both quantitative and qualitative data collected at the individual, organizational, and network levels of analysis showed that network effectiveness could be explained by various structural and contextual factors, specifically, network integration, external control, system stability, and environmental resource munificence. Based on the findings, we develop testable propositions to guide theory development and future research on network effectiveness.

  • Do Networks Really Work? A Framework for Evaluating Public-Sector Organizational Networks

    Although cooperative, interorganizational networks have become a common mechanism for delivery of public services, evaluating their effectiveness is extremely complex and has generally been neglected. To help resolve this problem, we discuss the evaluation of networks of community-based, mostly publicly funded health, human service, and public welfare organizations. Consistent with pressures to perform effectively from a broad range of key stakeholders, we argue that networks must be evaluated at three levels of analysis: community, network, and organization/participant levels. While the three levels are related, each has its own set of effectiveness criteria that must be considered. The article offers a general discussion of network effectiveness, followed by arguments explaining effectiveness criteria and stakeholders at each level of analysis. Finally, the article examines how effectiveness at one level of network analysis may or may not match effectiveness criteria at another level and the extent to which integration across levels may be possible.

  • Networking Literature About Determinants of Network Effectiveness

    Since the early 1990s, public networks have been implemented in many countries to solve ‘wicked’ public problems, addressing such issues as health, social care, local development and education. While considerable research has been carried out into public networks, both managers and scholars are left with some doubts about network effectiveness. In fact literature on this topic has been highly fragmented, comprising a plurality of definitions, multiple theories, multiple methods and multiple explanations. This paper aims to review and classify previous theoretical and evidence-based studies on network effectiveness and its determinants. Our aim is to rearrange existing literature into a unitary framework in order to shed light on both hitherto unfilled gaps and established theoretical cornerstones.

  • Promoting and Assessing Value Creation in Communities and Networks: A Conceptual Framework

  • Understanding the Similarities and Distinctions Between Improvement Science and Evaluation

    In this chapter, we discuss the similarities and points of departure between improvement science and evaluation, according to use, valuing, and methods—three dimensions of evaluation theory to which all theorists attend (Christie & Alkin, ). Using these three dimensions as a framework for discussion, we show some of the ways in which improvement science and evaluation are similar and how they are different in terms of purposes, goals, and processes. By doing so we frame the illustrative cases of improvement science that follow in this issue.

  • Methods for Evaluation of Small Scale Quality Improvement Projects

    Evaluation is an integral component of quality improvement and there is much to be learned from the evaluation of small scale quality improvement initiatives at a local level. This type of evaluation is useful for a number of different reasons including monitoring the impact of local projects, identifying and dealing with issues as they arise within a project, comparing local projects to draw lessons, and collecting more detailed information as part of a bigger evaluation project. Focused audits and developmental studies can be used for evaluation within projects, while methods such as multiple case studies and process evaluations can be used to draw generalised lessons from local experiences and to provide examples of successful projects. Evaluations of small scale quality improvement projects help those involved in improvement initiatives to optimise their choice of interventions and use of resources. Important information to add to the knowledge base of quality improvement in health care can be derived by undertaking formal evaluation of local projects, particularly in relation to building theory around the processes of implementation and increasing understanding of the complex change processes involved.

  • Process Evaluation on Quality Improvement Interventions

    To design potentially successful quality improvement (QI) interventions, it is crucial to make use of detailed breakdowns of the implementation processes of successful and unsuccessful interventions. Process evaluation can throw light on the mechanisms responsible for the result obtained in the intervention group. It enables researchers and implementers to (1) describe the intervention in detail, (2) check actual exposure to the intervention, and (3) describe the experience of those exposed. This paper presents a framework containing features of QI interventions that might influence success. Attention is paid to features of the target group, the implementers or change agents, the frequency of intervention activities, and features of the information imparted. The framework can be used as a starting point to address all three aspects of process evaluation mentioned above. Process evaluation can be applied to small scale improvement projects, controlled QI studies, and large scale QI programmes; in each case it plays a different role.

  • Evaluation of Quality Improvement Programmes

    In response to increasing concerns about quality, many countries are carrying out large scale programmes which include national quality strategies, hospital programmes, and quality accreditation, assessment and review processes. Increasing amounts of resources are being devoted to these interventions, but do they ensure or improve quality of care? There is little research evidence as to their effectiveness or the conditions for maximum effectiveness. Reasons for the lack of evaluation research include the methodological challenges of measuring outcomes and attributing causality to these complex, changing, long term social interventions to organisations or health systems, which themselves are complex and changing. However, methods are available which can be used to evaluate these programmes and which can provide decision makers with research based guidance on how to plan and implement them. This paper describes the research challenges, the methods which can be used, and gives examples and guidance for future research. It emphasises the important contribution which such research can make to improving the effectiveness of these programmes and to developing the science of quality improvement.

  • Practical Recommendations for the Evaluation of Improvement Initiatives

    A lack of clear guidance for funders, evaluators and improvers on what to include in evaluation proposals can lead to evaluation designs that do not answer the questions stakeholders want to know. These evaluation designs may not match the iterative nature of improvement and may be imposed onto an initiative in a way that is impractical from the perspective of improvers and the communities with whom they work. Consequently, the results of evaluations are often controversial, and attribution remains poorly understood. Improvement initiatives are iterative, adaptive and context-specific. Evaluation approaches and designs must align with these features, specifically in their ability to consider complexity, to evolve as the initiative adapts over time and to understand the interaction with local context. Improvement initiatives often identify broadly defined change concepts and provide tools for care teams to tailor these in more detail to local conditions. Correspondingly, recommendations for evaluation are best provided as broad guidance, to be tailored to the specifics of the initiative. In this paper, we provide practical guidance and recommendations that funders and evaluators can use when developing an evaluation plan for improvement initiatives that seeks to: identify the questions stakeholders want to address; develop the initial program theory of the initiative; identify high-priority areas to measure progress over time; describe the context the initiative will be applied within; and identify experimental or observational designs that will address attribution.