Abstract
The aim of this dissertation was to gain insights into the relationships between healthcare professionals’ work motivation, top-down and bottom-up quality improvements, and quality of care, in addition to investigating the relationships between aspects of bottom-up and top-down clinical governance (CG) approaches and healthcare professionals’ work motivation. CG is a whole system approach to continuous quality improvement, that encompasses top-down (e.g. accountability systems, quality assurance, risk management, guidelines and protocols) and bottom-up approaches (e.g. self-regulation, micro-level quality improvements, Safety-II perspectives and learning). However, one aspect that has often been overlooked in practice as well as in empirical research is hat CG approaches hold the potential to affect healthcare professionals’ motivation to provide care. This was the main topic of interest of this dissertation.
Overall, our findings showed that healthcare professionals’ autonomous work motivation has a pivotal role in both top-down and bottom-up CG. Vice versa, CG approaches hold the potential to affect healthcare professionals’ work motivation. A mismatch between top-down CG approaches and clinical practice might actually diminish (healthcare professionals’ motivation for) bottom-up quality improvements. Taking all together, we concluded that CG is a careful balancing act, in which the needs, values, and goals at all levels of the healthcare system should be considered and aligned.
Overall, our findings showed that healthcare professionals’ autonomous work motivation has a pivotal role in both top-down and bottom-up CG. Vice versa, CG approaches hold the potential to affect healthcare professionals’ work motivation. A mismatch between top-down CG approaches and clinical practice might actually diminish (healthcare professionals’ motivation for) bottom-up quality improvements. Taking all together, we concluded that CG is a careful balancing act, in which the needs, values, and goals at all levels of the healthcare system should be considered and aligned.
Original language | English |
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Qualification | Doctor of Philosophy |
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Award date | 26-Oct-2022 |
Place of Publication | [Groningen] |
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Publication status | Published - 2022 |