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Five Types of Practice-Based ImprovementIdeas in Health Care Services: An EmpiricallyDefined Typology
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.
Malmö högskola, Fakulteten för Hälsa och samhälle.
Landstinget i Kalmar län.
2011 (English)In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 20, no 2, 122-130 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2011. Vol. 20, no 2, 122-130 p.
Keyword [en]
health care settings, improvement projects, quality improvement initiatives
Keyword [sv]
Hälso- och sjukvård, Förbättringsarbete, Kvalitet
National Category
Social Sciences Interdisciplinary
URN: urn:nbn:se:liu:diva-68073DOI: 10.1097/QMH.0b013e3182134b3cOAI: diva2:416038
Available from: 2011-05-10 Created: 2011-05-10 Last updated: 2013-04-18
In thesis
1. Quality Improvement in Healthcare: Experiences from a Swedish County Council Initiative
Open this publication in new window or tab >>Quality Improvement in Healthcare: Experiences from a Swedish County Council Initiative
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Kvalitetsutveckling och förbättringsarbete i hälso- och sjukvården : Erfarenheter från ett svenskt landsting
Abstract [en]

Quality improvement (QI) has become an important issue in healthcare settings. A central question for many healthcare systems is how to manage improvement initiatives adequately. All county councils and regions managing healthcare in Sweden have started to work with QI at an organizational system level, to varied extents. The Kalmar county council improvement initiative constitutes the empirical basis of this thesis. The aim of the thesis is to provide knowledge about different aspects of a county-wide improvement initiative, and a broader understanding of factors and strategies that affect participation, management and outcomes. The overall study design is based on a case study.

The first two studies illuminate the practice-based (micro level), bottom-up perspective. Inductively five different areas (categories) were identified. Factors influencing participation in improvement initiatives provided the basis for the next study. The result showed that different staff categories were attracted by different initiatives. The next two studies illuminate the top-down (macro/meso) management perspective. Managers’ views of how patients can participate were investigated and a content analysis of the written answers was made. Four main areas (categories) were identified. A survey study investigated all of the county council managers’ experiences of the whole improvement initiative. Overall the managers thought that the improvement work was worth the effort. To evaluate the Breakthrough Collaborative program, a survey was developed and tested. This survey was used to investigate process and outcome of the BC program. The majority of the respondents were satisfied with their work, but wanted more time for teams to meet and work. To find out if an improvement program can affect outcome and contribute to sustainable changes, interviews were made with project applicants (n=202). Almost half (48%) of the projects were funded, and of those 51% were sustained. Of the rejected (not funded) projects, 28% were accomplished and sustained anyway. The results in this thesis cannot show that the “golden mean” exists, or that a single best way to manage changes and improvements in a healthcare organization has been found, but the way QI initiatives are organized does affect participation and outcomes. The intention, from the management topdown system level, encouraging staff and units and letting practice-based ideas develop at all system levels, can stimulate and facilitate improvement work.

Abstract [sv]

Kvalitetsutveckling och förbättringsarbete har blivit en viktig del av hälso- och sjukvården. En viktig fråga för landsting och regioner är hur kvalitetsutveckling skall drivas och styras. Syftet med detta arbete är att bidra till ökad kunskap om kvalitetsarbete i en hälso- och sjukvårdsorganisation, hur förbättringsinitiativ kan bedrivas och ledas, samt vilka faktorer som bidrar till ett framgångsrikt förbättringsarbete. Arbetet utgår empiriskt från en satsning på kvalitet och förbättringsarbete i landstinget i Kalmar län och är genomförd som en fallstudie (case).

Resultatet speglar vad ett landstings satsning på förbättringsarbete utifrån mikro-, macro- och mesonivå kan ge. De första två delstudierna speglar det praktikbaserade förbättringsarbetet utifrån ett praktikbaserat perspektiv. En innehållsanalys av projekten som ansökt om ekonomisk ersättning gjordes. Fem kategorier utformades, och projekten betonade områden som patientsäkerhet, förbättrad tillgänglighet och effektivitet. Studie II kartlade deltagande i förbättringsarbete utifrån två olika initiativ. Resultatet visade att de olika initiativen attraherade olika personalkategorier, men kunde samtidigt utesluta andra grupper. Chefernas åsikter om och erfarenheter av landstingets satsning undersöktes i studie III och IV. Cheferna var överlag positiva och nöjda med arbetet. Förbättringsprogrammen följdes med frågeformuläret Swedish Improvement Measurement Questionnaire (SIMQ) som testats och utvärderats. Resultatet visade att deltagarna är nöjda med arbetet med sin förbättringsidé, men att metodiken kan upplevas som svår. Dessutom efterlyste deltagarna mer tid för förbättringsarbete i vardagen. Till sist analyserades de projekt som sökt pengar för att driva förbättringsarbete. Nästan hälften av alla projekt (48%) hade fått ekonomisk ersättning, och av dessa hade fler än hälften (51%) uppnått sitt mål och infört en bestående förbättring. Den här avhandlingen påvisar vikten av att ledningen uppmärksammar, möjliggör och stimulerar förbättringsarbete. Genom att erbjuda flera olika sätt att bedriva förbättringsarbete ökar möjligheten för allas medverkan.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 115 p.
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1505
Improvement work, Swedish healthcare organizations, Quality of Healthcare, Quality Management, Förbättringsarbete, Kvalitetsutveckling, Svensk hälso- och sjukvårdsorganisation
National Category
Social Sciences Interdisciplinary
urn:nbn:se:liu:diva-91255 (URN)978-91-7519-664-0 (print) (ISBN)
Public defence
2013-05-23, Tem21, Hus T, Campus Valla, Linköpings universitet, Linköping, 10:15 (Swedish)
Available from: 2013-04-18 Created: 2013-04-18 Last updated: 2013-04-18Bibliographically approved

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