Empirical exploration of brilliance in health care: perceptions of health professionalsLeila Karimi A G G , Ann Dadich B , Liz Fulop C , Sandra G. Leggat A , Jiri Rada A , Kathryn J. Hayes C , Louise Kippist B , Kathy Eljiz D , Anne Smyth E and Janna Anneke Fitzgerald C
A Department of Public Health, School of Psychology and Public Health, La Trobe University, Plenty Road, Bundoora, Vic. 3086, Australia. Email: firstname.lastname@example.org; email@example.com; firstname.lastname@example.org
C Griffith Business School, Gold Coast Campus, Griffith University, Parklands Drive, Southport, Qld 4215, Australia. Email: email@example.com; Kathryn.Hayes@griffith.edu.au; Anneke.firstname.lastname@example.org
D Health Service Management, University of Tasmania, Tas, Australia. Email: Kathy.Eljiz@utas.edu.au
E School of Health, School of Medicine, University of New England, Armidale NSW 2351, Australia. Email: email@example.com
F School Public Health, Ilia State University, Kakutsa Cholokashvili Ave 3/5, Tbilisi 0162, Georgia.
G Corresponding author. Email: firstname.lastname@example.org
Australian Health Review 41(3) 336-343 https://doi.org/10.1071/AH16047
Submitted: 18 January 2016 Accepted: 5 June 2016 Published: 9 September 2016
Objective The aim of the present study was to develop a positive organisational scholarship in health care approach to health management, informed by health managers and health professionals’ experiences of brilliance in health care delivery.
Methods A sample of postgraduate students with professional and/or management experience within a health service was invited to share their experiences of brilliant health services via online discussions and a survey running on the SurveyMonkey platform. A lexical analysis of student contributions was conducted using the individual as the unit of analysis.
Results Using lexical analysis, the examination of themes in the concept map, the relationships between themes and the relationships between concepts identified ‘care’ as the most important concept in recognising brilliance in health care, followed by the concepts of ‘staff’ and ‘patient’.
Conclusions The research presents empirical material to support the emergence of an evidence-based health professional perspective of brilliance in health management. The findings support other studies that have drawn on both quantitative and qualitative materials to explore brilliance in health care. Pockets of brilliance have been previously identified as catalysts for changing health care systems. Both quality, seen as driven from the outside, and excellence, driven from within individuals, are necessary to produce brilliance.
What is known about the topic? The quest for brilliance in health care is not easy but essential to reinvigorating and energising health professionals to pursue the highest possible standards of health care delivery.
What does this paper add? Using an innovative methodology, the present study identified the key drivers that health care professionals believe are vital to moving in the direction of identifying brilliant performance.
What are the implications for practitioners? This work presents evidence on the perceptions of leadership and management practices associated with brilliant health management. Lessons learned from exceptionally well-delivered services contain different templates for change than those dealing with failures, errors, misconduct and the resulting negativity.
References Australian Government. National commission of audit: 9.3. A pathway to reforming health care. Canberra: Australian Government; 2014. Available at: http://www.ncoa.gov.au/report/appendix-vol-1/9-3-pathway-to-reforming-health-care.html [verified 12 November 2014].
 Council of Australian Governments. National health reform agreement. 2011. Available at: http://www.federalfinancialrelations.gov.au/content/npa/health_reform/national-agreement.pdf [verified 16 December 2015].
 Vriesendorp S, Peza L, Perry CP, Seltzer JB, O’Neil M, Reimann S, Gaul N, Clark M, Barraclough A, LeMay N, Buxbaum A. Health systems in action: an eHandbook for leaders and managers. Cambridge: Management Science for Health; 2010. Available at: https://www.msh.org/sites/msh.org/files/ehandbook_2014_final_29aug14.pdf [verified 22 July 2016].
 Mintzberg H. Managing. Boston: Prentice Hall; 2011.
 Daire J, Gilson L. Does identity shape leadership and management practice? Experiences of PHC facility managers in Cape Town, South Africa. Health Policy Plan 2014; 29 ii82–97.
| Does identity shape leadership and management practice? Experiences of PHC facility managers in Cape Town, South Africa.CrossRef | 25274644PubMed |
 Boyatzis RE. Competencies in the twenty-first century. J Manage Dev 2008; 27 5–12.
| Competencies in the twenty-first century.CrossRef |
 Hunter DJ, Baber J-A, Hayes KJ. Commentary: how will we know brilliance in healthcare when we see it, be it say of a team, unit or individual? What sort of approach could we adopt to define and describe it? Asia Pacific J Health Manage 2011; 6 15–18.
 Institute of Medicine. Best care at lower cost: the path to continuously learning health care in America. In: Mark S, Robert S, Leigh S, McGinnis JM, editors. The National Academies Press; 2012.
 Cameron KS, Dutton JE, Quinn RE. Foundations of positive organizational scholarship. In: Cameron KS, Dutton JE, Quinn RE, editors. Positive organizational scholarship: foundations of a new discipline. San Francisco: Berrett-Koehler Publishers; 2003. pp. 3–13.
 Caza BB, Caza A. Positive organizational scholarship: a critical theory perspective. J Manage Inq 2008; 17 21–33.
| Positive organizational scholarship: a critical theory perspective.CrossRef |
 Luthans F. Positive organizational behavior: developing and managing psychological strengths. Acad Manage Exec 2002; 16 57–72.
| Positive organizational behavior: developing and managing psychological strengths.CrossRef |
 Cameron KS, Caza A. Contributions to the discipline of positive organizational scholarship. Am Behav Sci 2004; 47 731–9.
| Contributions to the discipline of positive organizational scholarship.CrossRef |
 Donaldson SI, Ko I. Positive organizational psychology, behavior, and scholarship: a review of the emerging literature and evidence base. J Posit Psychol 2010; 5 177–91.
| Positive organizational psychology, behavior, and scholarship: a review of the emerging literature and evidence base.CrossRef |
 Dadich A, Fulop L, Ditton M, Campbell S, Curry J, Eljiz K, Fitzgerald A, Hayes KJ, Herington C, Isouard G, Karimi L, Smyth A. Finding brilliance using positive organizational scholarship in healthcare. J Health Organization Manage 2015; 29 750–77.
 Barney LJ, Griffiths KM, Christensen H, Jorm AF. Exploring the nature of stigmatising beliefs about depression and help-seeking: implications for reducing stigma. BMC Public Health 2009; 9 61
| Exploring the nature of stigmatising beliefs about depression and help-seeking: implications for reducing stigma.CrossRef | 19228435PubMed |
 Fredrickson BL, Joiner T. Positive emotions trigger upward spirals toward emotional well-being. Psychol Sci 2002; 13 172–5.
| Positive emotions trigger upward spirals toward emotional well-being.CrossRef | 11934003PubMed |
 Batalden PB, Nelson EC, Edwards WH, Godfrey MM, Mohr JJ. Microsystems in health care: part 9. Developing small clinical units to attain peak performance. Jt Comm J Qual Patient Saf 2003; 29 575–85.
 Mohr J, Batalden P, Barach P. Integrating patient safety into the clinical microsystem. Qual Saf Health Care 2004; 13 ii34–8.
| Integrating patient safety into the clinical microsystem.CrossRef | 15576690PubMed |
 Fulop L, Dadich A, Ditton M, Campbell S, Curry J, Eljiz K, Fitzgerald A, Hayes K, Herington C, Isouard G, Karimi L, Smyth A, Working on the edge: positive organisational scholarship in healthcare (POSH) and looking for what’s good in healthcare. In: 27th Australian and New Zealand Academy of Management Conference, 7–10 December 2013, Hobart, Tasmania; 2013.
 Havens DS. Positive organizational scholarship: tools for leading with excellence. Nurse Lead 2011; 9 26–30.
| Positive organizational scholarship: tools for leading with excellence.CrossRef |
 MacLeod H. Keynote presentation: the world is flat. Australian Centre for Clinician Leadership Conference, 16–19 April 2009 Sanctuary Cove, Qld.; 2009.
 MacLeod H, Hudson A, Kramer S, Martin M. The times they are a-changing: what worked and what we learned in deploying Ontario’s wait time strategy information system. Healthc Q 2009; 12 8–15.
| The times they are a-changing: what worked and what we learned in deploying Ontario’s wait time strategy information system.CrossRef | 19458502PubMed |
 MacLeod H. Asking the question. Do you see brilliance? Asia Pacific J Health Manage 2011; 6 4–6.
 Walløe L. The meaning of excellence and the need for excellence in research. Academia Europea meeting, 5 September 2009; Wroclav, Poland.
 U.S. Department of Health and Human Services. Understanding health care quality. 2013. Available at: http://www.ahrq.gov/legacy/consumer/guidetoq/guidetoq4.htm [verified 20 December2015].
 Edwards B. Service excellence in healthcare. Qual Health Care 1992; 1(Suppl) S42–4.
| Service excellence in healthcare.CrossRef |
 Shortell SM, Bennett CL, Byck GR. Assessing the impact of continuous quality improvement on clinical practice: what it will take to accelerate progress. Milbank Q 1998; 76 593–624.
| Assessing the impact of continuous quality improvement on clinical practice: what it will take to accelerate progress.CrossRef | 1:STN:280:DyaK1M%2FpsFektQ%3D%3D&md5=166f7c445265507c4fd1bc6d73bc938eCAS | 9879304PubMed |
 Hannan EL, Kilburn H, Racz M, Shields E, Chassin MR. Improving the outcomes of coronary artery bypass surgery in New York State. JAMA 1994; 271 761–6.
| Improving the outcomes of coronary artery bypass surgery in New York State.CrossRef | 1:STN:280:DyaK2c7lvVSnsw%3D%3D&md5=29ca20689b76d30bc7c1fb61c831f23fCAS | 8114213PubMed |
 Chassin MR. Achieving and sustaining improved quality: lessons from New York State and cardiac surgery. Health Aff 2002; 21 40–51.
| Achieving and sustaining improved quality: lessons from New York State and cardiac surgery.CrossRef |
 Hamilton BH, Nickerson JA, Washington HO. Team incentives and worker heterogeneity: an empirical analysis of the impact of teams on productivity and participation. J Polit Econ 2003; 111 465–97.
| Team incentives and worker heterogeneity: an empirical analysis of the impact of teams on productivity and participation.CrossRef |
 Cato ST, Gordon J. Relationship of the strategic vision alignment to employee productivity and student enrollment. Res Higher Educ J 2012; 15 1–20.
 Hellweg SA, Phillips SL. Communication and productivity in organizations. Public Productivity Rev 1982; 6 276–88.
| Communication and productivity in organizations.CrossRef |
 Laschinger HKS, Wong C, McMahon L, Kaufmann C. Leader behavior impact on staff nurse empowerment, job tension, and work effectiveness. J Nurs Adm 1999; 29 28–39.
| Leader behavior impact on staff nurse empowerment, job tension, and work effectiveness.CrossRef | 1:STN:280:DyaK1M3ms1Cjsw%3D%3D&md5=c5f811f09511e694f06883553c1a35d7CAS |
 Siu H, Spence Laschinger HK, Finegan J. Nursing professional practice environments: setting the stage for constructive conflict resolution and work effectiveness. J Nurs Adm 2008; 38 250–7.
| Nursing professional practice environments: setting the stage for constructive conflict resolution and work effectiveness.CrossRef | 18469619PubMed |
 Fulop L, Campbell S. Special feature: the brilliance project: trying to understand great performance in the health service. Asia Pacific JHealth Manage 2011; 6 9–14.
 Webb G. Deconstructing deep and surface: towards a critique of phenomenography. High Educ 1997; 33 195–212.
| Deconstructing deep and surface: towards a critique of phenomenography.CrossRef |
 Penn-Edwards S. Computer aided phenomenography: the role of Leximancer computer software in phenomenographic investigation. Qual Rep 2010; 15 252–67.
 Smith AE, Humphreys MS. Evaluation of unsupervised semantic mapping of natural language with Leximancer concept mapping. Behav Res Methods 2006; 38 262–79.
| Evaluation of unsupervised semantic mapping of natural language with Leximancer concept mapping.CrossRef | 16956103PubMed |
 de la Varre C, Ellaway R, Dewhurst D. An analysis of the large-scale use of online discussion in an undergraduate medical course. 2005. Available at: https://www.leximancer.com/wiki/images/6/6e/Discussion_board_analysis.pdf [verified 12 January 2016].
 Angus-Leppan T, Benn S, Young L. A sensemaking approach to trade-offs and synergies between human and ecological elements of corporate sustainability. Bus Strategy Environ 2010; 19 230–44.
 Gephart RP. Qualitative research and the Academy of Management Journal. Acad Manage J 2004; 47 454–62.
| Qualitative research and the Academy of Management Journal.CrossRef |
 Zuell C, Weber RP, Mohler P, editors. Computer-assisted text analysis for the social sciences. Volume 3. Mannheim: Center for Surveys, Methods and Analysis (ZUMA); 1989.
 Scott N, Smith AE. Use of automated content analysis techniques for event image assessment. Tour Recreat Res 2005; 30 87–91.
| Use of automated content analysis techniques for event image assessment.CrossRef |
 Grech M, Horberry T, Smith A. Human error in maritime operations: Analyses of accident reports using the Leximancer tool. In Proceedings of the 13th International Conference on Man-Machine-Environment; Long S, Dhillon BS. 2002; Baltimore, MD. USA: SAGE Publications.
 Young L, Denize S. Competing interests: the challenge to collaboration in the public sector. Int J Sociol Soc Policy 2008; 28 46–58.
| Competing interests: the challenge to collaboration in the public sector.CrossRef |
 Hewett DG, Watson BM, Gallois C, Ward M, Leggett BA. Intergroup communication between hospital doctors: implications for quality of patient care. Soc Sci Med 2009; 69 1732–40.
| Intergroup communication between hospital doctors: implications for quality of patient care.CrossRef | 19846246PubMed |
 Hepworth N, Paxton SJ. Pathways to help-seeking in bulimia nervosa and binge eating problems: a concept mapping approach. Int J Eat Disord 2007; 40 493–504.
| Pathways to help-seeking in bulimia nervosa and binge eating problems: a concept mapping approach.CrossRef | 17573682PubMed |
 Ribière V, Walter C. 10 years of KM theory and practices. Knowl Manag Res Pract 2013; 11 4–9.
| 10 years of KM theory and practices.CrossRef |
 Baumann AO, Deber RB, Silverman BE, Mallette CM. Who cares? Who cures? The ongoing debate in the provision of health care. J Adv Nurs 1998; 28 1040–5.
| Who cares? Who cures? The ongoing debate in the provision of health care.CrossRef | 1:STN:280:DyaK1M%2FlsVKisg%3D%3D&md5=5fb870e045f7d9fbd9f8b488ed1cb711CAS | 9840875PubMed |
 Glouberman S, Mintzberg H. Managing the care of health and the cure of disease – part 1: differentiation. Health Care Manage Rev 2001; 26 56–69.
| Managing the care of health and the cure of disease – part 1: differentiation.CrossRef | 1:STN:280:DC%2BD3M3ksFShuw%3D%3D&md5=3d4add2a9f4d82dff6fa7124e2a1d151CAS | 11233354PubMed |
 Southon G. Conflict between clinicians and managers: a structural problem. Health Manager 2003; 2003 6–8.
 Bartram T, Karimi L, Leggat SG, Stanton P. Social identification: linking high performance work systems, psychological empowerment and patient care. Int J Hum Resour Manage 2014; 25 2401–19.
| Social identification: linking high performance work systems, psychological empowerment and patient care.CrossRef |
 Leggat SG, Bartram T, Casimir G, Stanton P. Nurse perceptions of the quality of patient care: confirming the importance of empowerment and job satisfaction. Health Care Manage Rev 2010; 35 355–64.
| Nurse perceptions of the quality of patient care: confirming the importance of empowerment and job satisfaction.CrossRef | 20844360PubMed |
 Ullström S, Sachs MA, Hansson J, Øvretveit J, Brommels M. Suffering in silence: a qualitative study of second victims of adverse events. BMJ Qual Saf 2014; 23 325–31.
| Suffering in silence: a qualitative study of second victims of adverse events.CrossRef | 24239992PubMed |
 Borrill C, West M, Shapiro D, Rees A. Team working and effectiveness in health care. Br J Healthcare Manage 2000; 6 364–71.
| Team working and effectiveness in health care.CrossRef |
 Leggat SG. Effective healthcare teams require effective team members: defining teamwork competencies. BMC Health Serv Res 2007; 7 17
| 17284324PubMed |
 Macdonald R, Price I, Askham P. Leadership conversations: the impact on patient environments. Leadersh Health Serv 2009; 22 140–60.
| Leadership conversations: the impact on patient environments.CrossRef |
 Bowen DE, Ostroff C. Understanding HRM–firm performance linkages: the role of the ‘strength’ of the HRM system. Acad Manage Rev 2004; 29 203–21.