Table 2 Conditions favouring organisational changes
Determinants | Case 1 | Case 2 | Case 3 | Case 4 | Case 5 |
|---|---|---|---|---|---|
General environment | Serious financial problems and major financial cuts. | New provincial accountability agreement. | Presence of the Foundation of Leadership and its Thousand and One Leaders Program. | Financial pressure. | Absence of a faculty of medicine Few opportunities for external recognition. |
Fundamentals | Merger into a single region. Quality of care and client-centering recognized as important values. Teamwork and creativity encouraged | Merger of three hospitals. Increase in cognitive capacities by hiring new staff with higher qualifications and experience. Autonomy encouraged. | Placement under the guardianship of a supervisor in 2001 and again in 2002. New board committee structure and a new set of board policies. A new CEO appointed in 2003. High turnover of personnel. | Increasing services offered to meet to the needs of the local population Recruitment campaign to hire 50 physicians. Good relationships with the ministry of health. | Merger into a RHA Appointment of a new board. Focus on patient care. |
Strategies | Creation of forums where leadership seeks staff input; numerous newsletters; online chats; investigative teams frequently created to inform quick decisions. | Surveys, regular visits from vice-presidents, regular meetings of professional teams. Communication plan for the entire hospital for every decisions taken by the board of directors | Managers meet monthly with clinical and support assistants; multidisciplinary unit councils make decisions for major initiatives Professionals are consulted on all matters | Horizontal exchanges of ideas and horizontal learning and dissemination of information. | Training courses, including incident reporting system; audits; patient surveys; benchmarking. |
Leadership and Competencies | Strong leadership by experienced management at all levels CEO's involvement in QI. Creation of a quality department and quality teams for the accreditation process. | High level of leadership dissemination. CEO's personally involved in QI | Member of the Foundation of Leadership and its Thousand and One Leaders Program. Strong legitimacy of the quality director | Strong leadership by the CEO. Focus on outcomes and not processes - | Leadership for QI encouraged at all levels Director of QI and Risk Manager seen as leaders. |
Conceptualization /Philosophy | Developed a confident and accountable method of decision-making. | Seemed to have the ability to critique itself. | Seemed keen to accept new model of thinking. | Felt the duty to meet public expectations. | Presented a certain lack of self-worth |