| 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, 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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| 3. |
- 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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| 4. |
- 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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| 5. |
- 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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| 6. |
- 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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| 7. |
- 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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| 8. |
- 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
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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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| 9. |
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| 10. |
- 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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| 11. |
- 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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| 12. |
- 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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| 13. |
- 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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| 14. |
- 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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| 15. |
- 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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| 16. |
- 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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| 17. |
- 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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