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Despite a recent proliferation of interorganizational networks in health care, there is very little empirical guidance about how to facilitate their success over time. The current study tests a theory of cooperative evolution in the context of five matched pairs of successful versus "challenging" initiatives within six community health center-led networks. Researchers collected initial data in 2000/2001 and conducted follow-up interviews with key informants two years later. Analyses included semi-inductive coding of interview transcripts and systematic comparisons between successful and challenging cooperative efforts. As theory predicts, both initial conditions and subsequent adaptation affected project evolution, with successful and challenging projects following distinct trajectories. The external environment and momentum, however, played more salient roles in these health care safety net networks than they had in corporate ventures. These findings indicate the utility of qualitative techniques to adapt theories developed in other sectors to health care contexts.

AbstractThis article examines the circumstances under which nonprofit organizations adopt corporate governance practices. In the study reported here, the authors found that adoption of corporate governance practices depends primarily on the presence of a supportive institutional (that is, value) context as well as available resources to support governance restructuring. These findings strongly suggest that the adoption of structures and practices from the for‐profit sector is neither a feasible nor even a desirable solution to problems facing many nonprofit organizations.

Abstract Background Foundations and public agencies commonly fund focused initiatives for individual grantees. These discrete, stand-alone initiatives can risk failure by being carried out in isolation. Fostering synergy among grantees' initiatives is one strategy proposed for promoting the success and impact of grant programs. We evaluate an explicit strategy to build synergy within the Robert Wood Johnson Foundation's Southern Rural Access Program (SRAP), which awarded grants to collaboratives within eight southeastern U.S. states to strengthen basic health care services in targeted rural counties. Methods We interviewed 39 key participants of the SRAP, including the program director within each state and the principal subcontractors heading the program's funded initiatives that supported heath professionals' recruitment, retention and training, made loans to health care providers, and built networks among providers. Interews were recorded and transcribed. Two investigators independently coded the transcripts and a third investigator distilled the main points. Results Participants generally perceived that the SRAP yielded more synergies than other grant programs in which they had participated and that these synergies added to the program's impact. The synergies most often noted were achieved through relationship building among grantees and with outside agencies, sharing information and know-how, sharing resources, combining efforts to yield greater capacity, joining voices to advocate for common goals, and spotting gaps in services offered and then filling these gaps. The SRAP's strategies that participants felt fostered synergy included targeting funding to culturally and geographically similar states, supporting complementary types of initiatives, promoting opportunities to network through semi-annual meetings and regular conference calls, and the advocacy efforts of the program's leadership. Participants noted that synergies were sometimes hindered by turf issues and politics and the conflicting perspectives and cultures of participating organizations and racial groups. Inadequate funding through the SRAP, restricting program involvement to only a few needy counties, and instances of over- and under-involvement by the program's leadership were sometimes felt to inhibit synergies and/or their sustainability. Conclusion Participants of the SRAP generally perceived that the SRAP's deliberate strategies yielded synergies that added to the program's impact.

Purpose. To explore differences in manager beliefs about worksite health promotion programs (HPPs). Design. Cross-sectional written survey. Setting. Twenty-four manufacturing worksites, with 11,811 employees and 1719 eligible managers. Subjects. Sixty-six percent (1133/1719) of managers completed the survey; 1047 managers were categorized by level (169 senior, 567 middle, and 311 line supervisors). Analysis. Results are reported on overall manager beliefs (and by manager level) about importance, efficacy, barriers, and benefits of HPPs. Multilevel analysis modeled the influence of manager level, age, and experience with HPPs on beliefs about HPPs, while accounting for worksite-level effects. Results. Seventy-five percent of managers believed that offering HPPs is highly important. Eighty percent believed that HPPs improved employee health, 68% believed that they reduced health care costs, and 67% believed that they improved employee morale. Few significant differences by manager level were observed on the perceived importance of health promotion, employer responsibilities for health promotion and protection, and efficacy of health promotion strategies or perceived benefits. Senior managers (vs. line supervisors) were significantly less likely to believe that space or cost was a barrier to offering HPPs and were less likely than middle managers or line supervisors to believe that production conflicts were barriers to offering HPPs. Conclusion. Targeted interventions to address manager beliefs, including differences by age, experience, and manager level, are worth consideration when planning worksite HPPs.

AbstractThis review of the governance practices of twenty‐five public‐private partnerships involved in addressing a broad range of community health needs shows that governance in public‐private community partnerships departs significantly from traditional notions of institutional governance. Governance structures and degrees of progress toward governance goals vary widely and appear to be systematically related to the organization, composition, location, and activity of each partnership.

This article explores factors promoting leadership from the top for hospital quality improvement (CQI/FQM). From literature on governance, quality improvement, and organization theory, working hypotheses were developed about the effects of physician and management involvement in governance on CQIITQM adoption, board leadership for quality, and top management leadership for quality. Hypotheses were tested using a sample of 2,030 hospitals obtained by merging two national mailed surveys. Probit and logistic regression showed physician involvement in governance played a significant role in CQI/FQM adoption and board activity in quality improvement. Formal management involvement in governance demonstrated little effect on CQI/FQM adoption, board leadership for quality, or top management leadership for quality. Informal management involvement in governance, as reflected in opportunities to influence board composition, had negative effects on board and top management leadership for quality. Top management leadership for quality increased board leadership for quality. Implications are discussed.

Many believe that electronic medical record (EMR) systems hold promise for improving the quality of health care services. The body of research on this topic is still in the early stages, however, in part because of the challenge of measuring the capabilities of EMR systems. The purpose of this study was to identify classes of EMR system sophistication in hospitals as well as hospital characteristics associated with the sophistication categories. The data used were from the American Hospital Association (AHA) and the Health Information Management and Systems Society (HIMSS). The sample included acute care hospitals in the United States with 50 beds or more. We used latent class analysis to identify the sophistication classes and logistic regression to identify the relationships between these classes and hospital characteristics. Our study identifies cumulative categories of EMR sophistication: ancillary-based, ancillary/data aggregation, and ancillary-to-bedside. Rural hospital EMRs are likely to be ancillary based, while hospitals in a network are likely to have either ancillary-based or ancillary-to-bedside EMRs. Future research should explore the effect of network membership on EMR system development.

Health care practitioners and change experts contend that organizational readiness for change is a critical precursor to successful change implementation. This article assesses how organizational readiness for change has been defined and measured in health services research and other fields. Analysis of 106 peer-reviewed articles reveals conceptual ambiguities and disagreements in current thinking and writing about organizational readiness for change. Inspection of 43 instruments for measuring organizational readiness for change reveals limited evidence of reliability or validity for most publicly available measures. Several conceptual and methodological issues that need to be addressed to generate knowledge useful for practice are identified and discussed.

AbstractThis article examines key leadership issues in community health partnerships. We assert that leadership in a partnership is differentiated from that in a traditional, hierarchical organization in that participation is voluntary and egalitarian and often entails cooperation by organizations with different cultures and agendas. Partnership leaders, accordingly, often lack formal control over members and their actions. Using qualitative analysis of 115 site‐visit interviews of participants in four partnerships in the Community Care Networks demonstration program, we identify and discuss five themes of collaborative leadership: systems thinking, vision‐based leadership, collateral leadership, power sharing, and process‐based leadership. We then discuss the multiple challenges that collaborative leadership faces in a community health partnership.

Many innovations in the health sector are complex, requiring coordinated use by multiple organizational members to achieve benefits. Often, complex innovations are adopted with great anticipation only to fail during implementation. The health services literature provides limited conceptual guidance to researchers and practitioners about implementation of complex innovations. In the present study, we adapt an organizational framework of innovation implementation developed and validated in a manufacturing setting and explore the extent to which it aptly characterizes implementation in health sector organizations. Through comparative case studies of four cancer clinical research networks, we illustrate how this conceptual framework captures key determinants of the implementation of new programs in cancer prevention and control (CP/C) research and helps explain observed differences in implementation effectiveness. Key determinants include management support and innovation-values fit, which contribute to an organizational "climate" for implementation. We explore the implications for researchers and managers.

Health care organization leaders and policy makers seeking ways to reform the delivery of health care have become increasingly interested in transformational change. To foster understanding of how organizational transformation occurs and to stimulate further research, we report findings from a systematic review of empirical research on transformational change in the health care and non–health care literature, with a focus on the antecedents, processes (or paths), and outcomes of transformational change. Fifty-six studies, of which 13 were in health care, met our selection criteria. With one exception, all were published since 1990, indicating the recent upsurge of interest in this area. Limited differences were found between health care and non–health care studies. Available research documents the multiplicity of factors affecting change and the complexity of their interactions, but less information is available about the processes of transformational change than about its antecedents and consequences. Research and practice implications are discussed.

This study examines the association between scope of Quality Improvement (QI) implementation in hospitals and hospital performance on patient safety indicators. Secondary data sources included a 1997 survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions'Area Resource File, and two proprietary data sets. Using a sample of 1,784 community hospitals, the study employed two-stage instrumental variables estimation in which predicted values of four QI scope variables and control variables were used to estimate four patient safety indicators. Involvement by multiple hospital units in the QI effort is associated with worse values on all four patient safety indicators. Percentages of hospital staff and of senior managers participating in QI teams exhibited no statistically significant association with any patient safety indicator. Percentage of physicians participating in QI teams is associated with better values on two patient safety indicators.

The COVID-19 pandemic continues to expand globally, requiring massive public health responses from national and local governments. These bodies have taken heterogeneous approaches to their responses, including when and how to introduce and enforce evidence-based interventions—such as social distancing, hand-washing, personal protective equipment (PPE), and testing. In this commentary, we reflect on opportunities for implementation science to contribute meaningfully to the COVID-19 pandemic response. We reflect backwards on missed opportunities in emergency preparedness planning, using the example of PPE stockpiling and supply management; this planning could have been strengthened through process mapping with consensus-building, microplanning with simulation, and stakeholder engagement. We propose current opportunities for action, focusing on enhancing the adoption, fidelity, and sustainment of hand washing and social distancing; we can combine qualitative data, policy analysis, and dissemination science to inform agile and rapid adjustment to social marketing strategies to enhance their penetration. We look to future opportunities to enhance the integration of new evidence in decision-making, focusing on serologic and virologic testing systems; we can leverage simulation and other systems engineering modeling to identify ideal system structures. Finally, we discuss the ways in which the COVID-19 pandemic challenges implementation science to become more rapid, rigorous, and nimble in its approach, and integrate with public health practice. In summary, we articulate the ways in which implementation science can inform, and be informed by, the COVID-19 pandemic, looking backwards, proposing actions for the moment, and approaches for the future.