| 1. |
- 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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| 2. |
- 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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| 3. |
- 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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| 4. |
- 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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| 5. |
- 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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| 6. |
- 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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| 7. |
- 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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| 8. |
- 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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| 9. |
- 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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| 10. |
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| 11. |
- 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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| 12. |
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