Physician and nurse dyad partnership and its value: the antecedents and consequences of leader-leader exchange and leader-member exchange in healthcare
University of Wisconsin--Whitewater
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In an effort to decrease the cost of healthcare, the United States federal government has challenged healthcare organizations to decrease their operating expenses by changing the reimbursement structure of the Center for Medicare and Medicaid Services (CMS) from volume to value. This dissertation explored how healthcare organizations changed their leadership structure to align with the shift from volume to value by introducing a model of governance that focused on improving the quality of care versus treating the masses. The change in inpatient unit leadership introduced the dyad partnership between a physician and nurse leader. This model of leadership roots resides in the vertical-dyad linkage (VDL) theory, which evolved to the leader member exchange (LMX) theory. The physician-nurse dyad partnership (PNDP) theoretical principles stemmed from LMX, where high quality relationships were founded on mutual respect, trust, and obligation between the physician and nurse—the leader-leader exchange (LLX). This research examined the post effect of implementing the LLX-PNDP and LMX through employees’ perception of their leadership. We posited that the theoretical underpinnings of LLX and LMX strengthen the social capital of the four dimensions—care coordination, communication, teamwork, and trust—on inpatient units at a Midwestern healthcare organization. We also predicted that the enhancement of these factors positively impacted patient safety and job satisfaction. The methodology utilized secondary data collections from an employee engagement survey, inclusive of the employee perceptions of leadership’s ability to improve patient safety and job satisfaction. Second, a time series analysis was performed with historical data, consisting of quality safety indicators, to determine if these indicators improved over time. Lastly, we completed a qualitative case study, which reviewed the antecedents that led to why and how the senior leaders of the case organization decided to implement the PNDP model of governance. Findings from this dissertation have academic and practitioner implications as healthcare organizations strive to reduce costs while improving patient care.
Nurse and physician
Health care teams