| 1. |
- Bastholm Rahmner, Pia, et al.
(author)
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Physicians perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system
- 2004
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In: International journal of health care quality assurance incorporating leadership in helath services. - : Emerald. - 1366-0756 .- 2051-3135. ; 17:4, s. 173-179
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Journal article (peer-reviewed)abstract
- Seeks to identify physicians' perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system. Details a descriptive, qualitative study, with semi-structured individual interviews of 21 physicians in the Accident and Emergency Department of South Stockholm General Hospital. Identifies four descriptive categories for possibilities and obstacles. Concludes that gaining access to patient drug history enables physicians to carry out work in a professional way – a need the computerised prescription support system was not developed for and thus cannot fulfil. Alerts and producer-independent drug information are valuable in reducing workload. However, technical prerequisites form the base for a successful implementation. Time must be given to adapt to new ways of working.
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| 2. |
- Lindberg, Eva, et al.
(author)
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Clashes between understanding and doing – leaders’ understanding of management in intensive care during a period of reorganisation
- 2003
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In: International journal of health care quality assurance incorporating leadership in helath services. - : Emerald. - 1366-0756 .- 2051-3135. ; 16:7, s. 354-60
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Journal article (peer-reviewed)abstract
- Abstract: The objective was to elucidate hospital leaders’ understanding of the organisational structures and processes and their understanding of their leading role during an intensive period of reorganisation. From a qualitative exploratory study using semi-structured interviews and thematic analysis four themes were identified: understanding the function of leadership and management, understanding organisational structures and processes, their own role as leader, and the outside world. The results indicate that the organisation is characterised by disintegration and erratic structures. The leaders perceive that they lead a learning organisation but in practical care work the organisation functions more like an organisation streamlined for mass production. This discrepancy between their understanding and practical daily care work led to dissatisfaction and existential chaos among the leaders. Our findings show an example of “clashes with the individual attractor pattern”, an urgent, but not yet very clear problem in health-care organisations of today.
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| 3. |
- Lindberg, Eva, et al.
(author)
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Implementing TQM in the health care service
- 2005
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In: International journal of health care quality assurance incorporating leadership in helath services. - : Emerald. - 1366-0756 .- 2051-3135. ; 18:5, s. 370-84
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Journal article (peer-reviewed)abstract
- Purpose – The present study seeks to present a case study over four years following an implementation process of total quality management (TQM) on an ICU (intensive care unit). Design/methodology/approach – The aim was to describe consequences shown in the organisational climate, workload and staff wellbeing. A case study design was employed using a longitudinal method of data collection. Findings – Downsizing due to diminishing resources was a parallel process probably disturbing the TQM implementation. The workload increased by 20 per cent, whereas organisational and individual variables remained stable over time. However, sick leave increased dramatically and was higher than the general level within the Swedish population. The ICU had the capacity to adapt successfully by regulating working hours to workload. It is speculated that another cause behind sickness absence exists other than the general opinion. The literature used for the discussion departs from the relation between people's understanding and acting, sensemaking, and organisational theories describing complex adaptive systems emphasizing attraction patterns. Organisational ambiguity was a main finding in an earlier study that was used for interpretation of the result in the present study. As ambiguity seems to be a major and increasing problem, it has consequences for management as well as for continuous quality development. Originality/value – The implication of the study is the need to be able to successfully work in an ambiguous situation and use the quality system as a device in day-to-day work.
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| 4. |
- Lindberg, Eva, et al.
(author)
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Managing complexity : acknowledge the attraction patterns by supporting sensemaking and allowing the quality system to serve as the panoptic system
- 2002
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In: International journal of health care quality assurance incorporating leadership in helath services. - : Emerald. - 1366-0756 .- 2051-3135. ; 15:5, s. 213-6
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Journal article (peer-reviewed)abstract
- This paper is of a theoretical type ending with a model describing the frame and function of a quality system. Quality in health care is largely dependent on the behaviour and action of the health care staff. Furthermore behaviour and action emanate from the individual and group sensemaking. When viewing the organisation as a complex adaptive system, the necessity of becoming aware of, and co-evolving with the process of sensemaking becomes very clear. It has potential to view the individual’s attraction patterns as the channel for creativity. The quality system can serve as the framework on which to enlighten this vital dimension. The concept of meaning status in the group is useful when it comes to managing a complex system through a quality system. When so, the core objective of the quality system is to support and enhance the awareness of all the disparate meanings (future-perspective), stimulate reflection upon them and transform them into a collective meaning status (presence) in order to make effective decisions and a successful adaptation to change.
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| 5. |
- Lindberg, Eva, et al.
(author)
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The staff’s views on what’s the job – the starting point for quality improvement in health care
- 2003
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In: International journal of health care quality assurance incorporating leadership in helath services. - : Emerald. - 1366-0756 .- 2051-3135. ; 16:1, s. 47-54
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Journal article (peer-reviewed)abstract
- Abstract: Describes 12 members of staff’s views of their job and tasks in an intensive care unit of a middle-sized Swedish hospital. Open-ended questions were asked and the interviews were analysed using thematic technique. The character of the work and the work tasks was the key variable in the analysis. The participants thought of intensive care as turbulent and ambiguous, powerful but also menacing and a concept comprised of a dichotomy of fundamental values. The work task of the participants was conceptualised in terms of managing the health status of the patient, seeking to appreciate the patient’s needs and ensuring that the staff worked harmoniously and effectively as a team. Speculates that the existence of a real dichotomy in fundamental values might be caused by the difficult medical reality on the ward. The study confirms a necessity for a two-dimensional quality system where the deeper dimension deals with the disparate set of meaning status in the future perspective.
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| 6. |
- Schröder, Agneta, et al.
(author)
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Quality in Psychiatric Care : an instrument evaluating patients’ expectations and experiences
- 2007
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In: International journal of health care quality assurance. - : Emerald. - 1366-0756 .- 0952-6862 .- 2051-3135. ; 20:2, s. 141-160
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Journal article (peer-reviewed)abstract
- Purpose – The principal aim of this paper is to develop an instrument to measure quality of care in the psychiatric setting from an in-patient perspective and to describe quality of care by means of this instrument. A further aim is to investigate the influence of background variables and expectations on the experience of care. Design/methodology/approach – The instrument “Quality in psychiatric care” consists of two parts: one for measuring the patient's expectations regarding quality of care, the other for measuring his or her experiences regarding it. The instrument was derived from an earlier interview study of patients' perceptions of the quality of psychiatric care. A sample of 116 patients from eight in-patient wards in Sweden participated in the present study. Findings – Results indicate a generally high quality of care. Experienced quality of care was significantly lower, however, than expectations in all the dimensions of the instrument: total dimension, dignity, security, participation, recovery and environment. Patients who perceived that the time of discharge was consistent with the stage of their illness experienced significantly higher Recovery; patients with good psychiatric health experienced this too, but also significantly higher participation. Research limitations/implications – This new instrument needs to be further tested before the psychometric properties can be established. Originality/value – The value of the research is that instruments for measuring the quality of in-patient psychiatric care from the patient's perspective and with a theoretical foundation are less common.
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| 7. |
- Eckerlund, Ingemar, et al.
(author)
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Change-oriented patient questionnaires : testing a new method at three departments of ophthalmology.
- 1997
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In: International journal of health care quality assurance incorporating Leadership in health services. - : MCB University Press. - 1366-0756. ; 10, s. 254-259
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Journal article (other academic/artistic)abstract
- The use of patient questionnaires has increased widely in recent years. Their purpose, to incorporate patient perspectives into the orientation and design of health care, is, of course, commendable. However, the survey methods themselves have been less adequate, both in terms of validity and reliability, and with respect to the potential for using the results to improve the quality of health care. Presents a pilot study at three departments of ophthalmology in Sweden, involving a new method which meets reasonable demands for validity and reliability, and is explicitly change-oriented.
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| 8. |
- Ovretveit, J
(author)
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Formulating a health quality improvement strategy for a developing country
- 2004
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In: International journal of health care quality assurance incorporating Leadership in health services. - : Emerald. - 1366-0756. ; 17:7, s. 368-76
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Journal article (peer-reviewed)abstract
- The purpose of this paper is to present the idea of a national health quality plan as a way of mobilising and organising effort towards quality improvement, and stimulate debate and interest in the West in the subject, showing how quality improvement can be developed and invigorated by engaging in issues arising from quality strategies in developing countries. Considers why developing countries are concerned to improve the quality of health care and the different methods which can be used. Stresses the importance of recognising the starting‐point and what can help and hinder this work. Concentrates on improving the quality of health care, rather than the wider and important question of improving health. Concludes that developing countries do have the exerptise and that extra resources are needed, mostly for training and supervision. Opines that if implementation is not managed then the investment will be wasted.
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| 9. |
- Ovretveit, J, et al.
(author)
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Hospital quality management system in a low income Arabic country: an evaluation
- 2006
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In: International journal of health care quality assurance incorporating Leadership in health services. - : Emerald. - 1366-0756. ; 19:6-7, s. 516-32
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Journal article (peer-reviewed)abstract
- The paper seeks to present findings from an evaluation of a quality management system implemented in a low‐income country hospital.Design/methodology/approachThis is a single‐case before and after evaluation.FindingsThe quality system, although only 70 per cent implemented, resulted in increasing compliance with a few selected standards and produced modest improvements in patient satisfaction and utilisation. Hospital doctors and managers wanted to continue to develop the system and described conditions they thought important to spread to other hospitals.Research limitations/implicationsNo objective, clinical outcomes data were gathered, and the short timescale meant that the system was not fully implemented at the time of the evaluation.Practical implicationsIt is possible to improve patient care in rural hospitals with a few extra resources, in a culture not familiar with management processes, and to engage otherwise poorly motivated doctors in systematic improvement. However, certain conditions are necessary for introducing, sustaining and spreading quality improvement programmes.Originality/valueThis study and report is one of the first, detailed and systematic evaluations of a hospital quality management system in a highly resourced constrained situation in an Arabic country, which has implications for improving health care in other developing countries.
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| 10. |
- Svartbo, B, et al.
(author)
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Inpatient care quality: analyzing Swedish hospitals with stroke as a tracer
- 2000
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In: International journal of health care quality assurance incorporating Leadership in health services. - : Emerald. - 1366-0756. ; 13:4-5, s. 218-22
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Journal article (peer-reviewed)abstract
- Mortality statistics are an important source of information concerning variations in time and place, identification of risk factors and the evaluation of treatment programs. In this study, a new death certificate was completed “blind” on the basis of hospital records from the last episode of care, across a random sample of 1,376 cases. The results showed that the overlap between the official register’s underlying cause of death and that of a panel was 72 per cent at the three‐digit level. The official underlying cause of death from cerebrovascular diseases (CVD) was 72 cases in this sample, while 93 were deemed to have CVD by a panel. Additionally, of the 1,233 cases originally reported as non‐CVD, the panel deemed non‐CVD to be the true underlying cause in 1,176 cases. The paper concludes that CVD was most often correctly reported as the underlying cause of death in the investigated ages up to 75 years but plain differences were found between specialities and in different hospital size.
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| 11. |
- Øvretveit, J
(author)
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Producing useful research about quality improvement
- 2002
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In: International journal of health care quality assurance incorporating Leadership in health services. - : Emerald. - 1366-0756. ; 15:6-7, s. 294-302
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Journal article (peer-reviewed)abstract
- Many quality improvement interventions such as educational programmes, hospital quality strategies, and quality evaluation systems have not been evaluated. The aim of this paper is to encourage research into these “quality improvement processes” by presenting suitable designs and methods, and by describing research approaches which are less familiar in healthcare. The paper proposes that the choice of research design depends on the level and complexity of the intervention. Theory‐building approaches are more suitable than experimental theory testing approaches for evaluating higher‐level complex interventions and for understanding critical context factors. Collaborative action evaluation studies can provide useful information for decision makers – an example is given. “User focused” research can provide knowledge for developing more effective quality intervention processes and for making better decisions about their use and implementation.
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| 12. |
- Øvretveit, J
(author)
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The economics of quality--a practical approach
- 2000
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In: International journal of health care quality assurance incorporating Leadership in health services. - : Emerald. - 1366-0756. ; 13:4-5, s. 200-7
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Journal article (peer-reviewed)
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| 13. |
- Øvretveit, J
(author)
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The quality of health purchasing
- 2003
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In: International journal of health care quality assurance incorporating Leadership in health services. - : Emerald. - 1366-0756. ; 16:2-3, s. 116-27
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Journal article (peer-reviewed)abstract
- Much has been written about quality in patient care and clinical support services, but very little about the quality of purchasing. This paper gives an overview of quality issues in purchasing, and offers guidelines and practical steps for purchasers to improve service quality – both their own and their providers’. It defines quality in purchasing and considers how purchasers can influence markets and work with providers to improve health services quality. The paper gives practical guidance for improving quality, which recognises the limited resources and skills which purchasers have for the task. It addresses some issues raised by purchaser/managers: How does a purchasing organisation measure and improve quality? Is there a better way of specifying and monitoring quality than the “shopping‐list of standards” approach – what should be asked of providers? How can information about clinical quality, outcome and costs, be obtained in a form in which reliable comparisons can be made? Is quality accreditation or registration a good predictor of future quality?
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