QUALITY IMPROVEMENT

Quality Improvement Through Leadership

Ashley Winans
HCA 622
February 22, 2015
Professor Robert Clegg

QUALITY IMPROVEMENT

Quality Improvement Through Leadership

Quality is linked to continual improvement and organizations need to promote this as part
of their culture. The value of creating a culture of improvement must start at the top of the
organization (Ransom, Joshi, Nash & Ransom, 2008, P. 10). Alignment, defined as a position of
agreement or alliance, is crucial in order to run an organization effectively and efficiently as well
as to promote a a culture conducive to continual change and improvement. Creating alignment is
an essential leadership function and can differentiate an effective leader from the others.
Alignment in an organization can help to inspire as well as promote quality improvement.
Although this may seem like an easy conceptualization, alignment does not happen automatically
and, when done properly, often takes initiate from the individuals in leadership positions.
According to Ransom, leaders can increase organizational alignment by simultaneously
reviewing and monitoring the critical measures across multiple dimensions of performance
(Ransom, Joshi, Nash & Ransom, 2008, P. 218). Alignment can be established or created using
several methods and is the most effective when measurement is used in conjunction with
supporting the deployment of changes.

It has been shown that leader behavior influences both group and organizational
behavior; however, leadership remains a central, but sometimes controversial, topic in
organization research [which is] partially because leadership tends to be slandered and
criticized by the dominant paradigms and perspectives of an organization ( OReilly, Caldwell,
Chatman, Lapiz, M. & Self, 2010, P.1). The effectiveness of leadership is tested when an an
organization changes its strategy, and almost by design the leadership role is challenged as well.
Regardless of the effects of an individual leader, the alignment or the misalignment of leaders

QUALITY IMPROVEMENT

across hierarchical levels may enhance or detract from the successful implementation of a
strategic initiative. It is also interesting to note that the more highly a department perceives that
their leader supports a new initiative, the more likely they are to accept and adapt to new
changes. In a study which entailed implementing a new strategic initiative in hopes of improving
patient service and satisfaction, it was determined that it is the alignment of leadership across
hierarchical levels that matters (OReilly, Caldwell, Chatman, Lapiz, M. & Self, 2010, P. 112).
One exceptional example of methods of creating alignment and how the use of
measurements support their deployment is an article from Nursing Economics. This excellent
example is a detailed account of how to construct alignment from the ground up. Authors Miles
and Vallish describe their process of creating a customized professional framework for nursing.
Instead of adopting a cookie cutter framework or similar framework from another
organization, they chose to spend a considerable amount of time designing their own. Although,
they made mistakes along the way, they were pleased with the end product because their
framework ultimately ensures a cultural alignment and is cemented in their ownership of it and
its ideals. They were able to include the key processes which would greatly influence how their
work was conducted as well and allowed them more control over their desired outcomes. They
picked and developed their own evaluative methods in order to determine progress and perhaps
most importantly, which they used to bridge the gap between practice and theory. Their
framework also pulled from theory, most notably Donabedian's SPO Model (1980), and
achievements of measurable outcomes. (Miles & Vallish, 2010)

Miles and Vallish use measurements in order to support their deployment. They pulled
from supporting literature, conceptual models, guiding principles, and standards of excellence as
outlined by the American Nurses Credentialing Center. These measurements not only give them

QUALITY IMPROVEMENT

credibility, but more importantly established standards to hold themselves and their framework
up to. Effective leaders learn the models which work and often reframe the models into ones
that work for their specific situations (Ransom, Joshi, Nash & Ransom, 2008, P. 321). Because
Miles and Vallish have complete ownership over their system and framework, this will enable to
serve as more productive leaders and to better promote alignment and necessary values in their
organization. (Miles & Vallish, 2010)

In order to create alignment, several essential leadership traits are required. According to
Anne Sado, president of George Brown College in Toronto, an organization must first have a
vision and leadership which will aspire to uphold this vision and innovate. Sado identified four
essential leadership traits: People, purpose, perseverance, and patience. First, people want to be
engaged in a purposeful way. It is the job of a leadership team to provide an authentic work
environment where sharing knowledge, ideas and concerns about the business are encouraged
(Maguire, 2012, P. 11). It is also essential for leadership to ensure that people know the direction
in which the organization is going, how they fit into it, and how this purpose will fit into their
jobs and daily activities. (Maguire, 2012)

Perseverance is an essential and sometimes overlooked leadership trait. It speaks to an

individuals abilities to overcome challenges as well as inspire others to do the same. Maguire
points out that the difference between the impossible and the possible was perseverance
(Maguire, 2012, P. 11). Lastly, we have patience which is often called a virtue. It will allow a
leader to better achieve long term results and also to lead by example. (Maguire, 2012)

QUALITY IMPROVEMENT

Leadership and alignment are increasingly essential in the health IT world, which is
where there is increasing growth and room for quality improvement. According to Abel,
leadership is going to be increasingly important in the IT world. Leadership in IT will require:

investigating how the appropriately defined learning outcomes can be enabled by

applied innovation; it will require engendering widespread adoption; and it will
require being accountable and taking the lead in establishing and ascertaining the
learning impact of an institution's strategic investments in technology. (Abel, 2008,
P.13)
However, the function of IT leadership will be to comprehend the alignment of all outside factors
(such as perceived quality, access, and affordability) to both the integrity and mission statement
of the associated company or institution; much as mentioned previously by Miles and Vallish.
(Miles & Vallish, 2010)
Effective leadership is essential for quality improvement. Improvement requires both
processes and people to undergo change, and for this change to be truly transformative,
leadership is a crucial element. Although there is no specific formula for successful leadership
and change, leaders must work on a plan to achieve things within their control and influence
others as much as they can within their realm of influence.

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6
References

Abel, R. (2007). Innovation, Adoption, and Learning Impact: Creating the Future of IT.
EDUCAUSE Review, 42(2), 13.
Maguire, T. (2012). Four leadership traits. Canadian HR Reporter, 25(20), 11-12.
Miles, K. S., & Vallish, R. (2010, May-June). Creating a personalized professional practice
framework for nursing. Nursing Economics, 28(3), 171-178.
OReilly, C.A., Caldwell, D.F., Chatman, J.A., Lapiz, M. & Self, Q. (2010). How leadership
matters: the effects of leaders alignment on strategy implementation. The Leadership Quarterly,
21(2), 104-113.
Ransom, E.R., Joshi, M.S., Nash, D.B., & Ransom, S.B. (eds.). (2008). Healthcare quality book:
Vision, strategy, and tools (2nd ed.). Chicago, IL: Health Administration Press.

QUALITY IMPROVEMENT

APPENDIX A
Attach your appendix item here. If no appendices are needed, then omit this page. If more than
one appendix is needed, continue to the following page, place APPENDIX B (in all caps)
centered at the top of the page, and then attach the applicable item (e.g., table, figure, graph,
illustration, etc.). Continue the same process as necessary for all subsequent appendices.