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The purpose of this paper is to examine how the design and implementation of learning models for performance management can foster continuous learning and quality improvement within a publicly funded, multi-site community hospital organization.

Niagara Health’s patient flow performance management system, a learning model, was studied over a 20-month period. A descriptive case study design guided the analysis of qualitative observational data and its synthesis with organizational learning theory literature. Emerging from this analysis were four propositions to inform the implementation of learning models and future research.

This performance management system was observed to enable: ongoing performance-related knowledge exchange by creating opportunities for routine social interaction; collective recognition and understanding of practice and performance patterns; relationship building, learning for improvement, and “higher order” learning through dialogue facilitated using humble inquiry; and, alignment of quality improvement efforts to organizational strategic objectives through a multi-level feedback/feed-forward communication structure.

The single organization and descriptive study design may limit the generalizability of the findings and introduce confirmation bias. Future research should more comprehensively evaluate the impact of learning models on organizational learning processes and performance outcomes.

This study offers novel insight which may inform the design and implementation of learning models for performance management within and beyond the study site.

Few studies have examined the mechanics of performance management systems in relation to organizational learning theory and research. Broader adoption of learning models may be key to the development of continuously learning and improving health systems.

Health literate discharge practices meet patient and family health literacy needs in preparation for care transitions from hospital to home. The purpose of this paper is to measure health literate discharge practices in Ontario hospitals using a new organizational survey questionnaire tool and to perform psychometric testing of this new survey.

This survey was administered to hospitals in Ontario, Canada. Exploratory factor analysis and reliability testing were performed.

The participation rate of hospitals was 46 percent. Exploratory factor analysis demonstrated that there were five factors. The survey, and each of the five factors, had moderate to high levels of reliability.

There is a need to expand the focus of further research to examine the experiences of patients and families. Repeating this study with a larger sample would facilitate further survey development.

Measuring health literate discharge practices with an organizational survey will help hospital managers to understand their performance and will help direct quality improvement efforts to improve patient care at hospital discharge and to decrease hospital readmission.

There has been little research into how patients are discharged from hospital. This study is the first to use an organizational survey tool to measure health literate discharge practices.

The relatively recent attention that evidence-based decision making has received in health care management has been at least in part due to the profound influence of evidence-based medicine. The result has been several comparisons in the literature between the use of evidence in health care management decisions and the use of evidence in medical decision making. Direct comparison, however, may be problematic, given the differences between medicine and management as they relate to (1) the nature of evidence that is brought to bear on decision making; (2) the maturity of empirical research in each field (in particular, studies that have substantiated whether or not and how evidence-based decision making is enacted); and (3) the context within which evidence-based decisions are made. By simultaneously reviewing evidence-based medicine and management, this chapter aims to inform future theorizing and empirical research on evidence-based decision making in health care settings.

The purpose of this paper is to describe the development of a coherent conceptual framework that could guide research that enhances our understanding of the factors that influence extra-role workplace behaviors and work performance in health care. In health-care settings, work performance is dependent upon worker’s extra-role behaviors.

The authors draw upon theory and current research in the field of organizational behavior and work motivation to explain the relationships between extra-role behaviors (ERBs), commitment, perceived organizational support (POS) and justice. These behaviors are related to a number of factors, including one’s affective commitment, POS and organizational justice. The influence of most of these concepts on work outcomes has been established in disparate studies, but their precedence in terms of influencing extra-role behaviors is not well understood.

An augmented framework is produced, incorporating concepts of relevance to work motivation and work attitudes. Propositions, predicated on research evidence, are offered.

Spontaneous, emotional and/or reflexive behaviors are not accounted for in the conceptual framework.

By adjusting interaction with employees, managers can bring about positive effects, facilitating constructive ERBs, which can improve work performance and productivity, patient safety, care quality and enable cost savings.

This paper offers a novel comprehensive framework based upon a comprehensive literature review.

To examine the evolution of health care integration strategies and associated conceptualization and practice through a review and synthesis of over 25 years of international academic research and literature.

A search of the health sciences literature was conducted using PubMed and EMBASE. A total of 114 articles were identified for inclusion and thematically analyzed using a strategy content model for systems-level integration.

Six major, inter-related shifts in integration strategies were identified: (1) from a focus on horizontal integration to an emphasis on vertical integration; (2) from acute care and institution-centered models of integration to a broader focus on community-based health and social services; (3) from economic arguments for integration to an emphasis on improving quality of care and creating value; (4) from evaluations of integration using an organizational perspective to an emerging interest in patient-centered measures; (5) from a focus on modifying organizational and environmental structures to an emphasis on changing ways of working and influencing underlying cultural attitudes and norms; and (6) from integration for all patients within defined regions to a strategic focus on integrating care for specific populations. We propose that underlying many of these shifts is a growing recognition of the value of understanding health care delivery and integration as processes situated in Complex-Adaptive Systems (CAS).

This review builds a descriptive framework against which to assess, compare, and track integration strategies over time.

Large-scale change involves modifying not only the structures and functions of multiple organizations, but also the mindsets and behaviours of diverse stakeholders. This paper focuses on the latter: the informal, less visible, and often neglected psychological and social factors implicated in change efforts. The purpose of this paper is to differentiate between the concepts of organizational culture and mental models, to argue for the value of applying a shared mental models (SMM) framework to large-scale change, and to suggest directions for future research.

The authors provide an overview of SMM theory and use it to explore the dynamic relationship between culture and cognition. The contributions and limitations of the theory to change efforts are also discussed.

Culture and cognition are complementary perspectives, providing insight into two different levels of the change process. SMM theory draws attention to important questions that add value to existing perspectives on large-scale change. The authors outline these questions for future research and argue that research and practice in this domain may be best served by focusing less on the potentially narrow goal of “achieving consensus” and more on identifying, understanding, and managing cognitive convergences and divergences as part of broader research and change management programmes.

Drawing from both cultural and cognitive paradigms can provide researchers with a more complete picture of the processes by which coordinated action are achieved in complex change initiatives in the healthcare domain.

John D. Blair examines, in systematic detail, the challenges and opportunities that arise from the significantly different perspectives of context-specific versus context-free researchers and the literatures to which they contribute. He argues that reviews of one type or the other or both types of literatures may provide different understandings of the state of the art in a particular area of health care management. He also provides some detailed suggestions for writing quality reviews along with suggested topics for future reviews.