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.

From a management point of view there are many different approaches from which to choose in how to engage staff in initiatives to improve performance. The present study investigates how two different types of improvement strategies stimulate and encourage involvement of different professional groups in healthcare organizations. The first type, Designed Improvement Processes, is constituted of a methodologically guided collaborative program. The second type, Intrapreneurship Projects, is characterized by an “intrapreneur” working with an improvement project in a rather free manner. The data analysis was carried out through classifying the participants´ profession, position, gender and the organizational administration of which they were a part. The result showed that nurses were the largest group participating in both improvement initiatives. Physicians were also well represented, although they seemed to prefer the less structured Intrapreneurship Projects approach. Assistant nurses, being the second largest staff group, were poorly represented in both initiatives. This indicates that the benefits and support for one group may push another group aside. Managers need to give prerequisites and incentives for staff who do not participate to do so.

The aim of this study was to investigate managers’ opinions of how to take advantage of patients as resources in quality improvement work in the Swedish healthcare sector.

The aim of this study was to explore and evaluate managers’ views of a large-scale improvement program, including their experiences and opinions about improvement initiatives and drivers for change. The study is based on a survey used in 2 nationwide mappings of improvement initiatives and developmental trends in Swedish health care. The participants were all managers in a county council in Sweden. Data were analyzed descriptively, and statements were ranked in order of preferences. A majority of the respondents stated that they had worked with improvements since the county council improvement program started. The managers sometimes found it difficult to find data and measurements that supported the improvements, yet a majority considered that it was worth the effort and that the improvement work yielded results. The top-ranked driving forces were ideas from personnel and problems in the daily work. Staff satisfaction was ranked highest of the improvement potentials, but issues about patients’ experiences of their care and patient safety came second and third. The managers stated that no or only a few patients had been involved in their improvement initiatives. Large-scale county council improvement initiatives can illuminate quality problems and lead to increased interest in improvement initiatives in the health care sector.

BACKGROUND:

Quality improvement initiatives have expanded recently within the healthcare sector. Studies have shown that less than 40% of these initiatives are successful, indicating the need for an instrument that can measure the progress and results of quality improvement initiatives and answer questions about how quality initiatives are conducted. The aim of the present study was to develop and test an instrument to measure improvement process and outcome in Swedish healthcare.

METHODS:

A questionnaire, founded on the Minnesota Innovation Survey (MIS), was developed in several steps. Items were merged and answer alternatives were revised. Employees participating in a county council improvement program received the web-based questionnaire. Data was analysed by descriptive statistics and correlation analysis. The questionnaire psychometric properties were investigated and an exploratory factor analysis was conducted.

RESULTS:

The Swedish Improvement Measurement Questionnaire consists of 27 items. The Improvement Effectiveness Outcome dimension consists of three items and has a Cronbach's alpha coefficient of 0.67. The Internal Improvement Processes dimension consists of eight sub-dimensions with a total of 24 items. Cronbach's alpha coefficient for the complete dimension was 0.72. Three significant item correlations were found. A large involvement in the improvement initiative was shown and the majority of the respondents were satisfied with their work.

CONCLUSIONS:

The psychometric property tests suggest initial support for the questionnaire to study and evaluate quality improvement initiatives in Swedish healthcare settings. The overall satisfaction with the quality improvement initiative correlates positively to the awareness of individual responsibilities.

Since the mid-1990s, increased attention has been placed on quality improvement and patient safety within the healthcare context. This study aims to evaluate the use of the Breakthrough Series Collaborative methodology in a Swedish county council improvement program, comparing measurements at the beginning and after six months. A questionnaire was used, and improvement processes and outcomes were analysed. The results showed an overall large engagement in improvements, although the methodology and the facilitators were seen as only moderately supportive. Nursing educators have highlighted the importance of improvement education amongst healthcare professions, and nurses could play an active role in improving healthcare practices and patient safety.

The purpose of this study was to evaluate whether an improvement program can contribute to positive sustainable improvements in an organization, and whether financial incentives are driving forces for improvements. The material was all projects (n=232) that applied for funding in a county council improvement program between 2007 and 2010. The projects were analyzed as to whether they received funding (n=98) or were rejected (n=95). In addition, a categorization of the projects’ intentions was analyzed. Some projects were still ongoing, but 50 projects were implemented and sustained two or more years after being finalized. Implemented improvements were on different levels, from (micro level) units up to the entire (macro level) organization. In addition, 27 rejected projects were finalized without funding. Eighteen of those 27 were sustainably implemented. This study indicates that there are incentives other than financial at work if an improvement program will contribute to sustainable improvements in the organization. To encourage practice-based improvements is one way of incentivizing the intention and effort to become and perform better.