{"id":{"repo_id":"calgary","oai_identifier":"oai:ucalgary.scholaris.ca:1880/106688"},"canonical_url":"https://search.dev.ndltd.org/etd/calgary/oai:ucalgary.scholaris.ca:1880/106688","repository":{"repo_id":"calgary","name":"University of Calgary","base_url":"https://ucalgary.scholaris.ca/server/oai/request"},"display":{"title":"Consequence Delimiting: A Grounded Theory of Healthcare Leader Decision Making in the Context of Adverse Events","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.","abstract_html":"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.","abstract_has_math":false,"creators":["McRae, Leonard Glenn"],"institution":"Graduate Studies","degree_name":"Doctor of Philosophy (PhD)","degree_level":null,"degree_discipline":"Nursing","degree_department":null,"school":null,"contributors":[],"advisors":["White, Deborah Elizabeth"],"committee_chairs":[],"committee_members":["Estefan, Andrew","Raffin Bouchal, Shelley","Reilly, Sandra Muir","Sheps, Samuel Barry"],"year":2018,"date_issued":"2018-05-22","date_published":"2018-05-22","updated_at":"2026-07-24T01:30:29Z","subjects":["adverse events","healthcare leader","accountable leader","Classic Grounded Theory","consequence delimiting","determining accountability"],"languages":["eng"],"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."],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier.doi","label":"DOI","values":["http://dx.doi.org/10.11575/PRISM/31955"],"render_values":[{"text":"http://dx.doi.org/10.11575/PRISM/31955","href":"http://dx.doi.org/10.11575/PRISM/31955","code":true}]}]},"links":{"outbound_url":"http://hdl.handle.net/1880/106688","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["White, Deborah Elizabeth"]},{"key":"dc:contributor.committeemember","label":"Committee Member","values":["Estefan, Andrew","Raffin Bouchal, Shelley","Reilly, Sandra Muir","Sheps, Samuel Barry"]},{"key":"dc:creator","label":"Author","values":["McRae, Leonard Glenn"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2018-11"]},{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2018-05-28T15:09:21Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2018-05-28T15:09:21Z"]},{"key":"dc:date.issued","label":"Date","values":["2018-05-22"]},{"key":"dc:publisher.institution","label":"Dc Publisher Institution","values":["University of Calgary"]},{"key":"dc:type","label":"Dc Type","values":["doctoral thesis"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Nursing"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Doctor of Philosophy (PhD)"]},{"key":"thesis:institution_name","label":"Thesis Institution Name","values":["University of Calgary"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["adverse events","healthcare leader","accountable leader","Classic Grounded Theory","consequence delimiting","determining accountability"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["eng"]},{"key":"dc:rights","label":"Dc Rights","values":["University of Calgary graduate students retain copyright ownership and moral rights for their thesis. 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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."]},{"key":"dc:title","label":"Title","values":["Consequence Delimiting: A Grounded Theory of Healthcare Leader Decision Making in the Context of Adverse Events"]}]}],"canonical_facts":{"dc:contributor.advisor":["White, Deborah Elizabeth"],"dc:contributor.committeemember":["Estefan, Andrew","Raffin Bouchal, Shelley","Reilly, Sandra Muir","Sheps, Samuel Barry"],"dc:creator":["McRae, Leonard Glenn"],"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). 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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. 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