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Carstensen K, Goldman J, Kjeldsen AM, Lou S, Nielsen CP. Engaging health care professionals in quality improvement: A qualitative study exploring the synergies between projects of professionalisation and institutionalisation in quality improvement collaborative implementation in Denmark. J Health Serv Res Policy 2024; 29:163-172. [PMID: 38308439 PMCID: PMC11151708 DOI: 10.1177/13558196241231169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To examine the projects of professionalisation and institutionalisation forming health care professions' engagement in quality improvement collaborative (QIC) implementation in Denmark, and to analyse the synergies and tensions between the two projects given the opportunities afforded by the QICs. METHODS This was a cross-sectional interview study with professionals involved in the implementation of two national QICs in Denmark involving 23 individual interviews and focus group discussions with 75 people representing different professional groups. We conducted a reflexive thematic analysis of the data, drawing on institutional contributions to organisational studies of professions. RESULTS Study participants engaged widely in QIC implementation. This engagement was formed by a constructive interplay between the professions' projects of professionalisation and institutionalisation, with only few tensions identified. The project of professionalisation relates to a self-oriented agenda of contributing professional expertise and promoting professional recognition and development, while the project of institutionalisation focuses on improving health care processes and outcomes and advancing quality improvement. Both projects were largely similar across professional groups. The interplay between the two projects was enabled by the bottom-up approach to implementation, participation of QI specialists, and a clear focus on developing and delivering high-quality patient care. CONCLUSIONS Future strategies for QIC implementation should position QICs as a framework that promotes the integration of professions' projects of professionalisation and institutionalisation to successfully engage professionals in the implementation process, and thereby optimise the effectiveness of QICs in health care.
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Affiliation(s)
- Kathrine Carstensen
- PhD Student, DEFACTUM, Public Health Research, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Joanne Goldman
- Assistant Professor, Centre for Quality Improvement and Patient Safety and Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anne Mette Kjeldsen
- Associate Professor, Department of Political Science, Aarhus University, Aarhus, Denmark
| | - Stina Lou
- Senior Researcher and Associate Professor, DEFACTUM, Public Health Research, Central Denmark Region, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Camilla Palmhøj Nielsen
- Research Director and Associate Professor, DEFACTUM, Public Health Research, Central Denmark Region and Department of Public Health, Aarhus University, Aarhus, Denmark
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Carlqvist C, Ekstedt M, Lehnbom EC. Exploring the impact of pharmacist-supported medication reviews in dementia care: experiences of general practitioners and nurses. BMC Geriatr 2024; 24:520. [PMID: 38877433 PMCID: PMC11179365 DOI: 10.1186/s12877-024-05124-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/31/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Dementia is a major global public health challenge, and with the growing elderly population, its prevalence is expected to increase in the coming years. In Sweden, municipalities are responsible for providing special housing for the elderly (SÄBO), which offers services and care for older individuals needing specific support. SÄBO is both the person´s home and a care environment and workplace. Polypharmacy in patients with dementia is common and increases the risk of medication interactions. Involving clinical pharmacists in medication reviews has been shown to enhance medication safety and improve prescribing practices. However, the views of the standard care team involved in medication prescribing, administration, monitoring and documentation on integrating pharmacist services have received less attention. Thus, this study aims to explore how pharmacists' contributions can enhance medication safety, improve patient care efficiency, and potentially alleviate the workload of general practitioners for people with dementia living in special housing. METHODS This study has a descriptive qualitative study design using semi-structured interviews and qualitative content analysis. The study was conducted in a southern Swedish special housing and included nurses, assistant nurses, general practitioners (GPs), and a pharmacist. Due to the COVID-19 pandemic, interviews were conducted over the phone. The Swedish Ethical Review Authority approved the study. RESULTS The analysis revealed three main categories, and eleven subcategories.: (1) Integrating multidisciplinary approaches for holistic dementia care, (2) Strengthening dementia care through effective medication management and (3) Advancing dementia care through pharmacist integration and role expansion. Nurses focused on non-pharmacological treatments, while GPs emphasized the importance of medication reviews in assessing the benefits and side-effects of prescribed medication. Pharmacists were valued for their reliable medication expertise, appreciated by GPs for saving time and providing recommendations prior to consultations with individuals with dementia and their next-of-kin. Although medication reviews were considered beneficial, there was skepticism about their ability to solve all medication-related problems associated with dementia care. CONCLUSIONS This study highlights the critical role pharmacists play in enhancing medication safety and patient care efficiency in special housing for individuals with dementia. Despite the value of their contributions, communication barriers within healthcare teams pose significant challenges. Recognising potential pharmacist role expansion is essential to alleviate the workload of GPs and ensure effective collaborative practices for better patient outcomes.
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Affiliation(s)
- Catharina Carlqvist
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Elin C Lehnbom
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
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Blomgren J, Wells MB, Erlandsson K, Amongin D, Kabiri L, Lindgren H. Putting co-creation into practice: lessons learned from developing a midwife-led quality improvement intervention. Glob Health Action 2023; 16:2275866. [PMID: 37930253 PMCID: PMC10629418 DOI: 10.1080/16549716.2023.2275866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Integrating evidence-based midwifery practices improves healthcare quality for women and newborns, but an evidence-to-practice gap exists. Co-created quality improvement initiatives led by midwives could bridge this gap, prevent resource waste and ensure intervention relevance. However, how to co-create a midwife-led quality improvement intervention has not been scientifically explored. OBJECTIVE The objective of this study is to describe the co-creation process and explore the needs and determinants of a midwife-led quality improvement targeting evidence-based midwifery practices. METHODS A qualitative deductive approach using the Consolidated Framework for Advancing Implementation Science was employed. An analysis matrix based on the framework was developed, and the data were coded according to categories. Data were gathered from interviews, focus group discussions, observations and workshops. New mothers and birth companions (n = 19) were included through convenience sampling. Midwives (n = 26), professional association representatives, educators, policymakers, managers, and doctors (n = 7) were purposely sampled. RESULTS The co-creation process of the midwife-led Quality Improvement intervention took place in four stages. Firstly, core elements of the intervention were established, featuring a group of midwife champions leading a quality improvement initiative using a train-the-trainers approach. Secondly, the intervention needs, context and determinants were explored, which showed knowledge and skills gaps, a lack of shared goals among staff, and limited resources. However, there was clear relevance, compatibility, and mission alignment for a midwife-led quality improvement at all levels. Thirdly, during co-creation workshops with new mothers and companions, the consensus was to prioritise improved intrapartum support, while workshops with midwives identified enhancing the use of birth positions and perineal protection as key focus areas for the forthcoming Quality Improvement intervention. Lastly, the findings guided intervention strategies, including peer-assisted learning, using existing structures, developing educational material, and building stakeholder relationships. CONCLUSIONS This study provides a practical example of a co-creation process for a midwife-led quality improvement intervention, which can be relevant in different maternity care settings.
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Affiliation(s)
- Johanna Blomgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Michael B. Wells
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Erlandsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Institution of Health and Welfare, Dalarna University, Falun, Sweden
| | - Dinah Amongin
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lydia Kabiri
- Department of Nursing and Midwifery, School of Health Sciences, College of Health Sciences Makerere University, Kampala, Uganda
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promotion, Sophiahemmet University, Stockholm, Sweden
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Claessens F, Castro EM, Seys D, Brouwers J, Van Wilder A, Jans A, De Ridder D, Vanhaecht K. Sustainable quality management in hospitals: The experiences of healthcare quality managers. Health Serv Manage Res 2023:9514848231218631. [PMID: 38001556 DOI: 10.1177/09514848231218631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
BACKGROUND Quality management systems are essential in hospitals, but evidence shows a real literature gap on the sustainable implementation of quality. PURPOSE This study aimed to explore and identify enablers towards sustainable quality management in hospitals. Research design and Study Sample: Interviews were conducted with 23 healthcare quality managers from 20 hospitals. Data collection and/or Analysis: Data collection and analysis were conducted simultaneously by using the Qualitative Analysis Guide of Leuven and following the COREQ Guidelines. Thematic analysis from interview transcripts was performed in NVivo 12. RESULTS The results reveal two categories: (1) quality in the organisation's DNA and (2) quality in the professional's DNA. The first category consists of: bottom-up and top-down management, the organisation-wide integration of quality and an organisational culture shift. The second one consists of: quality awareness, understanding the added value, the encouragement and engagement, the accountability and ownership for quality. Moving towards sustainable quality management systems in hospitals requires a good interaction between a bottom-up approach and leadership to ensure continuous support from healthcare stakeholders. CONCLUSIONS This study contributes to existing conceptual and theoretical foundations with practical insights into sustainable quality management. The findings can guide quality departments and hospital management to regain professionals' commitment to quality and to establish a sustainable quality management system.
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Affiliation(s)
- Fien Claessens
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Eva Marie Castro
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Anneke Jans
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, Sint-Trudo Ziekenhuis, Sint-Truiden, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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Determining the Role of Employee Engagement in Nurse Retention along with the Mediation of Organizational Culture. Healthcare (Basel) 2023; 11:healthcare11050760. [PMID: 36900765 PMCID: PMC10001374 DOI: 10.3390/healthcare11050760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
In today's unpredictable environment, the rapid emergence of the COVID-19 pandemic has shaken the world and its healthcare infrastructure immensely. As nurses are the building blocks of the healthcare personnel labor market, organizations should develop tactics that aid in their retention. With a solid theoretical foundation in self-determination theory, this study aims to understand the role of employee engagement in keeping nurses in 51 hospitals in the Northern Indian region, along with the mediation of organizational culture through smart PLS. In a complementary mediation relationship with organizational culture, nurse retention is positively correlated with employee engagement.
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Andersson T, Linnéusson G, Holmén M, Kjellsdotter A. Nurturing innovative culture in a healthcare organisation - Lessons from a Swedish case study. J Health Organ Manag 2023; 37:17-33. [PMID: 36815697 PMCID: PMC10430797 DOI: 10.1108/jhom-05-2021-0181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/28/2022] [Accepted: 12/20/2022] [Indexed: 02/24/2023]
Abstract
PURPOSE Healthcare organisations are often described as less innovative than other organisations, since organisational culture works against innovations. In this paper, the authors ask whether it has to be that way or whether is possible to nurture an innovative culture in a healthcare organisation. The aim of this paper is to describe and analyse nurturing an innovative culture within a healthcare organisation and how culture can support innovations in such a healthcare organisation. DESIGN/METHODOLOGY/APPROACH Based on a qualitative case study of a healthcare unit that changed, within a few years, from having no innovations to repeatedly generating innovations, the authors describe important aspects of how innovative culture can be nurtured in healthcare. Data were analysed using inductive and deductive analysis steps. FINDINGS The study shows that it is possible to nurture an innovative culture in a healthcare organisation. Relationships and competences beyond healthcare, empowering structures and signalling the importance of innovation work with resources all proved to be important. All are aspects that a manager can influence. In this case, the manager's role in nurturing innovative culture was very important. PRACTICAL IMPLICATIONS This study highlights that an innovative culture can be nurtured in healthcare organisations and that managers can play a key role in such a process. ORIGINALITY/VALUE The paper describes and analyses an innovative culture in a healthcare unit and identifies important conditions and strategies for nurturing innovative culture in healthcare organisations.
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Affiliation(s)
- Thomas Andersson
- School of Business
,
University of Skövde
, Skövde,
Sweden
- Faculty of Theology, Diaconia and Leadership,
VID Specialized University
, Oslo,
Norway
| | - Gary Linnéusson
- School of Engineering,
Jönköping University
, Jönköping,
Sweden
| | - Maria Holmén
- Innovation Platform,
Region Västra Götaland
, Gothenburg,
Sweden
| | - Anna Kjellsdotter
- Research and Development Centre
,
Skaraborg Hospital
, Skövde,
Sweden
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Andersson T. If It Is Complex, Let It Be Complex - Dealing With Institutional Complexity in Hospitals Comment on "Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?". Int J Health Policy Manag 2022; 11:2346-2348. [PMID: 35279038 PMCID: PMC9808257 DOI: 10.34172/ijhpm.2022.6922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/21/2022] [Indexed: 01/12/2023] Open
Abstract
Waitzberg and colleagues identified strategies that managers and physicians in hospitals apply to reconcile dilemmas between clinical and economic considerations. Contributions that actually acknowledge the institutional complexity of hospitals and describe how to deal with it are rare. This comment explains the reason behind the institutional complexity in healthcare organizations and argues that institutional complexity is a good foundation for a well-functioning and sustainable healthcare, as long as we are able to deal with this complexity. This point underscores the importance of their contribution. However, even if the identified strategies on how to reconcile and balance different, competing demands are important, they are not easy to apply in practice. First, the strategies require frequent and high-quality interaction between different actors adhering to different institutional logics. Second, even when the strategies are applied successfully, it is difficult to make them sustainable since they rest on a fragile balance between competing logics. However, these are important avenues for future research for researchers who want to follow the route of Waitzberg and colleagues.
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Affiliation(s)
- Thomas Andersson
- School of Business, University of Skövde, Skövde, Sweden
- Faculty of Theology, Diaconal & Leadership, VID Specialized University, Oslo, Norway
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Boast LA, Hampson JA, Saville RL, Toplis E, Baguneid A, Williams DA, Choudhury A. Development of a respiratory quality improvement faculty in an acute hospital using QI methodology. BMJ Open Qual 2022; 11:bmjoq-2022-001990. [PMID: 36223957 PMCID: PMC9562750 DOI: 10.1136/bmjoq-2022-001990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/13/2022] [Indexed: 11/04/2022] Open
Abstract
National Health Service (NHS) clinical staff are required to demonstrate involvement in quality improvement (QI) and patient safety. Clinicians are often best placed to identify problems and design solutions for their own clinical environments, yet the rotational nature of training can impact on the design, implementation and sustainability of projects.The In-hospital Quality Improvement for Respiratory team was created in August 2020 within a busy respiratory department to inspire a culture of continuous improvement and provide a sustainable infrastructure to support and progress QI projects (QIPs).The trust uses the LifeQI platform which provides a change score from 0.5 (intention to participate) to 5.0 (outstanding sustainable results) as a representation of a QIP's progress.We aimed to increase the number of QIPs in the respiratory department registered on the LifeQI platform from 1 to at least 10 projects by September 2021.A QI framework was used to identify and address four primary improvement drivers: (1) QI understanding/training, (2) QI faculty communication, (3) QI participation, and (4) QIP completion using multiple Plan-Do-Study-Act cycles. Data were collected on the number of active respiratory projects registered within the LifeQI platform, mean LifeQI change score and the number of projects with a change score ≤1.Twenty-four new QIPs were initiated in the first 12 months, with a number of projects leading to sustainable change. The largest improvements were seen in autumn 2020 as the faculty's multidisciplinary membership expanded.We achieved our aim of increasing the number of registered QIPs, sustaining the QI faculty throughout the COVID-19 pandemic. Our multidisciplinary membership continues to increase and the faculty has improved access, organisation and project progression across a large department with an established process for rotating staff to join existing QIPs. Our model has the potential to be replicated in other clinical departments within NHS organisations.
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Affiliation(s)
- Lucy Anne Boast
- Department of Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Judith Anne Hampson
- Department of Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Rachel Louise Saville
- Department of Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Emma Toplis
- Department of Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Abdulla Baguneid
- Department of Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Daniel Alexander Williams
- Department of Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Aklak Choudhury
- Department of Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Claessens F, Seys D, Brouwers J, Van Wilder A, Jans A, Castro EM, Bruyneel L, De Ridder D, Vanhaecht K. A co-creation roadmap towards sustainable quality of care: A multi-method study. PLoS One 2022; 17:e0269364. [PMID: 35771777 PMCID: PMC9246114 DOI: 10.1371/journal.pone.0269364] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Hospitals demonstrated increased efforts into quality improvement over the past years. Their growing commitment to quality combined with a heterogeneity in perceptions among healthcare stakeholders cause concerns on the sustainable incorporation of quality into the daily workflow. Questions are raised on the drivers for a sustainable hospital quality policy. We aimed to identify drivers and incorporate them into a new, unique roadmap towards sustainable quality of care in hospitals. Design A multi-method design guided by an eight-phase approach to develop a conceptual framework consists of multiple, iterative phases of data collection, synthesis and validation. Starting with a narrative review followed by a qualitative in-depth analysis and including feedback of national and international healthcare stakeholders. Setting Hospitals. Results The narrative review included 59 relevant papers focusing on quality improvement and the sustainability of these improved quality results. By integrating, synthesising and resynthesizing concepts during thematic and content analysis, the narrative review evolved to an integrated, co-creation roadmap. The Flanders Quality Model (FlaQuM) is presented as a driver diagram that features six primary drivers for a sustainable quality policy: (1) Quality Design and Planning, (2) Quality Control, (3) Quality Improvement, (4) Quality Leadership, (5) Quality Culture and (6) Quality Context. Six primary drivers are described in 19 building blocks (secondary drivers) and 104 evidence-based action fields. Conclusions The framework suggests that a manageable number of drivers, building blocks and action fields may support the sustainable incorporation of quality into the daily workflow. Therefore, FlaQuM can serve as a useful roadmap for future sustainable quality policies in hospitals and for future empirical and theoretical work in sustainable quality management.
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Affiliation(s)
- Fien Claessens
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
- * E-mail:
| | - Deborah Seys
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
| | - Anneke Jans
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
- Department of Quality Management, Sint-Trudo Ziekenhuis, Sint-Truiden, Flanders, Belgium
| | - Eva Marie Castro
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
- Department of Quality Management, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Flanders, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy–Department of Public Health, KU Leuven–University of Leuven, Leuven, Flanders, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Flanders, Belgium
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Carstensen K, Kjeldsen AM, Lou S, Nielsen CP. The Danish health care quality programme: Creating change through the use of quality improvement collaboratives. Health Policy 2022; 126:749-754. [DOI: 10.1016/j.healthpol.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/27/2021] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
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Creese J, Byrne JP, Olson R, Humphries N. A catalyst for change: Developing a collaborative reflexive ethnographic approach to research with hospital doctors during the COVID-19 pandemic. METHODOLOGICAL INNOVATIONS 2022; 16:3-14. [PMID: 38603431 PMCID: PMC9713536 DOI: 10.1177/20597991221137813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The understanding of what ethnography looks like, and its purpose, is continuously evolving. COVID-19 posed a significant challenge to ethnographers, particularly those working in health-related research. Researchers have developed alternative forms of ethnography to overcome some of these challenges; we developed the Mobile Instant Messaging Ethnography (MIME) adaptation to ethnography in 2021 to overcome restrictions to our own research with hospital doctors. However, for ethnographic innovations to make a substantial contribution to methodology, they should not simply be borne of necessity, but of a dedicated drive to expand paradigms of research, to empower participant groups and to produce change - in local systems, in participant-collaborators and in researchers and the research process itself. In this paper, we reflect on our experiences using MIME, involving collaborative remote observation and reflection with 28 hospital doctors in Ireland from June to December 2021. After reviewing literature on ethnography in COVID-19 and general epistemological developments in ethnography, we detail the MIME approach and illustrate how MIME presents an evolution of the ethnographic approach, not only practically but in terms of its reflexive shift, its connected and co-creative foundations, and its ability to drive change in research approaches, participant life-worlds and real-world improvement.
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Affiliation(s)
- Jennifer Creese
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - John-Paul Byrne
- Graduate School of Population Healthcare Management, Royal College of Surgeons University of Medicine and Health Sciences, Dublin, Ireland
| | - Rebecca Olson
- School of Social Science, The University of Queensland, Saint Lucia, QLD, Australia
| | - Niamh Humphries
- Graduate School of Population Healthcare Management, Royal College of Surgeons University of Medicine and Health Sciences, Dublin, Ireland
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Boers B, Andersson T. Family members as hybrid owner-managers in family-owned newspaper companies: handling multiple institutional logics. JOURNAL OF FAMILY BUSINESS MANAGEMENT 2021. [DOI: 10.1108/jfbm-06-2021-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This article aims to increase the understanding of the role of individual actors and arenas in dealing with multiple institutional logics in family firms.
Design/methodology/approach
This study follows a case-study approach of two family-owned newspaper companies. Based on interviews and secondary sources, the empirical material was analysed focussing on three institutional logics, that is, family logic, management logic and journalistic logic.
Findings
First, the authors show how and in which arenas competing logics are balanced in family-owned newspaper companies. Second, the authors highlight that family owners are central actors in the process of balancing different institutional logics. Further, they analyse how family members can become hybrid owner-managers, meaning that they have access to all institutional logics and become central actors in the balancing process.
Originality/value
The authors reveal how multiple institutional logics are balanced in family firms by including formal actors and arenas as additional lenses. Therefore, owning family members, especially hybrid owner-managers, are the best-suited individual actors to balance competing logics. Hybrid owner-managers are members of the owner families who are also skilled in one or several professions.
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Alkhaldi RZ, Abdallah AB. The influence of soft and hard TQM on quality performance and patient satisfaction in health care: investigating direct and indirect effects. J Health Organ Manag 2021; ahead-of-print. [PMID: 34708997 DOI: 10.1108/jhom-10-2020-0416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The present study conceptualizes total quality management (TQM) in terms of soft and hard aspects and examines their effects on quality performance and patient satisfaction. The indirect effects of soft and hard TQM on patient satisfaction through quality performance are also investigated. DESIGN/METHODOLOGY/APPROACH A multi-item questionnaire was prepared to gather primary data from a sample of 312 medical employees in private hospitals in Jordan. The measurement model was evaluated for validity and reliability and determined to be acceptable. Structural equation modeling (SEM) was applied to test the research hypotheses. FINDINGS The results revealed that soft TQM has a strong positive effect on quality performance and patient satisfaction. Hard TQM was found to positively affect quality performance but to a lesser extent compared to soft TQM. The effect of hard TQM on patient satisfaction, meanwhile, was not significant. Quality performance positively mediated the relationship between TQM - both soft and hard - and patient satisfaction. ORIGINALITY/VALUE This study is one of the first to conceptualize TQM in terms of soft and hard aspects in a health care context. It offers valuable insights for managers of private hospitals looking to enhance quality performance and patient satisfaction. The results reveal that soft TQM is the primary driver of quality performance and patient satisfaction in the health care context, which is in stark contrast to the manufacturing sector.
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An evaluation of Lean and Six Sigma methodologies in the national health service. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2021. [DOI: 10.1108/ijqrm-05-2021-0140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to conduct an empirical study derived from the previous literature from the perspective of benefits, tools and techniques, continuous improvement (CI) and quality improvement (QI) methodologies and critical failure factors (CFFs) of Lean and Six Sigma (SS) in the national health service (NHS).
Design/methodology/approach
A literature review was carried out to identify previous findings, empirical data and critical variables concerning Lean and SS in healthcare for over ten years. Second, primary research in quantitative surveys and qualitative interviews was carried out with 110 participants who have experience using Lean and SS in the NHS.
Findings
Lean and SS have evolved into common practices within the NHS and now have an established list of tools and techniques frequently employed by staff. Lean and SS are considered robust CI methodologies capable of effectively delivering extensive benefits across many different categories. The NHS must overcome a sizable amount of highly important CFFs and divided organizational culture.
Originality/value
This paper has developed the most extensive empirical study ever produced on Lean and SS in the NHS and has expanded on previous works to create new and updated research. The findings produced in this paper will assist NHS medical directors and practitioners in obtaining up-to-date insight into Lean and SS status in the NHS. The paper will also guide the NHS to critically evaluate their current CI strategy to ensure long-term sustainability and deliver improved levels of service to patients.
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Gadolin C, Skyvell Nilsson M, Ros A, Törner M. Preconditions for nurses' perceived organizational support in healthcare: a qualitative explorative study. J Health Organ Manag 2021; 35:281-297. [PMID: 34523305 PMCID: PMC9136871 DOI: 10.1108/jhom-03-2020-0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose The purpose of this paper is to inductively explore the context-specific preconditions for nurses' perceived organizational support (POS) in healthcare organizations. Design/methodology/approach A qualitative interview study was performed, based on the critical incident technique (CIT), with 24 registered nurses in different specialities of hospital care. Findings The nurses perceived three actors as essential for their POS: the first-line manager, the overarching organization and their college. The preconditions affecting the nurses’ perceptions of organizational support were supportive structuring and structures at work, as well as individual recognition and professional acknowledgement. Originality/value Previous studies of POS have mostly had a quantitative outset. In this paper, context-specific preconditions for nurses' POS are described in depth, enabled by the qualitative approach of the study. The findings may be used to guide healthcare organizations and managers aiming to foster nurses' POS, and thereby, benefit nurses' well-being and retention, as well as healthcare quality and efficiency.
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Affiliation(s)
- Christian Gadolin
- Department of Health Sciences,
University West
, Trollhättan,
Sweden
| | | | - Axel Ros
- Region Jönköping County and Jönköping Academy for Improvement of Health and Welfare,
Jönköping University
, Jönköping,
Sweden
| | - Marianne Törner
- School of Public Health and Community Medicine,
Institute of Medicine, University of Gothenburg
, Gothenburg,
Sweden
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Gadolin C, Eriksson E, Alexandersson P. Coordination of paediatric oncology care: an explorative Swedish case study. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-10-2020-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The aim of this paper is to empirically describe and analyze factors deemed to be relevant for the successful provision of coordinated paediatric oncology care by physicians and nurses involved.
Design/methodology/approach
A qualitative case study primarily consisting of interviews.
Findings
The paper's findings indicate that certain factors (i.e. distinct mission, clear treatment protocols and support from external stakeholders) relevant for the provision of coordinated paediatric oncology care have not received sufficient attention in previous research. In addition, emphasis is placed on the necessity of facilitating constructive working relationships and a bottom-up perspective when pursuing improved care coordination.
Originality/value
The factors described and analyzed may act as insights for how paediatric oncology might be improved in terms of care coordination and thus facilitate care integration. In addition, the paper's findings identify factors relevant for further empirical studies in order to delineate their generalizability.
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Rogers L, De Brún A, Birken SA, Davies C, McAuliffe E. Context counts: a qualitative study exploring the interplay between context and implementation success. J Health Organ Manag 2021; ahead-of-print. [PMID: 33682395 PMCID: PMC9073593 DOI: 10.1108/jhom-07-2020-0296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Implementing change in healthcare is difficult to accomplish due to the unpredictability associated with challenging the status quo. Adapting the intervention/practice/program being implemented to better fit the complex context is an important aspect of implementation success. Despite the acknowledged influence of context, the concept continues to receive insufficient attention at the team-level within implementation research. Using two heterogeneous multidisciplinary healthcare teams as implementation case studies, this study evaluates the interplay between context and implementation and highlights the ways in which context influences the introduction of a collective leadership intervention in routine practice. DESIGN/METHODOLOGY/APPROACH The multiple case study design adopted, employed a triangulation of qualitative research methods which involved observation (Case A = 16 h, Case B = 15 h) and interview data (Case A = 13 participants, Case B = 12 participants). Using an inductive approach, an in-depth thematic analysis of the data outlined the relationship between team-level contextual factors and implementation success. FINDINGS Themes are presented under the headings: (1) adapting to the everyday realities, a key determinant for implementation success and (2) implementation stimulating change in context. The findings demonstrate a dynamic relationship between context and implementation. The challenges of engaging busy healthcare professionals emphasised that mapping the contextual complexity of a site and adapting implementation accordingly is essential to enhance the likelihood of successful implementation. However, implementation also altered the surrounding context, stimulating changes within both teams. ORIGINALITY/VALUE By exposing the reciprocal relationship between team-level contextual factors and implementation, this research supports the improved design of implementation strategies through better understanding the interplay and mutual evolution of evidence-based healthcare interventions within different contexts.
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Affiliation(s)
- Lisa Rogers
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Sarah A Birken
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carmel Davies
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
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Boström J, Hillborg H, Lilja J. Cultural dynamics and tensions when applying design thinking for improving health-care quality. INTERNATIONAL JOURNAL OF QUALITY AND SERVICE SCIENCES 2020. [DOI: 10.1108/ijqss-04-2019-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to contribute knowledge concerning the dynamics and potential cultural tensions that occur when applying user involvement and design thinking (DT) for improving quality in a health-care setting.
Design/methodology/approach
This paper is based on a case study following a quality improvement (QI) project in a medium-sized Swedish county council in the field of somatic care. The project involved eight health-care professionals, one designer, four patients and two relatives. A multiple data collection method over a period of ten months was used. It included individual interviews, e-mail correspondence and observations of workshops that covered the QI project.
Findings
The result shows tensions between QI work and the daily clinical work of the participants. These tensions primarily concern the conflict between fast and slow processes, the problem of moving between different fields of knowledge, being a resource for the individual clinic and the system and the participants’ expectations and assumptions about roles and responsibilities in a QI project. Furthermore, these findings could be interpreted as signs of a development culture in the health-care context.
Practical implications
There are several practical implications. Among others, the insights can inspire how to approach and contextualize the current concepts, roles and methods of DT and user involvement so that they can be more easily understood and integrated into the existing culture and way of working in the health-care sector.
Originality/value
This study provides a unique insight into a case, trying to uncover what actually is going on and perhaps, why certain things are not happening at all, when user involvement and design practices are applied for improving health-care quality.
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Hong DS, Boike T, Dawes S, Klash SJ, Kudner R, Okoye C, Rosu-Bubulac M, Watanabe Y, Wright JL, Jennelle RL. Accreditation Program for Excellence (APEx): A Catalyst for Quality Improvement. Pract Radiat Oncol 2020; 11:101-107. [PMID: 33279669 DOI: 10.1016/j.prro.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/09/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE In 2014 the American Society for Radiation Oncology's Accreditation Program for Excellence (APEx) was created in response to the Target Safely campaign. APEx is a powerful tool to measure and drive quality improvement in radiation oncology practices. METHODS AND MATERIALS A task group from the American Society for Radiation Oncology's Practice Accreditation Committee was formed to provide an overview of the APEx accreditation program including analysis from specific program data. RESULTS Through initiatives encouraged by the APEx program, participants are able to evaluate teamwork and effectiveness, implement documented procedures aimed at improving quality and safety, and establish quality management at the practice. The program's Self-Assessment measures performance with program requirements and indicates where compliance lacks standardization. Methods to address these deficiencies form part of on-going quality improvement. These quality outcomes promote the delivery of safe, high-quality care. CONCLUSION The accreditation process through APEx is a commitment to an ongoing safety culture. Any worthwhile accreditation program should provide a meaningful assessment of practice operations, supply the tools to identify deficiencies and provide the opportunity to showcase growth and development. A commitment to completing APEx is a commitment to excellence for patients and all those who care for them.
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Affiliation(s)
- David S Hong
- University of Southern California, Department of Radiation Oncology, Los Angeles, California
| | | | - Samantha Dawes
- American Society for Radiation Oncology, Arlington, Virginia.
| | | | - Randi Kudner
- American Society for Radiation Oncology, Arlington, Virginia
| | | | - Mihaela Rosu-Bubulac
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, Virginia
| | - Yoichi Watanabe
- University of Minnesota, Department of Radiation Oncology, Minneapolis, Minnesota
| | | | - Richard L Jennelle
- University of Southern California, Department of Radiation Oncology, Los Angeles, California
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Understanding institutional work through social interaction in highly institutionalized settings: Lessons from public healthcare organizations. SCANDINAVIAN JOURNAL OF MANAGEMENT 2020. [DOI: 10.1016/j.scaman.2020.101107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Gadolin C, Andersson T, Eriksson E, Hellström A. Providing healthcare through “value shops”: impact on professional fulfilment for physicians and nurses. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2020. [DOI: 10.1108/ijhg-12-2019-0081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to empirically explore and demonstrate the ability of healthcare professionals to attain professional fulfilment when providing healthcare inspired by “value shops”.Design/methodology/approachA qualitative case study incorporating interviews and observations was conducted.FindingsThe empirical data suggest that the professional fulfilment of both physicians and nurses is facilitated when care is organized through “value shops”. Both groups of professionals state that they are able to return to their “professional core”.Originality/valueThe beneficial outcomes of organizing healthcare inspired by the “value shop” have previously been explored in terms of efficiency and quality. However, the professional fulfilment of healthcare professionals when providing such care has not been explicitly addressed. Professional fulfilment is vital in order to safeguard high-quality care, as well as healthcare professionals' involvement and engagement in implementing quality improvements. This paper highlights the fact that care provision inspired by the “value shop” may facilitate professional fulfilment, which further strengthens the potential positive outcomes of the “value shop” when utilized in a healthcare setting.
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Norman AC, Elg M, Nordin A, Gäre BA, Algurén B. The role of professional logics in quality register use: a realist evaluation. BMC Health Serv Res 2020; 20:107. [PMID: 32046710 PMCID: PMC7014753 DOI: 10.1186/s12913-020-4944-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/28/2020] [Indexed: 12/03/2022] Open
Abstract
Background Clinical practice improvements based on quality-register data are influenced by multiple factors. Although there is agreement that information from quality registers is valuable for quality improvement, practical ways of organising register use have been notoriously difficult to realise. The present study sought to investigate the mechanisms that lead various clinicians to use quality registers for improvement. Methods This research involves studying individuals’ decisions in response to a Swedish programme focusing on increasing the use of quality registers. Through a case study, we focused on heart failure care and its corresponding register: the Swedish Heart Failure Register. The empirical data consisted of a purposive sample collected longitudinally by qualitative methods between 2013 and 2015. In total, 18 semi-structured interviews were carried out. We used realist evaluation to identify contexts, mechanisms, and outcomes. Results We identified four contexts – registration, use of output data, governance, and improvement projects – that provide conditions for the initiation of specific mechanisms. Given a professional theoretical perspective, we further showed that mechanisms are based on the logics of either organisational improvement or clinical practice. The two logics offer insights into the ways in which clinicians choose to embrace or reject certain registers’ initiatives. Conclusions We identified a strong path dependence, as registers have historically been tightly linked to the medical profession’s competence. Few new initiatives in the studied programme reach the clinical context. We explain this through the lack of an organisational improvement logic and its corresponding mechanisms in the context of the medical profession. Implementation programmes must understand the logic of clinical practice; that is, be integrated with the ways in which work is carried out in everyday practice. Programmes need to be better at helping core health professionals to reach the highest standards of patient care.
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Affiliation(s)
- Ann-Charlott Norman
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Box 1026, SE-551 11, Jönköping, Sweden.
| | - Mattias Elg
- Department of Management and Engineering, HELIX Competence Centre, Linköping University, Linköping, Sweden
| | - Annika Nordin
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Box 1026, SE-551 11, Jönköping, Sweden
| | - Boel Andersson Gäre
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Box 1026, SE-551 11, Jönköping, Sweden.,Futurum, Academy for Health and Care Region Jönköping County, Ryhov County Hospital, Jönköping, Sweden
| | - Beatrix Algurén
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Box 1026, SE-551 11, Jönköping, Sweden.,Department of Food and Nutrition, and Sport Science, Faculty of Education, University of Gothenburg, Gothenburg, Sweden
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Sjølie BM, Hartviksen TA, Bondas T. "Navigation to prioritizing the patient" - first-line nurse managers' experiences of participating in a quality improvement collaborative. BMC Health Serv Res 2020; 20:55. [PMID: 31969143 PMCID: PMC6977232 DOI: 10.1186/s12913-020-4918-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background First-line nurse managers are central to quality improvement work when changing work practices into better patient outcomes. Quality improvement collaboratives have been adopted widely to support quality management in healthcare services and shared learning. We have little knowledge of the first-line nurse managers’ own perspectives concerning their need for support and knowledge in quality improvement work. Therefore, the aim of this study was to gain understanding of first line nurse managers’ experiences in leading quality improvement work in their own organization when participating in a quality improvement collaborative. Methods An interpretive approach was chosen following Graneheim and Lundman’s qualitative content analysis. Data was collected through three focus group interviews with first-line nurse managers representing different workplaces: the local hospital, a nursing home, and a homecare service in a rural area of Norway. Results “Navigation to prioritizing the patient” emerged as an overarching metaphor to describe the first-line nurse managers experiences of leading quality improvement work, based on three themes: 1) fellowship for critical thinking and prioritizing the patient; 2) mastering the processes in quality improvement work; and 3) the everyday reality of leadership as a complex context. Conclusions A quality improvement collaborative encompassing knowledge transfer and reflection may create an important fellowship for health care leaders, encouraging and enabling quality improvement work in their own organization. It is crucial to invite all leaders from an organization to be able to share the experience and continue their collaboration with their staff in the organization. Continuity over time, following up elements of the quality improvement work at joint meetings, involvement by users, and self-development of and voluntary involvement in the quality improvement collaborative seem to be important for knowledge development in quality improvement. The supportive elements of the quality improvement collaborative fellowship were crucial to critical thinking and to the first-line nurse managers’ own development and security in mastering the quality improvement work processes. They preferred prioritizing the patients in quality improvement work, despite haste and obstructive situations in an everyday context.
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Affiliation(s)
- Berit Mosseng Sjølie
- Nord University, Faculty of Nursing and Health Sciences, Storgata 105, N-8370, Leknes, Norway.
| | - Trude Anita Hartviksen
- Nord University, Faculty of Nursing and Health Sciences, Storgata 105, N-8370, Leknes, Norway
| | - Terese Bondas
- University of Stavanger, Faculty of Health Sciences, P.O. Box 8600, Forus, N-4036, Stavanger, Norway
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Gadolin C. The influence of policy makers over Lean implementations in healthcare. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2019. [DOI: 10.1108/ijhg-02-2019-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
It is often argued that Lean enables the challenges of contemporary healthcare delivery to be tackled in relation to consistently high-quality care, while utilizing the full potential of available resources. Nevertheless, system-wide implementations of Lean are notoriously difficult and the desired results are often not achieved. Policy makers play a pivotal role in enabling healthcare organizations to enact more precise strategies and frameworks through steering professionals toward both adopting guidelines and becoming more comfortable with Lean as an improvement technique. However, the difficulties in achieving system-wide implementations of Lean indicate their shortcomings in this respect. The purpose of this paper is to outline how these shortcomings may be manifested empirically.
Design/methodology/approach
A qualitative content analysis of Swedish counties’ annual reports with regard to how the implementation of Lean is presented and promoted.
Findings
The study shows that policy makers have vague and divergent perceptions of what Lean is, and that they often reduce Lean to a means of achieving cost reductions and savings, while relying on the education of managers as the primary factor to ensure implementation.
Originality/value
In order for policy makers to facilitate system-wide implementations of Lean, this study indicates that they need to rectify their simplistic perception of Lean while elaborating on why and how Lean should be implemented in healthcare.
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Robinson J, Gelling L. Nurses+QI=better hospital performance? A critical review of the literature. Nurs Manag (Harrow) 2019; 26:22-28. [PMID: 31468826 DOI: 10.7748/nm.2019.e1858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 11/09/2022]
Abstract
NHS regulators, such as NHS Improvement and the Care Quality Commission, promote staff involvement in quality improvement (QI), while national nursing leaders and the Nursing and Midwifery Council advocate nurses' involvement in improving services. This article critically explores the evidence base for a national nursing strategy to involve nurses in QI using a literature review. A thematic analysis shows that nurse involvement in QI has several positive outcomes, which are also included in the NHS Improvement's Single Oversight Framework for NHS Providers. The article concludes that nurse involvement in QI helps improve hospital performance.
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Affiliation(s)
- Jane Robinson
- Nursing Directorate, NHS England and NHS Improvement, London, England
| | - Leslie Gelling
- Faculty of Health Social Care and Education, Anglia Ruskin University, Cambridge, England
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Selvin M, Almqvist K, Kjellin L, Lundqvist LO, Schröder A. Patient and staff experiences of quality in Swedish forensic psychiatric care: a repeated cross-sectional survey with yearly sampling at two clinics. Int J Ment Health Syst 2019; 13:8. [PMID: 30733827 PMCID: PMC6359846 DOI: 10.1186/s13033-019-0265-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/24/2019] [Indexed: 01/20/2023] Open
Abstract
Background Systematic efforts to improve the quality, safety and value of health care have increased over the last decades. Even so, it is hard to choose priorities and to know when the desired results are reached, especially in forensic psychiatric care where there can be a discrepancy between patient and staff expectations of what good quality of care is and how it should be reached. The aim of the present study was to describe and compare patient and staff experiences of quality of care in two forensic psychiatric clinics over a period of 4 years. Methods A quantitative design was used and yearly between 2011 and 2014, a total of 105 questionnaires were answered by patients and 598 by staff. Results The sample consisted of four different groups; patient and staff in Clinic A and Clinic B respectively. The repeated measurements showed that quality of care, as described by the patients, varied over time, with significant changes over the 4 years. The staff evaluations of the quality of care were more stable over time in both clinics compared with the patients. Generally, the staff rated the quality as being better than the patients but these differences tended to decrease when efforts were made to improve the care. Conclusions It is important to highlight both what staff and patients perceive as both high and low quality care. With regular measurements and sufficient resources, training, support and leadership, the chances of successful improvement work increase. This knowledge is important in forensic nursing practice, for teaching and for management and decision makers in the constant work of improving forensic psychiatric care.
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Affiliation(s)
- Mikael Selvin
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 85 Örebro, Sweden
| | - Kjerstin Almqvist
- 2Department for Social and Psychological studies, Karlstad University, Karlstad, Sweden
| | - Lars Kjellin
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 85 Örebro, Sweden
| | - Lars-Olov Lundqvist
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 85 Örebro, Sweden
| | - Agneta Schröder
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 85 Örebro, Sweden.,3Department of Nursing, Faculty of Health, Care and Nursing, Norwegian University of Science and Technology (NTNU), Gjövik, Norway
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Gadolin C. Professional employees’ strategic employment of the managerial logic in healthcare. QUALITATIVE RESEARCH IN ORGANIZATIONS AND MANAGEMENT: AN INTERNATIONAL JOURNAL 2018. [DOI: 10.1108/qrom-02-2016-1359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to describe and analyze how physicians and nurses strategically employ the managerial logic.Design/methodology/approachA qualitative case study incorporating interviews and observations.FindingsNeither physicians nor nurses were prone to strategically employing the managerial logic. However, when doing so nurses were able to acknowledge the legitimacy of managerial impact on practice, whereas the physicians were not. Consequently, physicians might find other, more subtle, ways to strategically employ the managerial logic.Originality/valueThis paper argues for and makes explicit the applicability of qualitative methods in order to delineate actors’ strategic use of available and accessible institutional logics, the conditions for such usage, as well as the multiplicity of actors’ interactions that needs to be taken into account when conducting qualitative data analysis of such occurrences. By the merits of the qualitative research approach utilized in this study, novel insights concerning the strategic use of the managerial logic in the everyday work of physicians and nurses were obtainable. These insights emphasize the necessity of acknowledging situational, organizational and institutional context, incorporating inter-professional power discrepancies and relationsvis-à-vismanagers.
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Andersson T, Liff R. Co-optation as a response to competing institutional logics: Professionals and managers in healthcare. JOURNAL OF PROFESSIONS AND ORGANIZATION 2018. [DOI: 10.1093/jpo/joy001] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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