Consequence Delimiting:  A Grounded Theory of Healthcare Leader Decision Making in the Context of Adverse Events

McRae, Leonard Glenn

Consequence Delimiting: A Grounded Theory of Healthcare Leader Decision Making in the Context of Adverse Events

dc.contributor.advisor	White, Deborah Elizabeth
dc.contributor.author	McRae, Leonard Glenn
dc.contributor.committeemember	Estefan, Andrew
dc.contributor.committeemember	Raffin Bouchal, Shelley
dc.contributor.committeemember	Reilly, Sandra Muir
dc.contributor.committeemember	Sheps, Samuel Barry
dc.date	2018-11
dc.date.accessioned	2018-05-28T15:09:21Z
dc.date.available	2018-05-28T15:09:21Z
dc.date.issued	2018-05-22
dc.description.abstract	Adverse events (AEs) remain a central focus of North American healthcare leaders (HLs) since the release of the Institute of Medicine’s (IOM) report: “To Err is Human” in 1999 (Institute of Medicine, 1999). The IOM reported that as many as 98,000 people died from preventable deaths every year in the United States as a result of errors in the delivery of healthcare. Studies in other healthcare systems report comparable rates of harm (Baker et al., 2004; Thomas et al., 2000; Vincent, Neale, & Woloshynowych, 2001). The high incidence of AEs coupled with healthcare leaders’ fiduciary and regulatory responsibilities to manage these events result in its central import for healthcare leaders. The aim of this study was to discover a general substantive theory on how HLs approach accountability in the context of adverse events (AEs). The research findings were that the main concern of HLs was determining how to respond to each AE. Consequence Delimiting emerged as the core category of this classic grounded theory (CGT). The theory was conceptualized as a stage theory where multiple phases proceed sequentially and each produces a product that is built upon by subsequent stages to ultimately produce an outcome. Consequence Delimiting begins at the time that the HL accountable for managing the AE; the accountable leader (AL) becomes aware of the AE and proceeds through the interrelated categories of apprehending, story constructing, expectation navigating and truth promoting to an event disposition. The emergent theory takes particular cognizance of the role that context and discretion play in determining the disposition of an AE. It highlights the influence of organizational and leadership culture, constraints and the role of pathways in influencing the disposition. Consequence Delimiting has implications for regulators and healthcare leaders interested in better understanding and improving patient safety in their organizations.	en_US
dc.identifier.citation	McRae, L. G. (2018). Consequence Delimiting: A Grounded Theory of Healthcare Leader Decision Making in the Context of Adverse Events (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/31955	en_US
dc.identifier.doi	http://dx.doi.org/10.11575/PRISM/31955
dc.identifier.uri	http://hdl.handle.net/1880/106688
dc.language.iso	eng
dc.publisher.faculty	Graduate Studies
dc.publisher.faculty	Nursing
dc.publisher.institution	University of Calgary	en
dc.publisher.place	Calgary	en
dc.rights	University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subject	adverse events
dc.subject	healthcare leader
dc.subject	accountable leader
dc.subject	Classic Grounded Theory
dc.subject	consequence delimiting
dc.subject	determining accountability
dc.subject.classification	Health Care Management	en_US
dc.subject.classification	Nursing	en_US
dc.title	Consequence Delimiting: A Grounded Theory of Healthcare Leader Decision Making in the Context of Adverse Events
dc.type	doctoral thesis
thesis.degree.discipline	Nursing
thesis.degree.grantor	University of Calgary
thesis.degree.name	Doctor of Philosophy (PhD)
ucalgary.item.requestcopy	true