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Dissertation/Thesis Abstract

Fostering creativity to improve health care quality
by Lee, Yuna Swatlian Hiratsuka, Ph.D., Yale University, 2017, 116; 10633255
Abstract (Summary)

Eliciting and evaluating new ideas to improve the quality of health care are important processes for health care organizations. Creativity, which refers to the generation of novel and useful ideas, is required for innovation and is valued by many organizations. Health care staff (e.g., primary care providers, nurses and medical assistants) can be an important source of creative ideas. In my dissertation, I conducted a longitudinal, mixed methods study of 220 improvement ideas generated over 18 months by improvement team members from 12 federally qualified community health centers. I also analyzed the experiences of 2,201 patients cared for by these individuals. I used data from patient surveys, quality improvement team meeting transcripts, staff surveys and wearable sociometric sensors.

Part one of this research draws on organizational theory to develop hypotheses and tests empirically the impact of creative idea implementation on patient care experiences, the relationship between idea creativity and implementation, and moderators of this relationship. Results suggest that the implementation of creative ideas is positively associated with better patient care experiences, but such ideas are less likely to be implemented. Three staff-level characteristics - more collaborative relationships, longer organizational tenure, and higher network centrality (a more central position in the organization's social network) – increase the likelihood that staff's creative ideas will be implemented. Part two of this research assesses the health care staff characteristics associated with idea creativity. The results show that staff with a peripheral perspective on care delivery (behavioral health provider and medical assistant), and staff with lower satisfaction and who have a shorter organizational tenure, are significant correlates of idea creativity. Part three of this dissertation focuses on the tactics that quality improvement leaders use to foster idea creativity, evolution, and implementation in their groups. The results suggest that the leader tactic of brainstorming is associated with groups having more creative, rapidly implemented, low-engagement ideas, which might be an effective tactic for leaders seeking disruptive change. The tactic of group reflection on process is associated with slower implemented, high-engagement ideas, which might help leaders elicit well-considered and deliberated solutions. I develop a conceptual framework for understanding creativity in health care organizations based on these findings, which may help scholars and health care professionals improve their understanding of health care innovation and how better to facilitate the expression and implementation of creative ideas.

This dissertation contributes to health services and organizational research by elucidating how creativity in health care organizations is fostered and facilitated, and how it affects outcomes. Understanding how creative ideas may improve the organization and delivery of quality care could facilitate efforts to discover and evaluate new ideas regarding the quality of health care delivery.

Indexing (document details)
Advisor: Cleary, Paul D.
School: Yale University
School Location: United States -- Connecticut
Source: DAI-B 78/11(E), Dissertation Abstracts International
Subjects: Public health, Organizational behavior, Health care management
Keywords: Creativity, Innovation, Patient Experience, Patient Satisfaction, Quality Improvement, Quality of Care
Publication Number: 10633255
ISBN: 978-0-355-10547-6
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