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  • 1.
    Andersson, Ann-Christine
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Managers’ Views and Experiences of a Large-Scale County Council Improvement Program: Limitations and Opportunities2013In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 22, no 2, p. 152-160Article in journal (Refereed)
    Abstract [en]

    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.

  • 2.
    Andersson, Ann-Christine
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Practice-based Improvements in Healthcare2010Licentiate 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.

    List of papers
    1. Practice-based improvement ideas in healthcare services
    Open this publication in new window or tab >>Practice-based improvement ideas in healthcare services
    2010 (English)Conference paper, Published paper (Other academic)
    Abstract [en]

    Objective. The present study will contribute to knowledge of how practitioners in a healthcare region engage in quality improvement initiatives. 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 healthcare sector.

    Design and settings. This study is based on the Kalmar county council Improvement Program. Healthcare departments and primary healthcare centers in the county council were invited to apply for money to accomplish improvement projects. The aim is to empirically identify and present the different kinds of practice-based improvement ideas developed in healthcare services. The 202 applications received from various healthcare departments and primary healthcare centers are analyzed using qualitative content analysis.

    Outcome and Results. Five 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. In addition, a common characteristic among the studied project applications is to increase patient safety, effectiveness and availability of care, and education/training. Those intentions are found in many of the applications and therefore give the impression of being most important to caregivers today.

    Conclusions. These projects point to the various problems and experiences healthcare professionals encounter in their day-to-day work. This paper provides valuable insights into the current state of improvement work in Swedish healthcare, and will serve as a foundation for further investigations in this quality program.

    Keywords
    Quality improvement initiatives, healthcare settings, improvement projects
    National Category
    Engineering and Technology
    Identifiers
    urn:nbn:se:liu:diva-63714 (URN)
    Conference
    12th International QMOD and Toulon-Verona Conference on Quality and Service Sciences (ICQSS) 27-29 August 2009, Verona, Italy
    Available from: 2010-12-30 Created: 2010-12-30 Last updated: 2010-12-30
    2. Who conducts quality improvement initiatives in healthcare services? An evaluation of an improvement program in acounty council in Sweden
    Open this publication in new window or tab >>Who conducts quality improvement initiatives in healthcare services? An evaluation of an improvement program in acounty council in Sweden
    2010 (English)Conference paper, Published paper (Other academic)
    Abstract [en]

    Purpose – The aim of this paper is to contribute to the knowledge of who engages in quality improvement initiatives and to describe whether staff professions or gender are relevant variables.

    Design/methodology/approach – This paper contains an evaluation of the participants in a specific defined strategic improvement initiative program in one county council in southeast Sweden. The improvement program was initiated by county council politicians to encourage improvement initiatives and to spread improvement skills and knowledge in the organization. The program is driven both “top down” (teaching/convincing line managers to demand improvements) and “bottom up” through improvement programs using methodology to help teams identify, plan and adopt improvements in their daily work. Data was collected from special applications (called Free Applications, FA) and from participants in the education program (called Improvement Program, IP), both of which include information about profession and 2 gender. A content analysis was made. After the first categorization of which types of improvement projects practitioners engage in, further analysis of staff disciplines, professions (hierarchy) and gender was done. The results were compared to the overall structure of staff presence in the county council.

    Findings – Changes in participation occurred over time. The FA (Free Applications) part (n=202) shows a higher share of leaders and managers (35%), but their participation in the IP (Improvement Program) (n=477) fluctuated (8-26%). Physicians were more represented in the FA than in the IP. The largest single group was nurses. Overall the gender perspective reflects the conditions of the county council, but in FA the representation of women was lower. Five types of improvement projects were identified: 1) Organizational process focus; 2) Evidence and quality; 3) Competence development; 4) Process Technology; and 5) Proactive patient work. Managers were most represented in the category “Organizational process”. The largest difference was seen in the category “Proactive patient work” with the highest occurrence among women (86%) and less among men (17%) and managers (21%). The patient as a contributor taking active part was not found in either the FA or the IP.

    Research limitations/implications – This study shows differences in participation between free applications and methodology-guided programs when it comes to professions and gender in the country council improvement drive. It may be useful for further research regarding how to successfully work for and implement improvements and change in healthcare environments.

    Practical implications – The study will discuss and contribute to further knowledge of whether profession, hierarchy and gender have an impact (obstructive or as an asset) in performing improvement work in healthcare settings.

    Originality/value - Not much has been written about who is accomplishing quality improvements in terms of profession and gender. This paper provides some valuable insights into the differences between staff categories (professions) and gender in the improvement work in Swedish healthcare.

    Keywords
    quality improvement, improvement work, healthcare settings, nursing staff professions, gender
    National Category
    Engineering and Technology
    Identifiers
    urn:nbn:se:liu:diva-63715 (URN)
    Conference
    13th International QMOD Conference, August 30 - September 01, Cottbus, Germany
    Available from: 2010-12-30 Created: 2010-12-30 Last updated: 2010-12-30
    3. Adapting a survey to evaluate quality improvements in Swedish healthcare
    Open this publication in new window or tab >>Adapting a survey to evaluate quality improvements in Swedish healthcare
    (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
    Identifiers
    urn:nbn:se:liu:diva-63716 (URN)
    Available from: 2010-12-30 Created: 2010-12-30 Last updated: 2010-12-30
  • 3.
    Andersson, Ann-Christine
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Quality Improvement in Healthcare: Experiences from a Swedish County Council Initiative2013Doctoral thesis, comprehensive summary (Other academic)
    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.

    List of papers
    1. Five Types of Practice-Based ImprovementIdeas in Health Care Services: An EmpiricallyDefined Typology
    Open this publication in new window or tab >>Five Types of Practice-Based ImprovementIdeas in Health Care Services: An EmpiricallyDefined Typology
    2011 (English)In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 20, no 2, p. 122-130Article 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.

    Keywords
    health care settings, improvement projects, quality improvement initiatives, Hälso- och sjukvård, Förbättringsarbete, Kvalitet
    National Category
    Social Sciences Interdisciplinary
    Identifiers
    urn:nbn:se:liu:diva-68073 (URN)10.1097/QMH.0b013e3182134b3c (DOI)
    Available from: 2011-05-10 Created: 2011-05-10 Last updated: 2018-01-12
    2. Improvement Strategies: Forms and Consequences for Participation in Healthcare Improvement Projects
    Open this publication in new window or tab >>Improvement Strategies: Forms and Consequences for Participation in Healthcare Improvement Projects
    2013 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    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.

    Keywords
    Gender, Healthcare settings, Nursing staff professions, Participation, Quality Improvement, Quality Management
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-91250 (URN)
    Available from: 2013-04-18 Created: 2013-04-18 Last updated: 2013-04-18Bibliographically approved
    3. Patient participation in quality improvement: managers’ opinions of patients as resources
    Open this publication in new window or tab >>Patient participation in quality improvement: managers’ opinions of patients as resources
    2012 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 23-24, p. 3590-3593Article in journal (Refereed) Published
    Abstract [en]

    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.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2012
    National Category
    Reliability and Maintenance
    Identifiers
    urn:nbn:se:liu:diva-85638 (URN)10.1111/j.1365-2702.2012.04254.x (DOI)000310978000030 ()
    Available from: 2012-11-26 Created: 2012-11-26 Last updated: 2017-12-07Bibliographically approved
    4. Managers’ Views and Experiences of a Large-Scale County Council Improvement Program: Limitations and Opportunities
    Open this publication in new window or tab >>Managers’ Views and Experiences of a Large-Scale County Council Improvement Program: Limitations and Opportunities
    2013 (English)In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 22, no 2, p. 152-160Article in journal (Refereed) Published
    Abstract [en]

    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.

    Place, publisher, year, edition, pages
    Lippincott Williams & Wilkins, 2013
    National Category
    Social Sciences Interdisciplinary
    Identifiers
    urn:nbn:se:liu:diva-91251 (URN)10.1097/QMH.0b013e31828bc276 (DOI)000209317100009 ()
    Available from: 2013-04-18 Created: 2013-04-18 Last updated: 2018-01-11Bibliographically approved
    5. Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare
    Open this publication in new window or tab >>Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare
    2013 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 48Article in journal (Refereed) Published
    Abstract [en]

    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.

    Place, publisher, year, edition, pages
    BioMed Central, 2013
    National Category
    Other Engineering and Technologies not elsewhere specified
    Identifiers
    urn:nbn:se:liu:diva-89620 (URN)10.1186/1472-6963-13-48 (DOI)000315037600001 ()
    Available from: 2013-02-28 Created: 2013-02-28 Last updated: 2017-12-06
    6. Evaluating a Breakthrough Series Collaborative in a Swedish healthcare context
    Open this publication in new window or tab >>Evaluating a Breakthrough Series Collaborative in a Swedish healthcare context
    2013 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    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.

    Keywords
    Breakthrough Series Collaborative, Nursing, Quality Improvement, Questionnaire, Swedish healthcare
    National Category
    Social Sciences Interdisciplinary
    Identifiers
    urn:nbn:se:liu:diva-91252 (URN)
    Available from: 2013-04-18 Created: 2013-04-18 Last updated: 2018-01-11Bibliographically approved
    7. Sustainable Outcomes of an Improvement Program: Do Financial Incentives Matter?
    Open this publication in new window or tab >>Sustainable Outcomes of an Improvement Program: Do Financial Incentives Matter?
    2013 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    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.

    Keywords
    Quality improvement, healthcare settings, improvement program, sustainable improvement, financial incentives
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-91254 (URN)
    Available from: 2013-04-18 Created: 2013-04-18 Last updated: 2013-04-18Bibliographically approved
  • 4.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Idvall, Ewa
    Malmö högskola, Fakulteten för Hälsa och samhälle.
    Perseius, Kent-Inge
    Landstinget i Kalmar län.
    Five Types of Practice-Based ImprovementIdeas in Health Care Services: An EmpiricallyDefined Typology2011In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 20, no 2, p. 122-130Article in journal (Refereed)
    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.

  • 5.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Idvall, Ewa
    Faculty of Health and Society, Malmö University.
    Perseius, Kent-Inge
    Kalmar County Council/Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Improvement Strategies: Forms and Consequences for Participation in Healthcare Improvement Projects2013Manuscript (preprint) (Other academic)
    Abstract [en]

    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.

  • 6.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Idvall, Ewa
    Faculty of Health and Society, Malmö University and Skåne University Hospital, 205 06 Malmö, Sweden.
    Perseius, Kent-Inge
    Research Unit, Psychiatry Division, Kalmar County Council, Sweden.
    Practice-based improvement ideas in healthcare services2010Conference paper (Other academic)
    Abstract [en]

    Objective. The present study will contribute to knowledge of how practitioners in a healthcare region engage in quality improvement initiatives. 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 healthcare sector.

    Design and settings. This study is based on the Kalmar county council Improvement Program. Healthcare departments and primary healthcare centers in the county council were invited to apply for money to accomplish improvement projects. The aim is to empirically identify and present the different kinds of practice-based improvement ideas developed in healthcare services. The 202 applications received from various healthcare departments and primary healthcare centers are analyzed using qualitative content analysis.

    Outcome and Results. Five 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. In addition, a common characteristic among the studied project applications is to increase patient safety, effectiveness and availability of care, and education/training. Those intentions are found in many of the applications and therefore give the impression of being most important to caregivers today.

    Conclusions. These projects point to the various problems and experiences healthcare professionals encounter in their day-to-day work. This paper provides valuable insights into the current state of improvement work in Swedish healthcare, and will serve as a foundation for further investigations in this quality program.

  • 7.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Idvall, Ewa
    Faculty of Health and Society, Malmö University and Skåne University Hospital, 205 06 Malmö, Sweden.
    Perseius, Kent-Inge
    Research Unit, Psychiatry Division, Kalmar County Council, Sweden.
    Who conducts quality improvement initiatives in healthcare services? An evaluation of an improvement program in acounty council in Sweden2010Conference paper (Other academic)
    Abstract [en]

    Purpose – The aim of this paper is to contribute to the knowledge of who engages in quality improvement initiatives and to describe whether staff professions or gender are relevant variables.

    Design/methodology/approach – This paper contains an evaluation of the participants in a specific defined strategic improvement initiative program in one county council in southeast Sweden. The improvement program was initiated by county council politicians to encourage improvement initiatives and to spread improvement skills and knowledge in the organization. The program is driven both “top down” (teaching/convincing line managers to demand improvements) and “bottom up” through improvement programs using methodology to help teams identify, plan and adopt improvements in their daily work. Data was collected from special applications (called Free Applications, FA) and from participants in the education program (called Improvement Program, IP), both of which include information about profession and 2 gender. A content analysis was made. After the first categorization of which types of improvement projects practitioners engage in, further analysis of staff disciplines, professions (hierarchy) and gender was done. The results were compared to the overall structure of staff presence in the county council.

    Findings – Changes in participation occurred over time. The FA (Free Applications) part (n=202) shows a higher share of leaders and managers (35%), but their participation in the IP (Improvement Program) (n=477) fluctuated (8-26%). Physicians were more represented in the FA than in the IP. The largest single group was nurses. Overall the gender perspective reflects the conditions of the county council, but in FA the representation of women was lower. Five types of improvement projects were identified: 1) Organizational process focus; 2) Evidence and quality; 3) Competence development; 4) Process Technology; and 5) Proactive patient work. Managers were most represented in the category “Organizational process”. The largest difference was seen in the category “Proactive patient work” with the highest occurrence among women (86%) and less among men (17%) and managers (21%). The patient as a contributor taking active part was not found in either the FA or the IP.

    Research limitations/implications – This study shows differences in participation between free applications and methodology-guided programs when it comes to professions and gender in the country council improvement drive. It may be useful for further research regarding how to successfully work for and implement improvements and change in healthcare environments.

    Practical implications – The study will discuss and contribute to further knowledge of whether profession, hierarchy and gender have an impact (obstructive or as an asset) in performing improvement work in healthcare settings.

    Originality/value - Not much has been written about who is accomplishing quality improvements in terms of profession and gender. This paper provides some valuable insights into the differences between staff categories (professions) and gender in the improvement work in Swedish healthcare.

  • 8.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Perseius, Kent-Inge
    Research Unit, Psychiatry Division, Kalmar County Council, Sweden.
    Idvall, Ewa
    Faculty of Health and Society, Malmö University and Skåne University Hospital, 205 06 Malmö, Sweden.
    Adapting a survey to evaluate quality improvements in Swedish healthcareManuscript (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).

  • 9.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Perseius, Kent-Inge
    Kalmar County Council, Sweden.
    Idwall, Ewa
    Malmö University, Sweden .
    Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 48Article in journal (Refereed)
    Abstract [en]

    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.

  • 10.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering. Linköping University, The Institute of Technology.
    Idvall, Ewa
    Malmö University, Sweden Skåne University Hospital, Sweden .
    Perseius, Kent-Inge
    Kalmar County Council, Sweden Karolinska Institute, Sweden .
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Evaluating a Breakthrough Series Collaborative in a Swedish Health Care Context2014In: Journal of Nursing Care Quality, ISSN 1057-3631, E-ISSN 1550-5065, Vol. 29, no 2, p. E1-E10Article in journal (Refereed)
    Abstract [en]

    This study evaluated the use of the Breakthrough Series Collaborative methodology in a Swedish county council improvement program, comparing measurements at the beginning and after 6 months. A questionnaire was used, and improvement processes and outcomes were analyzed. The results showed an overall large engagement in improvements, although the methodology and facilitators were seen as only moderately supportive.

  • 11.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Idvall, Ewa
    ) Faculty of Health and Society, Malmö University.
    Perseius, Kent-Inge
    Kalmar County Council/Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Evaluating a Breakthrough Series Collaborative in a Swedish healthcare context2013Manuscript (preprint) (Other academic)
    Abstract [en]

    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.

  • 12.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Idvall, Ewa
    Faculty of Health and Society, Malmö University.
    Perseius, Kent-Inge
    Kalmar County Council/Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Sustainable Outcomes of an Improvement Program: Do Financial Incentives Matter?2013Manuscript (preprint) (Other academic)
    Abstract [en]

    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.

  • 13.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology. Development Department , Kalmar County Council , Kalmar and Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Idvall, Ewa
    Department of Care Science, Faculty of Health and Society, Malmö University, Malmö and Department of Intensive Care and Perioperative Medicine , Skåne University Hospital, Malmö, Sweden.
    Perseius, Kent-Inge
    Nyckeln Competence Centre for Health Education, Kalmar County Council , Kalmar and Department of Neurobiology, Caring Sciences and Society , Karolinska Institutet , Stockholm , Sweden.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology. Linköping University, HELIX Vinn Excellence Centre.
    Sustainable outcomes of an improvement programme: do financial incentives matter?2013In: Total Quality Management and Business Excellence, ISSN 1478-3363, E-ISSN 1478-3371, Vol. 24, no 7-8, p. 959-969Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to evaluate whether an improvement programme can contribute to positive sustainable improvements in an organisation, 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 programme between 2007 and 2010. The projects were analysed as to whether they received funding (n=98) or were rejected (n=95). In addition, a categorisation of the projects intentions was analysed. Some projects were still ongoing, but 50 projects were implemented and sustained two or more years after being finalised. Implemented improvements were on different levels, from (micro-level) units up to the entire (macro-level) organisation. In addition, 27 rejected projects were finalised without funding. Eighteen of those 27 were sustainably implemented. This study indicates that there are incentives other than financial at work if an improvement programme contributes to sustainable improvements in the organisation. To encourage practice-based improvements is one way of incentivising the intention and effort to become and perform better.

  • 14.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Olheden, Anna
    Landstinget i Kalmar län.
    Patient participation in quality improvement: managers’ opinions of patients as resources2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 23-24, p. 3590-3593Article in journal (Refereed)
    Abstract [en]

    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.

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