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- Löfgren, S, et al.
(författare)
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Context challenges the champion: improving hip fracture care in a Swedish university hospital
- 2012
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Ingår i: International journal of health care quality assurance. - : Emerald. - 0952-6862. ; 25:2, s. 118-33
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is to describe and explain a clinician‐led improvement of a hip fracture care process in a university hospital, and to assess the results and factors helping and hindering change implementation.Design/methodology/approachThe paper has a mixed methods case study design. Data collection was guided by a framework directing attention to the content and process of the change, its context and outcomes.FindingsUsing a multiprofessional project team, beneficial changes in the early parts of the care process were achieved, but inability to change surgical staff work practices meant that the original goal of operating patients within 24 hours was not reached. After three years, top management introduced a hospital‐wide process improvement programme, which “took over” the responsibility for improving hip fracture care.Research implications/limitationsA clear vision why change is needed and what needs to be done, which is well communicated by a respected clinical leader, can motivate personnel, but other influences are also needed to bring about change. Without a plan agreed and supported by top management, changes are likely to be limited to parts of the process and improvements to patient care may be minimal. These and other findings may be applicable to similar situations in other services.Originality/valueThis case study is an illustration of both the strengths and the weaknesses of a “bottom‐up, clinician‐champion‐led improvement initiative” in a complex university hospital.
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- Sandahl, C, et al.
(författare)
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Simulation team training for improved teamwork in an intensive care unit
- 2013
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Ingår i: International journal of health care quality assurance. - : Emerald. - 0952-6862. ; 26:2, s. 174-88
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Tidskriftsartikel (refereegranskat)abstract
- This study aims to describe implementation of simulator‐based medical team training and the effect of this programme on inter‐professional working in an intensive care unit (ICU).Design/methodology/approachOver a period of two years, 90 percent (n=152) of the staff of the general ICU at Karolinska University Hospital, Huddinge, Sweden, received inter‐professional team training in a fully equipped patient room in their own workplace. A case study method was used to describe and explain the planning, formation, and results of the training programme.FindingsIn interviews, the participants reported that the training had increased their awareness of the importance of effective communication for patient safety. The intervention had even had an indirect impact by creating a need to talk, not only about how to communicate efficaciously, but also concerning difficult care situations in general. This, in turn, had led to regular reflection meetings for nurses held three times a week. Examples of better communication in acute situations were also reported. However, the findings indicate that the observed improvements will not last, unless organisational features such as staffing rotas and scheduling of rounds and meetings can be changed to enable use of the learned behaviours in everyday work. Other threats to sustainability include shortage of staff, overtime for staff, demands for hospital beds, budget cuts, and poor staff communication due to separate meetings for nurses and physicians.Originality/valueThe present results broaden our understanding of how to create and sustain an organizational system that supports medical team training.
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- Thor, J, et al.
(författare)
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Evolution and outcomes of a quality improvement program
- 2010
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Ingår i: International journal of health care quality assurance. - : Emerald. - 0952-6862. ; 23:3, s. 312-27
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is to examine the outcomes and evolution over a five‐year period of a Swedish university hospital quality improvement program in light of enduring uncertainty regarding the effectiveness of such programs in healthcare and how best to evaluate it.Design/methodology/approachThe paper takes the form of a case study, using data collected as part of the program, including quality indicators from clinical improvement projects and participants' program evaluations.FindingsOverall, 58 percent of the program's projects (39/67) demonstrated success. A greater proportion of projects led by female doctors demonstrated success (91 percent, n=11) than projects led by male doctors (51 percent, n=55). Facilitators at the hospital continuously adapted the improvement methods to the local context. A lack of dedicated time for improvement efforts was the participants' biggest difficulty. The dominant benefits included an increased ability to see the “bigger picture” and the improvements achieved for patients and employees.Research limitations/implicationsQuality measurement, which is important for conducting and evaluating improvement efforts, was weak with limited reliability. Nevertheless, the present study adds evidence about the effectiveness of healthcare improvement programs. Gender differences in improvement team leadership merit further study. Improvement program evaluation should assess the extent to which improvement methods are locally adapted and applied.Originality/valueThis case study reports the outcomes of all improvement projects undertaken in one healthcare organization over a five‐year period and provides in‐depth insight into an improvement program's changeable nature.
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- Jonsson, PM, et al.
(författare)
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Patient claims and complaints data for improving patient safety
- 2008
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Ingår i: International journal of health care quality assurance. - : Emerald. - 0952-6862. ; 21:1, s. 60-74
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is to describe patient complaints and claims data from Swedish databases and assess their value for scientific research and practical health care improvement.Design/methodology/approachThe article first describes previous research into patient claims and similar schemes. It then presents three types of data on patient claims and complaints in Sweden: data generated by the Patient Insurance Fund, the Medical Responsibility Board and the Patients' Advisory Committees and considers methodological issues in using the data.FindingsThe databases' value is problems related to spontaneous reporting, which makes it difficult to know how much the data correspond to general injury rates and health care patterns. Another issue is the balance between the size of study materials and the timeliness, e.g. when diagnosis‐specific analysis requires data pooling over several years in order to reach adequate case numbers. Adjustment for confounders not present in the databases, e.g. data on hospital case‐mix, may add to difficulties using the data in comparative analyses of safety performanceResearch limitations/implicationsThe databases' safety analysis and quality improvement value depends on understanding their function, data collection method and their limitations as a source of data about the true incidence and prevalence of injuries and safety problems.Originality/valueThis is the first thorough review of the possibilities and limitations associated with the use of claims and complaints data in health care research and improvement.
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