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Adapting a survey to evaluate quality improvements in Swedish healthcare
Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
Research Unit, Psychiatry Division, Kalmar County Council, Sweden.
Faculty of Health and Society, Malmö University and Skåne University Hospital, 205 06 Malmö, Sweden.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Quality improvement initiatives, a concept with origins in the manufacturing sector, have increased within the Swedish healthcare sector in recent decades. These efforts to improve quality can be seen as a response to demands for more cost-effectiveness and better medical results. However, studies have shown that less than 40% of these initiatives are successful (Olsson et al. 2007). The reason why specific improvement initiatives in healthcare fail or succeed is, therefore, a central question in studies of change. To be able to manage, improve and implement quality initiatives and improvements it is necessary to observe, measure and evaluate. Batalden and Davidoff (2007) point out that if there are no mechanisms to measure the changes, there is no way to know whether they actually lead to improvements. A more severe consequence, as stated by Sorian (2006), is that we sometimes accept an organizational system that not only fails to reward or encourage quality improvements but also sometimes punishes those who prioritize quality over cost-effectiveness. The need for more evidence about how to organize and manage new quality initiatives is identified as an important task within studies of healthcare improvement (Walshe 2009, Olsson et al. 2007).

National Category
Engineering and Technology
URN: urn:nbn:se:liu:diva-63716OAI: diva2:382390
Available from: 2010-12-30 Created: 2010-12-30 Last updated: 2010-12-30
In thesis
1. Practice-based Improvements in Healthcare
Open this publication in new window or tab >>Practice-based Improvements in Healthcare
2010 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

A central problem for the healthcare sector today is how to manage change and improvements. In recent decades the county councils in Sweden have started various improvement initiatives and programs in order to improve their healthcare services. The improvement program of the Kalmar county council, which constitutes the empirical context for this thesis, is one of those initiatives.

The purpose of this thesis is to contribute to a broader understanding of large-scale improvement program in a healthcare setting. This is done by analyzing practitioner’s improvement ideas, describing participants in the improvement projects, revising and testing a survey to measure the development of improvement ideas and describing the improvement program from a theoretical perspective. The theoretical change model used looks at change from two opposing directions in six dimensions; Goals, Leadership, Focus, Process, Reward system and Use of consultants.

The aims of the county council improvement program are to become a learning organization, disseminate improvement methodologies and implement continuous quality improvements in the organization. All healthcare administrations and departments in the county council were invited to apply for funds to accomplish improvement projects. Another initiative invited staff teams to work with improvement ideas in a program with support from facilitators, using the breakthrough methodology. Now almost all ongoing developments, improvements, patient safety projects, manager and leader development initiatives are put together under the county council improvement program umbrella.

In the appended papers both qualitative and quantitative research approach were used. The first study (paper I) analyzed which types of improvement projects practitioners are engaged in using qualitative content analysis. Five main categories were identified: Organizational Process; Evidence and Quality; Competence Development; Process Technology; and Proactive Patient Work. Most common was a focus on organizational changes and process, while least frequent was proactive patient work. Besides these areas of focus, almost all aimed to increase patient safety and increase effectiveness and availability.

Paper II described the participants in two of the initiatives, the categorized improvement projects in paper I and the team members in the methodology guided improvement programs. Strong professions like physicians and nurses were well represented, but other staff groups were not as active. Managers were responsible for a majority of the projects. The gender perspective reflected the overall mix of employees in the county council.

Paper III described a revision and test of a Minnesota Innovation Survey (MIS) that will be used to follow and measure how quality improvement ideas develop and improve over time. Descriptive statistics were presented. The respondents were satisfied with their work and what they had accomplished. The most common comment was about time, not having enough time to work with the improvement idea and the difficulty of finding time because of regular tasks. This was the first test of the revised survey and the high use of the answer alternative “Do not know” showed that the survey did not fit the context very well in its present version.

Trying to connect the county council improvement program and the initiatives studied in papers I and II with the change model gave rise to some considerations. The county council improvement program has an effort to combine organizational changes and a culture that encourages continuous improvements. Top-down and bottom-up management approaches are used, through setting out strategies from above and at the same time encouraging practitioners to improve their day-to-day work. Whether this will be a successful way to implement and achieve a continuous improvement culture in the whole organization is one of the main issues remaining to find out in further studies.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 58 p.
Linköping Studies in Science and Technology. Thesis, ISSN 0280-7971 ; 1455
National Category
Engineering and Technology
urn:nbn:se:liu:diva-63717 (URN)LiU-TEK-Lic 2010:26 (Local ID)978-91-7393-275-2 (ISBN)LiU-TEK-Lic 2010:26 (Archive number)LiU-TEK-Lic 2010:26 (OAI)
2010-12-02, Arcas, Campus Valla, Linköpings universitet, Linköping, 10:00 (Swedish)
Available from: 2010-12-30 Created: 2010-12-30 Last updated: 2011-01-03Bibliographically approved

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