Fostering Implementation o f Sta ff s Creative Ideas to Improve - PowerPoint PPT Presentation

Fostering Implementation o f Sta ff ’s Creative Ideas to Improve Patient Health Care Experiences Yuna S.H. Lee, PhD, MPH Yale School of Public Health Current A ffi liation: Columbia Mailman School of Public Health Paul D. Cleary, PhD, MS Yale School of Public Health Ingrid M. Nembhard, PhD, MS Yale School of Public Health and Yale School of Management

Background • New ideas to improve the quality of health care delivery needed (Institute of Medicine 2012) • Many aspects of U.S. health care benefit from innovation: ideas, practices, policies or technologies that are new to the context (Rogers, 2003) • Creativity, the generation of novel and useful ideas (Amabile, 1988), is required for innovation, and may be useful for quality improvement

Fostering Creativity f or Quality Improvement • Many health care organizations encourage their clinical sta ff (e.g., physicians, nurses) to generate creative ideas for quality improvement (Terwiesch, Mehta and Volpp 2013) • Improving patient care experiences is a quality improvement priority (Agency for Healthcare Research and Quality, 2015) • Fostering creative ideas requires organizational e ff ort • Creative ideas may pose tension in health care settings (Gilson, 2005)

Research Aims Issue: Little is known about creativity in health care organizations. 1. To examine the impact of implementation of creative ideas on patient care experiences 2. Relationship between idea creativity and implementation 3. Moderators of the relationship between idea creativity and implementation ¡

Conceptual Framework + - - + Creative Idea Patient Care Idea Creativity Implementation Experiences + + + + ¡ ¡ Organizational Network Collaboration ¡ Tenure Centrality ¡ ¡ Sta ff -legitimizing Factors

Study Setting • 12 federally qualified community health centers (CHCs) in one system, in one state • Provide comprehensive primary care services to over 130,000 patients a year • CHCs involved in an improvement initiative from September 2013 to March 2015 § Initiative focused on generating and implementing ideas to improve patient care experiences

Study Design Longitudinal (18-months), mixed-methods study 220 improvement 72 improvement 2,201 patients ideas team members cared for by these generated from 12 CHCs individuals

Study Data • Patient Care Experiences Survey • Improvement Team Meeting Transcripts • Sta ff Work Experiences Survey • Wearable Sociometric Sensors

Methods: Analysis 1 Multivariate, mixed models (clustered at provider and center-level) Variable type Variable and Source Measured by • Dependent Variable Patient Care Experiences Care Coordination (items) • (source: patient survey) Provider Rating • Independent Proportion of high-creativity Each idea rated for novelty and usefulness • Variable implemented ideas per center Averaged creativity scores per idea across 5 (source: meeting transcripts) raters (Icc=0.79) • Per center: # of high-creativity ideas implemented / total ideas • Covariates Patient-level covariates Age, gender, education, race/ethnicity, (source: patient survey) length of relationship, number of visits • General health status, mental health status • Center-level covariates Percent of patients’ uninsured, percent of (source: patient survey, meeting patients with Medicare, patient visits per minutes, sta ff survey) full-time employee • Total number of ideas • Psychological Safety

Examples o f Improvement Ideas Implementation Outcome/Level of Low Creativity (score <3) High Creativity (score ≥ 3) Creativity Set up iPad in waiting room with tutorial on Identify local community Idea Implemented partners and develop a resource patient portal to increase adoption of patient portal with contact details at home Schedule weekly meeting Sta ff create a podcast to Idea Not between medical assistant and educate patients about Implemented primary care provider managing hypertension

Results: Analysis I Dependent ependent Var ariable iable Car are C e Coor oordination dination Provider R vider Rating ating (out of 5) out of 5) (out of 10) out of 10) Independent ndependent Var ariable iable β (SE) (SE) β (SE) (SE) Proportion of high-creativity, 1.33 (0.56) ** 2.15(0.96) ** implemented ideas per center N = 2,201; *p<0.05, **p<0.01, additional covariates included in analyses but not shown Implementation of creative ideas is positively associated with better patient care experiences Correlations Full Model

Methods: Analysis II Cox Proportional Hazards Models (clustered at sta ff and center-level) Variable type Variable and Source Measured by Dependent Variable Idea Implementation Idea implemented (source: meeting transcripts) Independent Idea Creativity Average creativity score per idea Variable (source: meeting transcripts) Moderating Collaboration Two or more people jointly raised idea Variables (source: meeting transcripts) Organizational Tenure “How long have you been employed?” (source: sta ff survey) (Less than 6 months” to “10 or more years” Network centrality Betweenness Centrality=normalized (0-1) (source: wearable sensors) number of times an individual acts as a bridge along the shortest path between two other individuals (Wasserman & Faust 1994) Covariates Sta ff -level covariates § Professional role (primary care provider, (source: sta ff surveys) nurse, medical assistant, behavioral health provider), § Gender Center-level covariates Center fixed e ff ects

Results: Analysis II Dependent ependent Var ariable iable Idea Creativit Idea Cr eativity and Idea I y and Idea Implementation mplementation Idea Idea 0.45 ¡ Idea ¡Implementa+on ¡Hazard ¡Ra+o ¡ Independent ndependent 0.4 ¡ Implementation mplementation 0.35 ¡ Var ariable iable 0.3 ¡ Hazard R Hazar d Ratio ( atio (CI) CI) 0.25 ¡ 0.2 ¡ Idea Creativity 0.40 (0.28-0.55) ** 0.15 ¡ 0.1 ¡ 0.05 ¡ 0 ¡ N=220; *p<0.05, **p<0.01, additional covariates included 1 ¡ 2 ¡ 3 ¡ 4 ¡ 5 ¡ professional role, gender and center Idea ¡Crea+vity ¡ Idea creativity is negatively associated with idea implementation Correlations Full Model

Results: Analysis II Full Model

Key Findings • Paradox of creative idea implementation in health care • Understanding how creative ideas may improve the organization and delivery of care could inform ongoing e ff orts to discover and evaluate new ideas • Resistance to creativity in health care similar to other industries • Legitimizing factors may serve as countervailing force • Generation and implementation of creative ideas are di ff erent processes, with each process a ff ected by di ff erent sta ff characteristics and behaviors • Creativity in health care organizations requires focused, concerted e ff ort

Study Limitations § Cannot conclude causal relationship nor specify if individual ideas had direct impact on patient care experiences § Results may not generalize to all primary care clinics § Intra-organizational factors that may a ff ect implementation not included

Implications For Health Services Research • Clinical sta ff may play key role in quality improvement • Implementation science frameworks may need to consider idea creativity For Organizational Research • Health care studies may provide new insights for creativity research • Greater need to study sta ff dynamics associated with successful creative idea implementation For Health Care Managers • Value in promoting sta ff creativity to improve quality improvement • Need to dedicate e ff ort to foster and facilitate creativity This research contributes to our understanding of why creativity matters, and why it should matter to health care

Thank you! yuna.lee@yale.edu / ysl2118@cumc.columbia.edu

Care Coordination Items • In the last 6 months, when this provider ordered a blood test, x-ray or other test for you, how often would someone from this provider’s o ffi ce follow up to give you these results? • In the last 6 months, did you get the help you needed from this provider’s o ffi ce to manage these di ff erent providers and services? • In the last 6 months, how often did the provider named in question 1 seem informed and up to date about the care you got from specialists? • In the last 6 months how often did you and anyone in this provider’s o ffi ce talk about all the prescription medicines you were taking? Return