Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Mar;28(3):198-204.
doi: 10.1136/bmjqs-2018-008291. Epub 2018 Oct 31.

Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service

Lorelei Jones  1 , Linda Pomeroy  2 , Glenn Robert  3 , Susan Burnett  4 , Janet E Anderson  3 , Stephen Morris  2 , Estela Capelas Barbosa  2 , Naomi J Fulop  2
Affiliations

Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service

Lorelei Jones et al. BMJ Qual Saf. 2019 Mar.

Abstract

Background: Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis' typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.

Methods: We conducted fieldwork over a 30-month period as part of an evaluation in six healthcare provider organisations in England. Our data comprised board member interviews (n=54), board meeting observations (24 hours) and relevant documents.

Results: Two organisations transformed their processes in a way that was consistent with the objectives of the intervention, and one customised the intervention with positive effects. In two further organisations, the intervention was only loosely coupled with organisational processes, and participation in the intervention stopped when it competed with other initiatives. In the final case, the intervention was corrupted to reinforce existing organisational processes (a focus on external regulatory requirements). The organisational response was contingent on the availability of 'slack'-expressed by participants as the 'space to think' and 'someone to do the doing'-and the presence of a functioning board.

Conclusions: Underperforming organisations, under pressure to improve, have little time or resources to devote to organisation-wide quality improvement initiatives. Our research highlights the need for policy-makers and regulators to extend their focus beyond the choice of intervention, to consider how the chosen intervention will be implemented in public sector hospitals, how this will vary between contexts and with what effects. We provide useful information on the necessary conditions for a board-level quality improvement intervention to have positive effects.

Keywords: governance; organizational theory; quality improvement.

PubMed Disclaimer

Conflict of interest statement

Competing interests: JEA, SB, NJF and GR were part of the QUASER team which developed The Hospital Guide used in the intervention.

Comment in

References

    1. Baker GR, Denis J-L, Pomey M-P. Effective governance for quality and patient safety in Canadian healthcare organizations. Canadian Health Services Research Foundation, 2010. - PubMed
    1. Bismark MM, Studdert DM. Governance of quality of care: a qualitative study of health service boards in Victoria, Australia. BMJ Qual Saf 2014;23:474–82. 10.1136/bmjqs-2013-002193 - DOI - PMC - PubMed
    1. Millar R, Mannion R, Freeman T, et al. Hospital board oversight of quality and patient safety: a narrative review and synthesis of recent empirical research. Milbank Q 2013;91:738–70. 10.1111/1468-0009.12032 - DOI - PMC - PubMed
    1. NHS Improvement Developing people, improving care. A national framework for action on improvement and leadership development in NHS-funded services. London: NHS Improvement, 2017.
    1. Care Quality Commission and NHS Improvement Consultation on use of resources and well-led assessments. London: Care Quality Commission and NHS Improvement, 2016.

Publication types