טכניון מכון טכנולוגי לישראל
הטכניון מכון טכנולוגי לישראל - בית הספר ללימודי מוסמכים  
Ph.D Thesis
Ph.D StudentRashkovits Sarit
SubjectThe Effect of Decentralization on Medical Quality Measures
and Proactive Processes of Initiating Change
Leadership style and Team Learning in
the Clinic
DepartmentDepartment of Industrial Engineering and Management
Supervisor Professor Emeritus Miriam Erez
Full Thesis textFull thesis text - English Version


Abstract

This study assessed the effect of a decentralization process that was implemented in the largest health care provider in Israel ("Clalit Health Services"), on the quality of the health care, and identified factors that mediate and moderate the relationship between the decentralization and the performance outcomes at the clinic level.

The sample consisted of 61 clinics in Haifa and West Galilee region, each serving at least 3,000 patients.

The decentralization process consisted of two main factors: decentralization of the management information system which provides feedback information on the clinic's performance to the clinic managers, and the requirement to prepare an annual work plan for improving the clinic's performance.

We used a longitudinal research design to asses the effect of the decentralization process over time on 13 medical quality measures. Then, we identified the clinic manager's initiating change leadership style and team variables of effort and learning as participating in this effect. We tested the complete research model on 3 diabetic quality measures (percentage of diabetic patients who took the important diagnostic tests of: HbA1c level, LDL level and Microalbumin level) which served as performance outcome measures.

We found that in most of the 13 medical quality measures the decentralized clinics performed better overtime then the non decentralized clinics.  Furthermore, we found that the clinic manager's initiating change leadership style was affected by the decentralization. The clinic manager's initiating change leadership style further influenced the quality of the medical health care, and it partially mediated the effect of the decentralization on two of the three medical quality measures. Also, the clinic manager's initiating change leadership style was affected by the manager's self efficacy regarding the demands imposed by the decentralization. Moreover, the clinic manager's initiating change leadership style moderated the effect of the decentralization on the team learning of the clinic management team. Last, we found that the clinic management team learning moderated the effect of the effort invested in the clinic on the clinic performance for all three diabetic quality measures. In two of these measures, when team learning level was low an inverted U shape effect was found for the effort on the clinic performance, meaning that too little effort or too much effort were negatively related to the clinic's performance. But when team learning was high, effort had a positive effect on the clinic performance.