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The survey documented the admin- istrators’ rating of the importance of the initiatives, the interviewees’ degree of involvement with each initiative, and identification of who else was involved with each initiative. Of particular impor- tance to this study were open-ended questions asking participants to identify critical success factors for each initiative.
Analytical Approach For purposes of this article, we focused on two analytical steps:
1. Compiling demographic data collected to present a profile of the 61 interviewees, including age, gender, healthcare experience, tenure, and rank
2. Conducting qualitative analysis to identify common themes related to success factors for the implementation of change initiatives identified by the interviewees using rich qualitative data from the 61 personal interviews
The structure of the qualitative anal- ysis was not led by previous knowledge about success factors or steps toward successful implementation of change
initiatives as presented in the literature review. The research team approached the results of the administrators’ inter- views with the purpose of theory build- ing by identifying all the dimensions and themes related to success factors for the implementation of change initiatives in the healthcare setting. The research team followed grounded theory meth- odology by applying inductive content analysis when coding the interview data. Team members used open coding and then organized the codes into corre- sponding subcategories, which resulted in the overarching themes (Strauss & Corbin, 1997). Codes were identified and named at different levels of analysis and consisted mostly of descriptive, with some inferential, code and theme names (Miles & Huberman, 1994). Coding of the interview transcripts was performed in teams of two researchers with the addition of a third independent coder, who validated the initial coding and helped settle discrepancies. The themes and their corresponding codes are pre- sented in Figure 2 and discussed further in the Results section.
Each theme resulted from a pattern identified in the interviewees’ responses. During the coding process, the research team made an initial pass through the transcripts followed by a review of the coding and assignment criteria (Miles & Huberman, 1994). Team members met regularly to reevaluate code assignments and corrections based on the definitions resulting from cross-examination. This process helped ensure interrater reliabil- ity as codes were assigned, and members reviewed each other’s coded material to ensure consistency.
OF HEALTHCARE MANAGEMENT 59:1 IANUARY/FEBRUARY 2014
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SUGGESS FAGTORS FOR STRATEGIG C H A N G E INITIATIVES
RESULTS First, we offer a brief description of the two research settings, the children’s health system and the multihospital health system, including the nature of the strategic change initiatives studied. Second, we present profiles of the inter- view participants to provide some con- textual background to their response. Finally, we present success factor themes resulting ftom the interviews.
Children’s Health System The children’s health system is located in a large metropolitan area. Interview participants included executive leaders, vice presidents, directors, and assistant directors in the main operating structure of the organization. This organization was pursuing the following strategic change initiatives:
1. Two building projects—a clinical building to house a new program, and a new satellite hospital
2. Research initiatives involving large investments
3. The launch of a physician service organization to serve as a hospital- based billing and collections service for staff and contracted physicians’ professional fees
4. The implementation and integration of a new electronic health record system (EHR)
5. A medical school consolidation initiative, which involved restructuring and formalizing the system’s relationship with a medical partner to improve the overall health of the children in the service area
6. An inpatient quality and patient safety program
7. Various patient flow improvement initiatives
8. A cost containment initiative to improve staff management and resource utilization
Multihospital Health System The multihospital system is a large, regional, multihospital health system. The study participants were located at the system’s corporate office and were responsible for its overall direc- tion, operation, and financial health. At the time of the analysis, five initia- tives designed to transform the way the health system and its member hospitals operated were being pursued as part of the system’s strategic plan. Each initia- tive was associated with specific goals to be met over the next 5 to 10 years and included the following:
1. A culture change initiative, including application to the Malcolm Baldrige National Quality Award program
2. A physician engagement initiative to advance physician alignment with the organization
3. A quality and safety initiative, which focused on reducing medical errors
4. A cost-effectiveness initiative to help the organization improve resource management
5. A provider and coordinator of care initiative to align and integrate patient care and coordination throughout the system
JOURNAL OF HEALTHCARE MANAGEMENT 59:1 JANUARY/FEBRUARY 2014
Participants’ Profiles The results presented in Table 1 address the first analytical step regarding the profile of the 61 interviewees from the two health systems.
The interviewees had from 1 to 41 years of healthcare experience, had been at their current organization from 6 months to 39 years, and included 19 physician administrators. The partici- pants were split almost equally in terms of gender—29 females and 32 males. At the children’s health system, the major- ity of the interviewees held positions of director, chief, or medical director; vice president; or senior vice president. The multihospital health system’s interview- ees mostly held executive vice president.
president, senior vice president, or vice president positions.
Success Factors The qualitative data results were derived from the question about success fac- tors associated with each change initia- tive identified by the interviewee. The process of inductive qualitative analysis resulted in 39 emerging codes for the success factor responses, which were grouped into 10 overarching success fac- tor themes (see Figure 2).
Next, the 10 success factor themes were organized by strategic change initiative and health system. All code counts associated with the 10 themes are presented in Table 2.
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