What makes an effective Quality Improvement Manager? A qualitative study in the New Zealand Health System.

Purpose: Quality improvement is an international priority, and health organisations invest heavily in this endeavour. Little, however, is known of the role and perspectives of Quality Improvement Managers who are responsible for quality improvement implementation. We explored the quality improvement managers' accounts of what competencies and qualities they require to achieve day-to-day and long-term quality improvement objectives.

Evaluating factors associated with the cancellation and delay of elective surgical procedures: a systematic review.

Background: Elective surgery cancellation is considered a fundamental problem in health care services-it causes considerable disruption to patient flow, further eroding often already stretched operating capacity, and consequentially reduces both hospital performance and patient satisfaction. This research presents a systematic review (SR) of the reasons for surgery cancellation among different hospitals and countries. By highlighting these causes, we identify how to reduce cancellations, thereby improving the use of surgical capacity and resources and creating a more predicable patient flow.

Why is Quality Improvement so Challenging? A Viable Systems Model Perspective to Understand the Frustrations of Healthcare Quality Improvement Managers.

The challenges facing Quality Improvement Managers (QIMs) are often understood and addressed in isolation from wider healthcare organisation within which quality improvement initiatives are embedded. We draw on Stafford Beer's Viable System Model (VSM) to shed light on how the viability of quality improvement depends on the effective functioning of five critical quality improvement systems and the extent to which these systems are integrated within the healthcare organisation. These systems are System 1 (Operations), System 2 (Coordination), System 3 (Operational Control), System 4 (Development) and System 5 (Policy).

Lean thinking in healthcare - Findings from a systematic literature network and bibliometric analysis.

This paper draws on 299 published articles from six databases, and utilizes a novel methodology combining elements of a systematic literature review, citation network analysis, and bibliometric analysis, to track the development of Lean Thinking (LT) in healthcare-a popular improvement methodology increasingly being adopted by healthcare organizations. A review of the LT literature in healthcare identifies that a piecemeal approach appears to have been taken regarding LT in health, with departmental focused implementations rather than LT's intended systems approach. In addition, tool-myopic thinking tends to be a prevalent practice and often governs implementations, with less attention provided to soft practices such as continuous improvement and employee empowerment, undermining the long-term sustainability of LT's improvements.

Cheques and challenges: business performance in New Zealand general practice.

INTRODUCTION New Zealand general practice mainly functions as small businesses, usually owned by a single or small group of doctors. Consequently, owners often have to balance the provision of patient care with varying funding priorities, changing patient needs and the pressures of running a sustainable business. Such balancing inevitably leads to tensions developing between these factors.

Alignment of governance and senior executive perceptions of culture.

Purpose The purpose of this paper is to examine the alignment of perceived organizational culture between Health Board chairs and Board members with that of their respective senior executive teams. It compares the degree of alignment between these two groups, and analyses them against District Health Board (DHB) performance using the New Zealand Ministry of Health's national measure "shorter stays in Emergency Departments." Design/methodology/approach Primary survey data were collected across eight DHBs using a modified version of the Organizational Culture Assessment Instrument and utilizes a sample of both higher and lower performing DHBs as defined by the "shorter stays" measure.

Service delivery under translation: multi-stakeholder accountability in the non-profit community sector in New Zealand.

This paper addresses the challenge reported in the research literature of providing adequate accounts of service quality and value to multiple stakeholders. Rather than starting with a particular accountability practice, we examine the accounts of complex service delivery and results from the perspective of five key stakeholder groups. The case study at the empirical centre of this research is a small New Zealand non-profit organisation that provides community-based wraparound casework to young people, and their families, with multiple and complex needs.