| 1. |
- Andersson, Ann-Christine, et al.
(författare)
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Challenges to Improve Inter-Professional Care and Service Collaboration for People Living With Psychiatric Disabilities in Ordinary Housing.
- 2016
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Ingår i: Quality Management in Health Care. - : Lippincott Williams and Wilkins Ltd.. - 1063-8628 .- 1550-5154. ; 25:1, s. 44-52
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe health care- and social service professionals' experiences of a quality-improvement program implemented in the south of Sweden. The focus of the program was to develop inter-professional collaboration to improve care and service to people with psychiatric disabilities in ordinary housing. Focus group interviews and a thematic analysis were used. The result was captured as themes along steps in process. (I) Entering the quality-improvement program: Lack of information about the program, The challenge of getting started, and Approaching the resources reluctantly. (II) Doing the practice-based improvement work: Facing unprepared workplaces, and Doing twice the work. (III) Looking back-evaluation over 1 year: Balancing theoretical knowledge with practical training, and Considering profound knowledge as an integral part of work. The improvement process in clinical practice was found to be both time and energy consuming, yet worth the effort. The findings also indicate that collaboration across organizational boundaries was broadened, and the care and service delivery were improved.
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| 2. |
- Andersson, Ann-Christine, et al.
(författare)
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Five Types of Practice-Based ImprovementIdeas in Health Care Services: An EmpiricallyDefined Typology
- 2011
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Ingår i: Quality Management in Health Care. - : Lippincott Williams & Wilkins. - 1063-8628 .- 1550-5154. ; 20:2, s. 122-130
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to empirically identify and present different kinds of practice-based improvement ideas developed in health care services. The focus is on individual placement needs, problems/issues, and the ability to organize work on the development, implementation, and institutionalization of ideas for the health care sector. This study is based on a Swedish county council improvement program. Health care departments and primary health care centers in the Kalmar County Council were invited to apply for money to accomplish improvement projects. A qualitative content analysis was done of 183 proposed applications from various health care departments and primary health care centers. The following 5 types of improvement projects were identified: organizational process, evidence and quality, competence development, process technology, and proactive patient work. This illustrates the range of strategies that encourage letting individual units define their own improvement needs. These projects point to the various problems and experiences health care professionals encounter in their day-to-day work. To generalize beyond this improvement program and to validate the typology, we applied it to all articles found when searching for quality improvement projects in the journal Quality Management in Health Care during the last 2 years and found that all of them could be fitted into at least 1 of those 5 categories. This article provides valuable insights into the current state of improvemen work in Swedish health care, and will serve as a foundation for further investigations in this quality improvement program.
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| 3. |
- Andersson, Ann-Christine, 1968-, et al.
(författare)
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Identification of children as relatives with a systematic approach: a prerequisite in order to offer advice and support
- 2018
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Ingår i: Quality Management in Health Care. - : Wolters Kluwer. - 1063-8628 .- 1550-5154. ; 27:3, s. 172-177
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to elucidate conditions at all system levels in a specific health care service to develop practices for identification of children as relatives. An interactive research approach with the intention to create mutual learning between practice and research was used. The participating health care service cared for both clinic in- and outpatients with psychiatric disorders. Health care professionals from different system levels (micro, meso, macro) participated, representing different professions. At the first project meeting, it was obvious that there was no systematic approach to identify children as relatives. At the micro level, activities such as a pilot survey and an open house activity were carried out. At the meso level, it was discussed how to better support collaboration between units. At the management (macro) level, it was decided that all units should appoint at least one child agent, with the aim to increase collaboration throughout the whole health care service. To change focus, in this case from only parents to inclusion of children, is an important challenge faced by health care services when forced to incorporate new policies and regulations. The new regulations contribute to increased complexity in already complex organizations. This study highlights that such challenges are underestimated.
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| 4. |
- Andersson, Ann-Christine
(författare)
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Managers' views and experiences of a large-scale county council improvement program : limitations and opportunities
- 2013
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Ingår i: Quality Management in Health Care. - : Lippincott Williams & Wilkins. - 1063-8628 .- 1550-5154. ; 22:2, s. 152-160
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore and evaluate managers’ views of a large-scale improvement program, including their experiences and opinions about improvement initiatives and drivers for change. The study is based on a survey used in 2 nationwide mappings of improvement initiatives and developmental trends in Swedish health care. The participants were all managers in a county council in Sweden. Data were analyzed descriptively, and statements were ranked in order of preferences. A majority of the respondents stated that they had worked with improvements since the county council improvement program started. The managers sometimes found it difficult to find data and measurements that supported the improvements, yet a majority considered that it was worth the effort and that the improvement work yielded results. The top-ranked driving forces were ideas from personnel and problems in the daily work. Staff satisfaction was ranked highest of the improvement potentials, but issues about patients’ experiences of their care and patient safety came second and third. The managers stated that no or only a few patients had been involved in their improvement initiatives. Large-scale county council improvement initiatives can illuminate quality problems and lead to increased interest in improvement initiatives in the health care sector.
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| 5. |
- Andersson-Gäre, Boel, et al.
(författare)
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The health care quality journey of Jonkoping County Council, Sweden
- 2007
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 16:1, s. 2-9
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Tidskriftsartikel (refereegranskat)abstract
- For a decade Jonkoping County Council in Sweden has undertaken a countywide effort to improve health and health care with measured success. This issue describes this quality improvement journey.
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| 6. |
- Aronsson, Håkan, 1961-, et al.
(författare)
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Managing health care decisions and improvement through simulation modeling
- 2011
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Ingår i: Quality Management in Health Care. - : Wolters Kluwer. - 1063-8628 .- 1550-5154. ; 20:1, s. 15-29
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Tidskriftsartikel (refereegranskat)abstract
- Simulation modeling is a way to test changes in a computerized environment to give ideas for improvements before implementation. This article reviews research literature on simulation modeling as support for health care decision making. The aim is to investigate the experience and potential value of such decision support and quality of articles retrieved. A literature search was conducted, and the selection criteria yielded 59 articles derived from diverse applications and methods. Most met the stated research-quality criteria. This review identified how simulation can facilitate decision making and that it may induce learning. Furthermore, simulation offers immediate feedback about proposed changes, allows analysis of scenarios, and promotes communication on building a shared system view and understanding of how a complex system works. However, only 14 of the 59 articles reported on implementation experiences, including how decision making was supported. On the basis of these articles, we proposed steps essential for the success of simulation projects, not just in the computer, but also in clinical reality. We also presented a novel concept combining simulation modeling with the established plan-do-study-act cycle for improvement. Future scientific inquiries concerning implementation, impact, and the value for health care management are needed to realize the full potential of simulation modeling.
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| 7. |
- Book, Stefan, 1966, et al.
(författare)
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Perceptions of Improvement Work in Swedish Health Care: Implications for Improvement Practices.
- 2003
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 12:4, s. 217-224
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- This study explored perceptions of improvement work in Swedish health care. The article discusses effects that these perceptions may have on improvement processes. As part of a broader study surveying managers' (n = 2313) view of improvement work in Swedish health care, this study focused on those 845 managers who regarded their improvement work as bringing about benefits. Three underlying factors that may characterize the managers' perceptions are exposed. More than 50% of the respondents perceive a complexity in the practices and techniques associated with improvement work. Furthermore, approximately 50% of the managers recognize a conflict in the meeting between the improvement work and the organization. This indicates that adaptation is a primary concern in this work. The managers' perceptions also reveal that the experience of improvement work in Swedish health care may be positive, although the perception is that it does not necessarily generate more health care per monetary unit.ABSTRACT FROM AUTHOR
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| 8. |
- Dahlin, Sara, 1980, et al.
(författare)
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Process Mining for Quality Improvement: Propositions for Practice and Research
- 2019
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 28:1, s. 8-14
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Process mining offers ways to discover patient flow, check how actual processes conform to a standard, and use data to enhance or improve processes. Process mining has been used in health care for about a decade, however, with limited focus on quality improvement. Hence, the aim of the article is to present how process mining can be used to support quality improvement, thereby bridging the gap between process mining and quality improvement. METHOD: We have analyzed current literature to perform a comparison between process mining and process mapping. RESULT: To better understand how process mining can be used for quality improvement we provide 2 examples. We have noted 4 limitations that must be overcome, which have been formulated as propositions for practice. We have also formulated 3 propositions for future research. CONCLUSION: In summary, although process mapping is still valuable in quality improvement, we suggest increased focus on process mining. Process mining adds to quality improvement by providing a better understanding of processes in terms of uncovering (un)wanted variations as to obtain better system results.
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| 9. |
- Ebbevi, David, et al.
(författare)
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Value-based health care for chronic care : aligning outcomes measurement with the patient perspective
- 2016
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Ingår i: Quality Management in Health Care. - : Lippincott, Williams & Wilkins. - 1063-8628 .- 1063-8628 .- 1550-5154. ; 25:4, s. 203-212
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Tidskriftsartikel (refereegranskat)abstract
- Background: Value-based health care is increasingly used for developing health care services by relating patient outcomes to costs. A hierarchical value scorecard for creating outcome measurements has been suggested: The 3-Tier model. The objective of this study was to test the model against the patient's view of value in a chronic care setting. Methods: Semistructured interviews with 22 persons with rheumatoid arthritis were conducted, transcribed, and analyzed using qualitative content analysis. Themes were extracted, and the model was critically applied and revised. Results: The study validates existing dimensions in the model but suggests adding information, social health, predictability, and continuity to make it more useful and representative of patients' preferences. Conclusion: Although the model aims to focus on outcomes relevant to patients, it lacks dimensions important to individuals with rheumatoid arthritis. The data illustrate difficulties in finding patients' preferred outcomes and imply tactics for arriving at meaningful measurements.
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| 10. |
- Edvinsson, Joakim, et al.
(författare)
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Senior alert: A quality registry to support a standardized, structured, and systematic preventive care process for older adults
- 2015
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 24:2, s. 96-101
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Tidskriftsartikel (refereegranskat)abstract
- The average life expectancy and the proportion of the elderly in the Western countries are increasing. The care processes used for the elderly are known to differ between the care providers in Sweden. Accordingly, the need to develop a system to support the processes in order to attain a standardized, structured, and systematic approach to improve preventive care processes for the elderly has been called for. The County Council of Jönköping developed a national Web-based quality registry, Senior Alert, with a focus on the following areas: falls, pressure ulcers, malnutrition, and oral health. The patients are evaluated using validated risk assessment instruments, and the care is planned, executed, evaluated. The registry supports the users to work with preventive care systematically and in a standardized way and provides feedback to the care providers on their preventive care processes. The registry helps the caregivers fulfill the preventive care according to the best available clinical knowledge and practice. The registry also provides the government and health care politicians with data for setting aims for elderly care. The registry is used in 90% of the municipalities and county councils throughout the country. The total number of risk assessments completed from 2009 to 2014 exceeded 1 000 000.
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| 11. |
- Elg, Mattias, et al.
(författare)
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Goal Orientation and Conflicts : Motors of Change in Development Projects in Health Care Service
- 2007
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 16:1, s. 84-97
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Tidskriftsartikel (refereegranskat)abstract
- The article presents parts of a larger research study which aims to explain how a process-oriented innovation unfolds and develops over time in the health care system in Sweden. It is said that local development teams have a rather broad notion of what it takes to implement the flow model. The theory used to explain the developmental patterns which have been identified in the national and local projects was presented.
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| 12. |
- Eriksson, Nomie, 1955-, et al.
(författare)
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Interprofessional Barriers : A Study of Quality Improvement Work Among Nurses and Physicians
- 2017
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Ingår i: Quality Management in Health Care. - : Lippincott Williams & Wilkins. - 1063-8628 .- 1550-5154. ; 26:2, s. 63-69
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Tidskriftsartikel (refereegranskat)abstract
- This article studies interprofessional barriers between nurses and physicians in the context of quality improvementwork. A total of 17 nurses and 10 physicians were interviewed at 2 hospitals in Sweden. The study uncovered anumber of barriers relating to both the relative status of each group and their defined areas of responsibility.
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| 13. |
- Eriksson, Nomie, et al.
(författare)
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Involvement Drivers : A Study of Nurses and Physicians in Improvement Work
- 2016
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Ingår i: Quality Management in Health Care. - : Lippincott Williams & Wilkins. - 1063-8628 .- 1550-5154. ; 25:2, s. 85-91
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Tidskriftsartikel (refereegranskat)abstract
- This article reports on the involvement of nurses and physicians in improvement work, with a special focus on the drivers. The purpose was to describe how the nurse and physician groups understand involvement drivers for improvement work and to explain the differences in how they understand involvement. The study was conducted at 2 Swedish hospitals, and a total of 20 nurses and 10 physicians were interviewed. The theoretical framework, developed by an interpretative approach, identifies and describes a number of involvement drivers. On clustering the drivers into larger involvement factors, the study shows clear differences and profiles in terms of the 2 groups' perception and understanding of the involvement—drivers. Each group's profile was then analyzed on the basis of concept of professional culture.
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| 14. |
- Jesper, Olsson, et al.
(författare)
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Surveying improvement activities in health care on a national level--the swedish internal collaborative strategy and its challenges
- 2003
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Ingår i: Quality Management in Health Care. - : Ovid Technologies (Wolters Kluwer Health). - 1063-8628 .- 1550-5154. ; 12:4, s. 202-216
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Tidskriftsartikel (refereegranskat)abstract
- In order to map improvement activities in Swedish health care, we surveyed the managers of all primary health care centers (n = 958) and clinical hospital departments (n = 1355), with a response rate of 46%. The majority reports that their staff view improvement work positively. The most common driver of improvement is work environment problems, whereas external drivers have less influence. Among 35 methods, the most commonly used are educational initiatives, stress management, guidelines, and leadership development, whereas accreditation is used the least. Respondents who report extensive improvement efforts indicate the greatest benefit from educational interventions, analysis of patient incidents, guidelines, and rapid cycle tests. Respondents claim that improvement initiatives yield positive results, in particular regarding the working environment, administrative routines, workflow, and communication, although only 15%-30% of respondents report having data to support their claims. Our findings indicate an introverted focus of most improvement efforts, starting with staff and administration needs. Further research is needed to understand how and why some centers and departments have managed to achieve strategic, measurable, patient-focused, systems improvements, whereas most have not.
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| 15. |
- Johansson, Linda, et al.
(författare)
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Health Care Professionals' Usage and Documentation of a Swedish Quality Registry Regarding Preventive Nutritional Care
- 2017
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Ingår i: Quality Management in Health Care. - : Lippincott Williams & Wilkins. - 1063-8628 .- 1550-5154. ; 26:1, s. 15-21
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: To describe health care staff members' usage and documentation in a Swedish quality registry focusing on a preventive care process regarding the risk area of malnutrition among persons with dementia. The preventive care process includes risk assessment, analysis of underlying causes, planning and performing interventions, as well as evaluating effects.Methods: Data were collected from 2 Swedish quality registries, Senior Alert and the Swedish Dementia Register (Svedem). In total, 1929 people with dementia were assessed and 1432 registered as being at risk of malnutrition or malnourished.Results: Performed nutritional interventions were registered in approximately 65% of cases. In more than 80% of registrations, the analyses of underlying causes were missing. Those who had registered underlying causes had significantly more interventions and the evaluation of the performed intervention was registered. The time between assessment and evaluation depended on care setting and ranged from 0 to 702 days.Conclusions: Limitations in registration were noted; however, the register allows staff to focus on nutritional care and has resulted in many risk assessments. Rarely people were registered in all steps of the preventive care process. Large variances in when the performed interventions were evaluated makes it difficult to measure improvements.
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| 16. |
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| 17. |
- Kollberg, Beata, et al.
(författare)
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Challenges Experienced in the Development of Performance Measurement Systems in Swedish Health Care
- 2006
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 15:4, s. 244-256
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Tidskriftsartikel (refereegranskat)abstract
- The article discusses a study on the challenges faced by the Swedish health care industry in the development of performance measurement systems. The importance of performance measurement to the management of contemporary health care is explained. The need for the upper management to establish a quality council is also elaborated.
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| 18. |
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| 19. |
- Malmvall, Bo-Erik, et al.
(författare)
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Reduction of antibiotics sales and sustained low incidence of bacterial resistance : report on a broad approach during 10 years to implement evidence-based indications for antibiotic prescribing in Jönköping County, Sweden
- 2007
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 16:1, s. 60-67
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Tidskriftsartikel (refereegranskat)abstract
- Background: Increased prevalence of resistance in major pathogens decreases the possibility to treat common infectious conditions. In the beginning of the 1990s, resistant pneumococci spread among children in southern Sweden, which alarmed both the profession and the medical authorities. We describe the measures taken to curb the spread of resistance and to reduce the use of antibiotics in outpatient care.Method: A national organization, Strama (Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance), was initiated in 1994 and a regional committee was formed in Jönköping County in 1995. A multifaceted program was started aiming at reducing antibiotic use in the county by 25% and that the prevalence of resistant pneumococci should not increase.Results: The efforts by the Jönköping County committee has resulted in a 31% total reduction of the consumption of antibiotic drugs in primary care between 1993 and 2005 and a 50% reduction among children aged 0 to 4 years. There has been no increase in the prevalence of resistant pneumococci or Haemophilus influenzae in the county. The decrease in antibiotic use was greater than the average in Sweden.Conclusion: Our regional efforts have been successful. This has probably been achieved by a sustained strategy including repeated campaigns in the media, information to the profession, implementation of guidelines, and feedback to the profession on data on antibiotic prescribing and resistance. We believe it is of outmost importance not only to inform the profession but also the public on the limited effects of antibiotics in most respiratory tract infections.
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| 20. |
- McAlearney, Ann Scheck, et al.
(författare)
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Organizational coherence in health care organizations : conceptual guidance to facilitate quality improvement and organizational change
- 2014
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Ingår i: Quality Management in Health Care. - : Lippincott Williams & Wilkins. - 1063-8628 .- 1550-5154. ; 23:4, s. 254-267
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations. Methods: We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model. Results and Conclusions: We suggest that organizational coherencemay be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.
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| 21. |
- McAlearney, Ann Scheck, et al.
(författare)
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Organizational coherence in health care organizations : conceptual guidance to facilitate quality improvement and organizational change
- 2013
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 22:2, s. 86-99
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations.METHODS: We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model.RESULTS AND CONCLUSIONS: We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.
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| 22. |
- Müllern, Tomas, et al.
(författare)
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Revisiting empowerment : a study of improvement work in health care teams
- 2012
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Ingår i: Quality Management in Health Care. - : Wolters Kluwer. - 1063-8628 .- 1550-5154. ; 21:2, s. 81-92
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Tidskriftsartikel (refereegranskat)abstract
- This article reports on a study of team empowerment in a large clinic at a Swedish hospital. The focus of the study was to understand how a high degree of empowerment enabled the teams to develop and sustain a high level of performance. More specifically, a model of empowerment was used to identify important factors that contribute to team empowerment in 3 teams at the clinic. In the analysis of the empirical data, 21 factors were identified and the degree of empowerment in the 3 teams was assessed.
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| 23. |
- Norman, Ann-Charlott, 1965-, et al.
(författare)
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One Lens Missing? Clarifying the Clinical Microsystem Framework with Learning Theories
- 2013
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Ingår i: Quality Management in Health Care. - : Lippincott Williams & Wilkins. - 1063-8628 .- 1550-5154. ; 22:2, s. 126-136
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The clinical microsystem (CMS)approach is widely used and is perceived as helpfulin practice but, we ask the question: “Is its learningpotential sufficiently utilized?” Objectives: Toscrutinize aspects of learning within the CMSframework and to clarify the learning aspects theframework includes and thereby support theframework with the enhanced learning perspectivethat becomes visible. Methods: Literature on theCMS framework was systematically searched andselected using inclusion criteria. An analytical toolwas constructed in the form of a theoretical lensthat was used to clarify learning aspects that areassociated with the framework. Findings: Theanalysis revealed 3 learning aspects: (1) The CMSframework describes individual and social learningbut not how to adapt learning strategies forpurposes of change. (2) The metaphorical languageof how to reach a holistic health care system foreach patient has developed over time but can stillbe improved by naming social interactions totranscend organizational boundaries. (3) Powerstructures are recognized but not as a characteristicthat restricts learning due to asymmetriccommunication. Conclusion: The “lens” perspectivereveals new meanings to learning that enhance ourunderstanding of health care as a social system andprovides new practical learning strategies.
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| 24. |
- Nyström, Monica
(författare)
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Characteristics of health care organizations associated with learning and development : lessons from a pilot study
- 2009
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Ingår i: Quality Management in Health Care. - Lippincott : Williams & Williams. - 1063-8628 .- 1550-5154. ; 18:4, s. 285-294
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Tidskriftsartikel (refereegranskat)abstract
- Characteristics of health care organizationsassociated with an ability to learn from experiencesand to develop and manage change were exploredin this study. Understanding of these characteristicsis necessary to identify factors influencing successin learning from the past and achieving futurehealth care quality objectives. A literature review ofthe quality improvement, strategic organizationaldevelopment and change management,organizational learning, and microsystems fieldsidentified 20 organizational characteristics, groupedunder (a) organizational systems, (b) key actors, and(c) change management processes. Qualitativemethods, using interviews, focus group reports, andarchival records, were applied to find associationsbetween identified characteristics and 6 Swedishhealth care units externally evaluated as deliveringhigh-quality care. Strong support for a characteristicwas defined as units having more than 4 sourcesdescribing the characteristic as an importantsuccess factor. Eighteen characteristics had strongsupport from at least 2 units. The strongest evidencewas found for the following: (i) key actors havelong-term commitment, provide support, and makesense of ambiguous situations; (ii) organizationalsystems encourage employee commitment,participation, and involvement; and (iii) changemanagement processes are employedsystematically. Based on the results, a new model of“characteristics associated with learning anddevelopment in health care organizations” isproposed.
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| 25. |
- Nyström, Monica E, et al.
(författare)
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Perceived organizational problems in health care : a pilot test of the structured problem and success inventory
- 2012
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 21:2, s. 93-103
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Tidskriftsartikel (refereegranskat)abstract
- Our objective was to test whether the Structured Problem and Success Inventory (SPI) instrument could capture mental representations of organizational and work-related problems as described by individuals working in health care organizations and to test whether these representations varied according to organizational position. A convenience sample (n = 56) of middle managers (n = 20), lower-level managers (n = 20), and staff (n = 16) from health care organizations in Stockholm (Sweden) attending organizational development courses during 2003-2004 was recruited. Participants used the SPI to describe the 3 most pressing organizational and work-related problems. Data were systematically reviewed to identify problem categories and themes. One hundred sixty-four problems were described, clustered into 13 problem categories. Generally, middle managers focused on organizational factors and managerial responsibilities, whereas lower-level managers and staff focused on operational issues and what others did or ought to do. Furthermore, we observed similarities and variation in perceptions and their association with respondents' position within an organization. Our results support the need for further evaluation of the SPI as a promising tool for health care organizations. Collecting structured inventories of organizational and work-related problems from multiple perspectives may assist in the development of shared understandings of organizational challenges and lead to more effective and efficient processes of solution planning and implementation.
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| 26. |
- Olsson, Jesper, et al.
(författare)
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Reflections on transnational transferability of improvement technologies-A comparison of factors for successful change in the United States and northern Europe
- 2003
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 12:4, s. 259-269
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Tidskriftsartikel (refereegranskat)abstract
- Two reliable models for predicting the success of change initiatives have been developed through the same research process. One model represents what is important in order to conduct successful improvements in the United States. The other model has been developed to predict successful improvement initiatives in Sweden. Through qualitative comparison between two reliable models we found some similarities and differences framing the underlying management heuristics for driving improvement initiatives. These findings are important pieces in transnational knowledge acquirement on quality improvements. They contribute a basis for discussions on transferability of management change concepts, and prompts for areas in need of considerations of adaptation before using different improvement ideas in other contexts than those for which they were developed.
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| 27. |
- Olsson, Jesper, et al.
(författare)
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The one-person randomized controlled trial
- 2005
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Ingår i: Quality Management in Health Care. - : Ovid Technologies (Wolters Kluwer Health). - 1063-8628 .- 1550-5154. ; 14:4, s. 206-216
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Tidskriftsartikel (refereegranskat)abstract
- Currently, the gold standard for collection of clinical evidence is the randomized controlled trial (RCT), preferably with large, multicenter samples of subjects. Although this approach provides valuable information, many clinicians find it difficult to translate RCT results to the individual patient level. In this report, a statistical approach called Design of Experiments (DOE) is described as a method of applying the principles of RCTs one person at a time. An overview of the method, with a simple clinical example, is presented. As shown, DOE is a more efficient method than the sequential approach often taken by clinicians and their patients when evaluating various treatment choices. Further, the effect of multiple interventions can be assessed, alone or in combination with each other. In this way, DOE can be an important addition to the field of evidence-based medicine, although further studies are needed.
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| 28. |
- Peterson, Anette, et al.
(författare)
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Collaboratively improving diabetes care in Sweden using a national quality register: Successes and challenges: a case study
- 2015
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 24:4, s. 212-221
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Tidskriftsartikel (refereegranskat)abstract
- Background: Since 1996, the Swedish National Diabetes Register (NDR) enabled health care providers to monitor their clinical performance over time and compare it with the national average. All health systems of Swedish county councils report data. By 2014, the NDR included data from 360 000 patients. Comparisons among county councils show significant variations in clinical outcomes and in adherence to evidence-based national guidelines. The purpose of this study was to evaluate whether and how a quality improvement collaborative could influence clinical practice and outcomes. Methods: Twenty-three diabetes teams from all over Sweden, both primary care units and internal medicine departments, joined a quality improvement collaborative. The project was inspired by the Breakthrough Collaborative Model and lasted for 20 months. Evaluation data were collected from the teams' final reports and the NDR throughout the study period. Results and Conclusion: The teams reported improved patient outcomes significantly compared with the national average for systolic blood pressure and low-density lipoprotein levels. In contrast, glycated hemoglobin A1c levels deteriorated in the whole NDR population. Five themes of changes in practice were tested and implemented. Success factors included improved teamwork, with active use of register data, and testing new ideas and learning from others. © 2015 Wolters Kluwer Health, Inc. All rights reserved.
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| 29. |
- Peterson, Anette, et al.
(författare)
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Improving guideline adherence through intensive quality improvement and the use of a National Quality Register in Sweden for acute myocardial infarction
- 2007
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 16:1, s. 25-37
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Data from the Swedish National Register in Cardiac Care have shown over the last 10 years an enduring gap between optimal treatment of acute myocardial infarction (AMI) according to current guidelines and the treatment actually given. We performed a controlled, prospective study in order to evaluate the effects of applying a multidisciplinary team-based improvement methodology to the use of evidence-based treatments in AMI, together with the use of a modified National Quality Register. The project engaged 25% of the Swedish hospitals.METHOD: Multidisciplinary teams from 20 hospitals participating in the National Register in Cardiac Care, ranging from small to large hospitals, were trained in continuous quality improvement methodology. Twenty matched hospitals served as controls. Our efforts were focused on finding and applying tools and methods to increase adherence to the national guidelines for 5 different treatments for AMI. For measurement, specially designed quality control charts were made available in the National Register for Cardiac Care.RESULTS: To close the gap, an important issue for the teams was to get all 5 treatments in place. Ten of the hospitals in the study group reduced the gap in 5 of 5 treatments by 50%, while none of the control hospitals did so.CONCLUSIONS: This first, controlled prospective study of a registry supported by multidisciplinary team-based improvement methodology showed that this approach led to rapidly improved adherence to AMI guidelines in a broad spectrum of hospitals and that National Quality Registers can be helpful tools.
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| 30. |
- Peterson, Anette, et al.
(författare)
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The educational impact of implementing National Quality Registries in Sweden - A national collaboration project
- 2019
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Ingår i: Quality Management in Health Care. - : Wolters Kluwer. - 1063-8628 .- 1550-5154. ; 28:4, s. 222-228
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: There is a need for improved clinical outcomes, and a useful tool in this endeavor is the use of National Quality Registries (NQRs). To learn more about the impact of NQRs, a National Collaboration Project was formed. This follow-up study had 2 aims: first, to describe the value and learning of a National Collaboration Project focusing on the use of NQRs in collaboration between universities, health care organizations, and the regional registry centers; and, second, to describe what activities are still ongoing.METHOD: A qualitative design was used to obtain a detailed description of the extent to which project leaders perceived that the goals had been achieved after participation in the national project. A qualitative descriptive content analysis was performed.RESULTS: Four main categories were found. The context proved to be crucial for how the local projects were formed and developed. Networking was highlighted as an important part of learning. Another mentioned part of learning was the change planned and implemented in the curriculum to promote the use of NQRs. Finally, the importance of anchoring and spreading the lessons learned was also stressed.CONCLUSION: Using NQRs in multidisciplinary education is successful in many ways, but this study shows that certain factors need to be in place to make it work in practice.
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| 31. |
- Poksinska, Bozena
(författare)
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The current state of Lean implementation in health care : literature review
- 2010
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 19:4, s. 319-329
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE:The purpose of this article is to discuss the current state of implementation of Lean production in health care. The study focuses on the definition of Lean in health care and implementation process, barriers, challenges, enablers, and outcomes of implementing Lean production methods in health care.DESIGN/METHODOLOGY/APPROACH:A comprehensive search of the literature concerning the implementation of Lean production in health care was used to generate a synthesis of the literature around the chosen research questions.FINDINGS:Lean production in health care is mostly used as a process improvement approach and focuses on 3 main areas: (1) defining value from the patient point of view, (2) mapping value streams, and (3) eliminating waste in an attempt to create continuous flow. Value stream mapping is the most frequently applied Lean tool in health care. The usual implementation steps include conducting Lean training, initiating pilot projects, and implementing improvements using interdisciplinary teams. One of the barriers is lack of educators and consultants who have their roots in the health care sector and can provide support by sharing experience and giving examples from real-life applications of Lean in health care. The enablers of Lean in health care seem not to be different from the enablers of any other change initiative. The outcomes can be divided into 2 broad areas: the performance of the health care system and the development of employees and work environment.
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| 32. |
- Rejler, Martin, et al.
(författare)
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Improved population-based care: : Implementing patient- and demand-directed care for inflammatory bowel disease and evaluating the redesign with a population-based registry
- 2007
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Ingår i: Quality Management in Health Care. - : Lippincott Williams & Wilkins. - 1063-8628 .- 1550-5154. ; 16:1, s. 38-50
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Tidskriftsartikel (refereegranskat)abstract
- The gastroenterology unit at the Höglands Hospital in Eksjö is responsible for the care of all 466 patients with inflammatory bowel disease (IBD) in a geographic area including approximately 115,000 inhabitants. In 2000, the frustration over an inadequate traditional outpatient clinic inspired us to redesign our outpatient unit to become more patient and demand directed. The redesign included the following: A direct telephone line for patients to a specialized nurse, available during working hours; appointments were scheduled in accordance with expected needs, and emergency appointments were available daily; traditional follow-ups of IBD patients were replaced by an annual telephone contact with a specialized nurse; the team agreed on a patient-centered value base for its work, and the redesign was monitored using clinical outcome measures reflecting 4 dimensions (see parentheses below) of the care in a Value compass; quality of life (functional) and routine blood samples (clinical) were followed yearly and collected in a computerized IBD registry together with basic information about the patients; access and waiting lists together with patient satisfaction (satisfaction) are followed regularly; and ward utilization (financial) was registered. Our study shows that the new design offers a more efficient outpatient clinic in which waiting lists are markedly reduced although production rates remains the same. Utilization data show a significant decrease in comparison with national data, showing that the new care is economically favorable. The clinical results regarding anemia frequency in the IBD population are highly comparable with or even better than those found in the literature. We also show good results regarding quality of life where more than 88% of patients achieve set goals. In conclusion, our new patient- and demand-directed care seems to be more efficient and with clinical and quality-of-life results remaining on a high standard.
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| 33. |
- Santos, Marco, 1978, et al.
(författare)
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Making Quality Registers Supporting Improvements: A Systematic Review of the Data Visualization in 5 Quality Registries
- 2014
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 23:2, s. 119-128
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Forskningsöversikt (refereegranskat)abstract
- Traditionally, quality registries have been initiated, developed, and used by physicians essentially for research purposes. There is an unrealized opportunity to expand and strengthen the contribution of quality registries in health care quality improvement. This article aims to characterize quality registry annual reports regarding factors deemed important to process improvement. The 2012 annual reports of the 5 most highly developed Swedish quality registries were examined. Each of the 636 charts included was coded according to an abstraction form. Results show that league tables are highly prevalent, whereas funnel plots and control charts are rare. Health care quality is monitored over time on the basis of few and highly aggregated measurements, and it is usually measured using percentages. In conclusion, quality registry annual reports lack both the level of detail and the consideration of random variation necessary to being able to be systematically used in process improvement. Users of annual reports are recommended caution when discussing differences in quality, both over time and across health care providers, as they can be due to chance and insufficient guidance is provided on the reports in this regard. To better support process improvement, annual reports should thus be more detailed and give more consideration to random variation.
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| 34. |
- Staines, Anthony, et al.
(författare)
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Sustaining improvement? The 20-year Jönköping Quality Improvement program revisited
- 2015
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 24:1, s. 21-37
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is scarce evidence of organization-wide and sustained impact of quality improvement (QI) programsin health care. For 20 years, the Jönköping County Council’s (Sweden) ambitious program has attracted attention from practitioners and researchers alike. Methods: This is a follow-up case of a 2006 study of Jönköping’s improvement program, triangulating data from 20 semi-structured interviews, observation and secondary analysis of internal performance data. Results: In 2010, clinical outcomes had clearly improved in 2 departments (pediatrics, intensive care), while process improvements were evident in many departments. In an overall index of the 20 Swedish county councils’ performance, Jönköping had improved its ranking since 2006 to lead in 2010. Five key issues shaped Jönköping’s improvement program since 2006: a rigorously managed succession of chief executive officer; adept management of a changing external context; clear strategic direction relating to integration; a broadened conceptualization of “quality” (incorporating clinical effectiveness, patient safety, and patient experience); and continuing investment in QI education and research. Physician involvement in formal QI initiatives had increased since 2006 but remained a challenge in 2010. A new clinical information system was being deployed but had not yet met expectations. Conclusions: This study suggests that ambitious approaches can carry health care organizations beyond the sustainability threshold.
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| 35. |
- Thörne, Karin, et al.
(författare)
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Co-producing interprofessional round work : Designing spaces for patient partnership
- 2017
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Ingår i: Quality Management in Health Care. - : Wolters Kluwer. - 1063-8628 .- 1550-5154. ; 26:2, s. 70-82
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Tidskriftsartikel (refereegranskat)abstract
- Within wide-ranging quality improvement agendas, patient involvement in health care is widely accepted as crucial. Ward rounds that include patients' active participation are growing as an approach to involve patients, ensure safety, and improve quality. An emerging approach to studying quality improvement is to focus on "clinical microsystems," where patients, professionals, and information systems interact. This provides an opportunity to study ward rounds more deeply. A new model of conducting ward rounds implemented through quality improvement work was studied, using the theory of practice architectures as an analytical tool. Practice architecture focuses on the cultural-discursive, social-political, and material-economic conditions that shape what people do in their work. Practice architecture is a sociomaterial theoretical perspective that has the potential to change how we understand relationships between practice, learning, and change. In this study, we examine how changes in practices are accomplished. The results show that practice architecture formed co-productive learning rounds, a possible model integrating quality improvement in daily work. This emerged in the interplay between patients through their "double participation" (as people and as information on screens), and groups of professionals in a ward round room. However, social interplay had to be renegotiated in order to accomplish the goals of all ward rounds.
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| 36. |
- Ulhassan, W., et al.
(författare)
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Antecedents and characteristics of lean thinking implementation in a swedish hospital : A case study
- 2013
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 22:1, s. 48-61
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Tidskriftsartikel (refereegranskat)abstract
- Despite the reported success of Lean in health care settings, it is unclear why and how organizations adopt Lean and how Lean transforms work design and, in turn, affects employees' work. This study investigated a cardiology department's journey to adopt and adapt Lean. The investigation was focused on the rationale and evolution of the Lean adoption to illuminate how a department with a long quality improvement history arrived at the decision to introduce Lean, and how Lean influenced employees' daily work. This is an explanatory single case study based on semistructured interviews, nonparticipant observations, and document studies. Guided by a Lean model, we undertook manifest content analysis of the data. We found that previous improvement efforts may facilitate the introduction of Lean but may be less important when forecasting whether Lean will be sustained over time. Contextual factors seemed to influence both what Lean tools were implemented and how well the changes were sustained. For example, adoption of Lean varied with the degree to which staff saw a need for change. Work redesign and teamwork were found helpful to improve patient care whereas problem solving was found helpful in keeping the staff engaged and sustaining the results over time.
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| 37. |
- Ulhassan, Waqar, et al.
(författare)
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How Visual Management for Continuous Improvement Might Guide and Affect Hospital Staff : A Case Study
- 2015
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Ingår i: Quality Management in Health Care. - : Lippincott Williams and Wilkins. - 1063-8628 .- 1550-5154. ; 24:4, s. 222-228
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Tidskriftsartikel (refereegranskat)abstract
- Visual management (VM) tools such as whiteboards, often employed in Lean thinking applications, are intended to be helpful in improving work processes in different industries including health care. It remains unclear, however, how VM is actually applied in health care Lean interventions and how it might influence the clinical staff. We therefore examined how Lean-inspired VM using whiteboards for continuous improvement efforts related to the hospital staff's work and collaboration. Within a case study design, we combined semistructured interviews, nonparticipant observations, and photography on 2 cardiology wards. The fate of VM differed between the 2 wards; in one, it was well received by the staff and enhanced continuous improvement efforts, whereas in the other ward, it was not perceived to fit in the work flow or to make enough sense in order to be sustained. Visual management may enable the staff and managers to allow communication across time and facilitate teamwork by enabling the inclusion of team members who are not present simultaneously; however, its adoption and value seem contingent on finding a good fit with the local context. A combination of continuous improvement and VM may be helpful in keeping the staff engaged in the change process in the long run.
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| 38. |
- Vackerberg, Nicoline, et al.
(författare)
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What is best for Esther? Building improvement coaching capacity with and for users in health and social Care-A case study
- 2016
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Ingår i: Quality Management in Health Care. - : LIPPINCOTT WILLIAMS & WILKINS. - 1063-8628 .- 1550-5154. ; 25:1, s. 53-60
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Tidskriftsartikel (refereegranskat)abstract
- While coaching and customer involvement can enhance the improvement of health and social care, many organizations struggle to develop their improvement capability; it is unclear how best to accomplish this. We examined one attempt at training improvement coaches. The program, set in the Esther Network for integrated care in rural Jonkoping County, Sweden, included eight 1-day sessions spanning 7 months in 2011. A senior citizen joined the faculty in all training sessions. Aiming to discern which elements in the program were essential for assuming the role of improvement coach, we used a case-study design with a qualitative approach. Our focus group interviews included 17 informants: 11 coaches, 3 faculty members, and 3 senior citizens. We performed manifest content analysis of the interview data. Creating will, ideas, execution, and sustainability emerged as crucial elements. These elements were promoted by customer focusembodied by the senior citizen trainershared values and a solution-focused approach, by the supportive coach network and by participants' expanded systems understanding. These elements emerged as more important than specific improvement tools and are worth considering also elsewhere when seeking to develop improvement capability in health and social care organizations.
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| 39. |
- Vedin, Tomas, et al.
(författare)
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Management of Traumatic Brain Injury in the Emergency Department : Guideline Adherence and Patient Safety
- 2017
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Ingår i: Quality Management in Health Care. - : Lippincott Williams & Wilkins. - 1063-8628 .- 1550-5154. ; 26:4, s. 190-195
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Tidskriftsartikel (refereegranskat)abstract
- Background: Traumatic brain injury is a common reason not only for emergency visits worldwide but also for significant morbidity and mortality. Several clinical guidelines exist but adherence is generally low.Aim: To study attitudes toward computed tomography of the head among emergency department Change to physicians throughout the article who manage patients with trauma to the head and doctors' adherence to guidelines.Methods: Quantitative questionnaire study with questionnaires collected over 3 months before introduction of new guidelines. After introduction, intermission of 8 months passed when information and education were given. Thereafter, questionnaires were collected for another 3 months.Results: A total of 694 patients were registered at the emergency department. A total of 161 questionnaires were analyzed; 50.9% did not use guidelines, 39% before intermission, and 60.5% after. When Canadian CT Head Rule was applied, 30.4% of patients with no loss of consciousness were referred to computed tomography, violating guideline recommendation.Conclusion: Guidelines are designed to improve performance but are not always applied correctly or as frequently as intended. Information and education did not increase guideline adherence. To improve guideline adherence, more innovative measures than formal guidelines must be undertaken. To find out what these measures are, we suggest qualitative studies to elucidate interventions that will have bigger impact on performance.
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| 40. |
- Örtendahl, Monica
(författare)
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Different time perspectives of the doctor and the patient reduce quality in health care
- 2008
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Ingår i: Quality Management in Health Care. - 1063-8628 .- 1550-5154. ; 17:2, s. 136-139
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Tidskriftsartikel (refereegranskat)abstract
- Time-related problems interfere with treatment decisions and evaluations in health care, both from the perspective of the doctor and from the perspective of the patient. The compliance level of the patient and subsequent evaluations in clinical practice might be affected by a discrepancy in the time perspective. Context factors related to time and health perspectives are relevant to clinical decisions and quality management. A summary of evaluation factors in quality management is presented: (a) the time perspective of the patient is different from the time perspective of the doctor, both in an objective and in a subjective manner; (b) disease chronicity chronic affects the perception of time; (c) assessments need to extend over a period sufficiently long for variations in a disease activity to be noticed; (d) there is variation both in time for an outcome to occur and in time span for that outcome; (e) the number of patients benefiting from certain drugs and variability over time is valuable information; (f) the outcome of a specified treatment could be estimated for different periods in a sequence; and (g) changes occur in judgments and decisions over time both for the doctor and for the patient.
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| 41. |
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| 42. |
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| 43. |
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| 44. |
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| 45. |
- Johansson, L., et al.
(författare)
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Health Care Professionals' Usage and Documentation of a Swedish Quality Registry Regarding Preventive Nutritional Care
- 2017
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Ingår i: Quality Management in Health Care. - : Ovid Technologies (Wolters Kluwer Health). - 1063-8628. ; 26:1, s. 15-21
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To describe health care staff members' usage and documentation in a Swedish quality registry focusing on a preventive care process regarding the risk area of malnutrition among persons with dementia. The preventive care process includes risk assessment, analysis of underlying causes, planning and performing interventions, as well as evaluating effects. Methods: Data were collected from 2 Swedish quality registries, Senior Alert and the Swedish Dementia Register (Svedem). In total, 1929 people with dementia were assessed and 1432 registered as being at risk of malnutrition or malnourished. Results: Performed nutritional interventions were registered in approximately 65% of cases. In more than 80% of registrations, the analyses of underlying causes were missing. Those who had registered underlying causes had significantly more interventions and the evaluation of the performed intervention was registered. The time between assessment and evaluation depended on care setting and ranged from 0 to 702 days. Conclusions: Limitations in registration were noted; however, the register allows staff to focus on nutritional care and has resulted in many risk assessments. Rarely people were registered in all steps of the preventive care process. Large variances in when the performed interventions were evaluated makes it difficult to measure improvements.
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| 46. |
- Kollberg, Beata, et al.
(författare)
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Design and Implementation of a Performance Measurement System in Swedish Health Care Services : A Multiple Cases Study of 6 Development Teams
- 2005
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Ingår i: Quality Management in Health Care. - 1063-8628. ; 14:2, s. 95-111
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Tidskriftsartikel (refereegranskat)abstract
- Performance measurement is considered to be an important part in improving and controlling contemporary organizations. Despite the increased interest in using and improving performance measurement systems, the number of researchers investigating the design and implementation process in more detail is still very small. The purpose of this article is to increase the understanding of how a performance measurement system, called the flow model, is designed and implemented by development teams in Swedish health care. The purpose of the flow model is to follow up the requirements in the National Care Guarantee through 8 measures. From a multiple case study of 6 local development teams, we conclude that the performance measurement system of the flow model is designed and implemented in Swedish County Councils through 3 development tracks, which are reflected in close interaction between the local development team and people in clinical departments. Enabling factors in the design and implementation are (1) the recognition of a need to change the current situation, (2) the teams' interaction with people in the clinical departments. (3) the national network meetings arranged by the financier. (4) the struggle to motivate and inform the top management, and (5) the establishment of contact with other development teams and ongoing projects.
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| 47. |
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| 48. |
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