In a longitudinal qualitative study, the authors evaluated two health care quality improvement (QI) methods that emphasized either participation (local approach) or expertise (central approach). They followed teams using these approaches to develop depression care QI programs for primary care practices over several years, observing their processes and outcomes and learning about participants' perceptions, beliefs, and experiences. Concordant with the literature, most participants preferred the local approach, but some were willing to relinquish some decision making to experts. Participants identified unique advantages of both the local (e.g., maximizes buy-in and local fit) and central (e.g., maximizes efficiency, reduces burden) approaches. The authors propose a hybrid model in which experts make strategic decisions about what practices to adopt and local site personal make tactical decisions about implementation. They believe that balancing participation and expertise provides the best formula for producing lasting QI for health care organizations across a wide variety of circumstances.
Armstrong, D. (2002). Clinical autonomy, individual and collective: The problem of changing doctors' behavior. Social Science & Medicine, 55, 1771-1777.
2.
Badamgarav, E., Weingarten, S.R., Henning, J.M., Knight, K., Hasselblad, V., Gano, A., Jr., et al. (2003). Effectiveness of disease management programs in depression: A systematic review. American Journal of Psychiatry,160, 2080-2090.
3.
Berwick, D.M. (1989). Continuous improvement as an ideal in health care . New England Journal of Medicine, 320, 53-56.
4.
Burger, J.M., McWard, J., & LaTorre, D. (1989). Boundaries of self-control: Relinquishing control over aversive events. Journal of Social and Clinical Psychology , 8, 209-221.
5.
Casalino, L.P. (2004). Physicians and corporations: A corporate transformation of American medicine?Journal of Health Politics, Policy, and Law, 29, 869-883.
6.
Cotton, J.L. (1995). Participation's effect on performance and satisfaction: A reconsideration of Wagner. Academy of Management Review , 20, 276-278.
7.
Elden, M. (1986). Sociotechnical systems ideas as public policy in Norway: Empowering participation through worker-managed change. Journal of Applied Behavioral Science, 22, 239-255.
8.
Emery, F. (1993). The second design principle: Participation and the democratization of work. In E. Trist & J. Murray (Eds.), The social engagement of social science: A Tavistock anthology (Vol. 2, pp. 214-233). Philadelphia: University of Pennsylvania Press.
9.
Exworthy, M., Wilkinson, E.K., McColl, A., Moore, M., Roderick, P., Smith, H., et al. (2003). The role of performance indicators in changing the autonomy of the general practice professional in the UK. Social Science & Medicine, 56, 1493-1504.
10.
Fixsen, D.L., Naoom, S.F., Blasé, K.A., Friedman, R.M., & Wallace, F. (2005). Implementation research: A synthesis of the literature (FMHI Publication #231). Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute , National Implementation Research Network.
11.
Gask, L. (2004). Powerlessness, control, and complexity: The experience of family physicians in a group model HMO. Annals ofFamily Medicine, 2, 150-155.
12.
Greenhalgh, T., Robert, G., McFarlane, F., Bate, P., Kyriakidou, O. (2004). Diffusion of innovation in service organizations: Systematic review and recommendations. Milbank Quarterly, 82, 581-629.
13.
Grol, R., Wensing, M., & Eccles, M. (2005). Improving patient care: The implementation of change in clinical practice. London: Elsevier.
14.
Hackman, J.R., & Wageman, R. (1995). Total quality management: Empirical, conceptual, and practical issues. Administrative Science Quarterly,40, 309-342.
15.
Heller, F. (1998). Influence at work: A 25-year program of research . Human Relations, 51, 1425-1456.
16.
Karasek, R.A. (1979). Job demands, job decision latitude, and mental strain: Implications for job redesign. Administrative Science Quarterly,24, 285-301.
17.
Katon, W., Von Korff, M., Lin, E., Walker, E., Simon, G.E., Bush, T., et al. (1995). Collaborative management to achieve treatment guidelines: Impact on depression in primary care. Journal of theAmerican Medical Association, 5, 1026-1031.
18.
Krippendorf, K. (2004). Content analysis: An introduction to its methodology . Thousand Oaks, CA: Sage.
19.
Larson, M.S. (1977). The rise of professionalism. Berkeley: University of California Press.
20.
Levin, H.M. (2004, February). Work democracy: Is it feasible?Paper presented at the Interrupting Oppression and Sustaining Justice Conference, New York.
21.
Locock, L., Regen, E., & Goodwin, N. (2004). Managing or managed? Experience of general practitioners in English primary care groups and trusts. Health Services Management Research, 17, 24-35.
22.
Luck, J., Parker, L.E., Hagigi, F., Yano, E.M., & Kirchner, J.E. (2006). Marketing: An essential component for effectively implementing evidence-based interventions in the VA. Workshop presented at the VA Health Services Annual Meeting, Washington, DC.
23.
Mechanic, D. (1991). Sources of countervailing power in medicine. Journal of Health Politics, Policy, and Law, 16, 485-498.
24.
Mechanic, D. (1997). Approaches for coordinating primary and specialty care for persons with mental illness. General HospitalPsychiatry , 19, 395-402.
25.
Mechanic, D. (2000). Managed care and the imperative for a new professional ethic. Health Affairs,19, 100-111.
26.
Miller, K.I., & Monge, P.R. (1986). Participation, satisfaction, and productivity: A meta-analytic review. Academy of Management Journal, 29, 727-753.
27.
Muhr, T. (2004). Atlas.ti Version 5.0. Berlin , Germany: Scientific Software Development.
28.
Navarro, V. (1989). Professional dominance or proletarianization? Neither?Milbank Quarterly,66 (Suppl. 2), 57-75.
29.
Parker, L.E. (1993). When to fix it and when to leave: Relationships among perceived control, self-efficacy, dissent, and exit. Journal of Applied Psychology, 78, 949-959.
30.
Patton, M.Q. (1990). How to use qualitative methods in evaluation. Newbury Park, CA: Sage.
31.
Sagie, A. (1995). Employee participation and work outcomes: An end to the dispute?Academy of Management Review, 20, 278-280.
32.
Sagie, A., Elizur, D., & Koslowsky, M. (1990). Effect of participation in strategic and tactical decisions on acceptance of planned change. Journal of Social Psychology, 130, 459-465.
33.
Sagie, A., Elizur, D., & Koslowsky, M. (1995). Decision type, participative decision making (PDM), and organizational behavior: An experimental simulation. Human Performance, 8, 81-94.
34.
Sagie, A., & Koslowsky, M. (1994). Organizational attitudes and behaviors as a function of participation in strategic and tactical change decisions: An application of path-goal theory. Journal of Organizational Behavior, 15, 37-47.
35.
Schoonhoven, C.B. (1986). Sociotechnical considerations for the development of the space station: Autonomy and the human element in space. Journal of Applied Behavioral Science, 22, 201-221.
36.
Starr, P. (1982). The social transformation of American medicine: The rise of a sovereign profession and the making of a vast industry. New York: Basic Books.
37.
Starr, P. (2004). Social transformation 20 years on. Journal of Health Politics, Policy, and Law, 29, 1005-1019.
38.
Tjosvold, D., & Tjosvold, M.M. (1995). Cross-functional work: The challenge of involving professionals. In M.M. Beyerlein, D. A. Johnson, & S.T. Beyerlein (Eds.), Advances in interdisciplinary studies of work teams (Volume 1, pp. 1-34). Greenwich, CT: JAI.
39.
White, W.D. (2004). Reason, rationalization, and professionalism in the era of managed care. Journal of Health Politics, Policy, and Law, 29, 853-868.
