Improving the Quality of Health Care Services through Diversity and Inclusive Leadership

 说明(申请人提供)：为了满足来自低收入和不同种族/民族背景的儿童的需求，卫生保健组织不断努力培养更多种族多元化的劳动力，以匹配他们的客户。1-4然而，实现劳动力多样化可能会导致新的服务提供挑战，例如增加工作人员冲突、不信任和流动率，5-9这可能会减少工作人员对质量改进工作的参与度10，并最终导致更差的服务质量和效率。10，11通过创造一个包容各方的工作场所，将劳动力多样性转化为积极成果的一种方式。8，12，13虽然包容(即，个人作为组织中独特而重要的一部分的价值感8 22)与几个有益的结果有关，如提高工作满意度、留任和创新，8其在改善保健服务质量和有效性方面的作用尚未得到检验，组织领导人如何促进工作场所包容性也鲜为人知。14-16目标：拟议的研究将使用一种创新的视角，考虑儿科医院的动态和日益多样化的背景，以检查领导力和工作环境可能如何影响保健服务的质量。与AHRQ的使命相关：拟议的项目与改善美国医疗保健的关键问题相关17，18并响应保健研究和质量机构(AHRQ)的使命，该机构致力于支持提高低收入儿童保健服务质量的研究。目的：拟议研究的具体目标是：(1)检查包容性对医疗服务质量和有效性的影响程度；(2)检查领导力和包容性对医疗服务创新的影响程度，并最终影响医疗服务的质量和有效性；(3)探索领导力、包容性、创新和医疗服务质量之间潜在关系的机制。方法：采用纵向混合方法设计，建议的研究将集中在美国最多样化的儿科医院之一的病理和实验室医学部。该部门在该医院的研究、治疗和诊断方面发挥着关键作用，该医院为来自加利福尼亚州洛杉矶的低收入市中心儿童提供服务。首先，将使用对医院员工的定量调查来完成目标1和目标2(调查数据将在三个时间点收集，每6个月收集一次)，然后对不同样本的医院员工进行定性访谈和观察，以实现目标3。调查数据将用于测试领导力、包容性、创新和医疗保健服务质量的概念模型，而访谈和观察将用于帮助解释概念模型中的关系如何在日常组织过程中表现出来。影响：从拟议的研究中获得的信息可以用来帮助提供工作场所干预措施，旨在提高儿科保健服务的质量和有效性。

 DESCRIPTION (provided by applicant): To meet the needs of children from low-income and diverse racial/ethnic backgrounds, health care organizations continually strive to develop more ethnically diverse workforces to match their clientele.1-4 Achieving a diverse workforce, however, can result in new service delivery challenges such as increased staff conflict, distrust, and turnover,5-9 which can decrease staff engagement in quality improvement efforts10 and ultimately result in poorer service quality and effectiveness.10,11 One way to channel workforce diversity into positive outcomes is by creating an inclusive workplace.8,12,13 Although inclusion (i.e., an individual's sense of being valued as a unique and important part of an organization8,22) has been linked to several beneficial outcomes, such as increased job satisfaction, retention, and innovation,8 its role has yet to be examined with improving the quality and effectiveness of health care services, and little is known about how organizational leaders can promote workplace inclusion.14-16 Objective: The proposed study will use an innovative lens that considers the dynamic and increasingly diverse context of pediatric hospitals to examine how leadership and the work environment may influence the quality of health care services. Relevance to the Mission of AHRQ: The proposed project is relevant to critical issues in improving health care in the United States17, 18 and is responsive to the mission of the Agency for Healthcare Research and Quality (AHRQ), which strives to support research that enhances the quality of health care services for low-income children. Aims: The specific aims of the proposed research are to: (1) examine the extent to which inclusion influences the quality and effectiveness of health care services; (2) examine the extent to which leadership and inclusion influence innovation and ultimately the quality and effectiveness of health care services; and (3) explore the mechanisms underlying potential relationships among leadership, inclusion, innovation, and the quality of health care services. Method: Using a longitudinal mixed-method design, the proposed study will focus on a pathology and laboratory medicine department of one of the most diverse pediatric hospitals in the United States. The department plays a critical role in research, treatment, and diagnoses for the hospital, which serves low- income, inner-city children from Los Angeles, California. Initially, quantitative surveys of hospital staff members will be used to accomplish Aim 1 and Aim 2 (survey data will be collected at three time points at 6-month intervals), followed by qualitative interviews and observations with diverse samples of hospital staff members to accomplish Aim 3. The survey data will be used to test a conceptual model of leadership, inclusion, innovation, and health care service quality, whereas the interviews and observations will be used to help explain how the relationships in the conceptual model manifest themselves in day-to-day organizational processes. Implications: The information gained from the proposed research can be used to help inform workplace interventions designed to improve the quality and effectiveness of pediatric health care services.