Enhancing Organizational Change and Improvement Prospects: Lessons from an HIV Testing Intervention for Veterans

By Sobo, Elisa J.; Bowman, Candice et al. | Human Organization, Winter 2008 | Go to article overview

Enhancing Organizational Change and Improvement Prospects: Lessons from an HIV Testing Intervention for Veterans


Sobo, Elisa J., Bowman, Candice, Aarons, Gregory A., Asch, Steven, Gifford, Allen L., Human Organization


Most research on why health care quality improvement implementation succeeds or fails focuses on front-line or providerbased factors. However, background factors related to the structures and processes of projects themselves also pose challenges. Using a focused ethnographic assessment approach, we undertook a case study to characterize particularly challenging background factors in an ongoing implementation effort. We found that the organizational structure of the project under study sustained several key "cultural" differences in stakeholder agendas. Moreover, it fostered the emergence of strategic communication processes that, despite their immediate utility, sometimes undermined progress and threatened long-term relations by distorting information flow in particularly patterned ways. These included a "focus on the local" and "information reconfigurations" or "partiality" that sometimes led to miscommunication or interpretive disjunctions between various stakeholders. Successful cross-organizational communication is in certain ways a crosscultural achievement, and several guidelines were devised to facilitate this. Our experience with other health care systems and with health services research in general suggests that our findings and recommendations are broadly applicable. Because the main barriers identified were generated by complex organizational arrangements, lessons learned may also be transferable to other complex organizational contexts.

Key words: implementation science, quality improvement, organizational culture, health services research and delivery, collaboration, HIV/AIDS

Introduction

Improving health care is hard. It is hard at the local level and may be even harder in large health care organizations, where various departments or units are concerned with different aspects of quality and safety. The difficulties entailed in cross-organizational communication and collaboration may mean that the diverse aims and agendas of such groups remain in competition. This can, itself, create and maintain missed opportunities for improvement as well as fostering organizational environments in which improvement is much harder-won than need be.

How can we enhance opportunities for productive crossorganizational collaboration? This article presents several strategies to that end, derived from a case study of efforts to increase HIV testing within the United States Veterans Health Administration (VHA). The intervention unwittingly placed various stakeholder groups in competition with one another, undermining cross-organizational communication and creating barriers to full collaboration. Transferable lessons were learned about ways to mitigate such competition, thereby smoothing bumpy relations and enhancing collaboration. Our combined experience suggests that this is a systemic, socioculturally rooted problem inherent in large, complex organizations. Therefore, the strategies we devised to combat it are summarized at the article's end.

Background

Quality Enhancement Research in the VHA

The VHA's Quality Enhancement Research Initiative (QUERI) exists to enhance VHA health care in regard to organizationally-prioritized high-risk and/or highly prevalent diseases or conditions. Work is carried out through nine individual "centers" by affiliated, grant-funded researchers. The centers are physically located at VHA facilities throughout the United States, but report directly to the central office (VHACO). Therefore, while each has a specific disease or condition-related focus, each center's work is intended to cross-cut activities in all 21 of the VHA's regional integrated service networks or VISNs.

Following accepted health services research (HSR) standards described by Donabedian (1966, 1980), in evaluating quality of care, QUERI focuses on structures (provider and organizational characteristics), processes (providers' clinical actions toward patients), and outcomes (health status, economic impact, satisfaction). …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • A full archive of books and articles related to this one
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Enhancing Organizational Change and Improvement Prospects: Lessons from an HIV Testing Intervention for Veterans
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

    Already a member? Log in now.