Patient involvement in quality improvement: a survey comparing naturalistic and reflective approaches.

Background: This study investigates reflective and naturalistic approaches to patient involvement in quality improvement. The reflective approach, using, for example, interviews, provides insights into patient needs and demands to support an established improvement agenda. The naturalistic approach, for example, observations, is used to discover practical problems and opportunities that professionals are currently unaware of.

Predicting Outcome for Early Attention Training After Acquired Brain Injury.

Background: The training of impaired attention after acquired brain injury is central for successful reintegration in daily living, social, and working life. Using statistical process control, we found different improvement trajectories following attention training in a group of relatively homogeneous patients early after acquired brain injury (ABI).

Objective: To examine the contribution of pre-injury factors and clinical characteristics to differences in outcome after early attention training.

Exploring power shifts as an enabler for a strengthened patient role in quality improvements: a Swedish survey study.

Objectives: This study examined the relationship between professionals' perceptions of a strengthened role for the patient and of patient involvement in quality improvement (QI) and whether professionals' experiences in improvement science were a moderator on such a relationship.

Design: From a predominantly close-ended, 44-item questionnaire, 4 questions specifically concerning professionals' perception on patient involvement in QI were analysed.

Setting: Three Swedish regions.

The role of professional logics in quality register use: a realist evaluation.

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.

Beneficial effects of early attention process training after acquired brain injury: A randomized controlled trial.

Background: Evaluation of outcome after intensive cognitive rehabilitation early after brain injury is complicated due to the ongoing biological recovery process.

Objective: To evaluate the efficacy of Attention Process Training early after acquired brain injury through time-series measurement with statistical process control.

Design: Randomized controlled trial.

Exploring the phase for highest impact on radicality: a cross-sectional study of patient involvement in quality improvement in Swedish healthcare.

Objectives: Involving patients in quality improvement is often suggested as a critical step for improving healthcare processes. However, this comes with challenges related to resources, tokenism, validity and competence. Therefore, to optimise the use of available resources, there is a need to understand at what stage in the improvement cycle patient involvement is most beneficial.

Statistical process control: A feasibility study of the application of time-series measurement in early neurorehabilitation after acquired brain injury.

Background: Progress in early cognitive recovery after acquired brain injury is uneven and unpredictable, and thus the evaluation of rehabilitation is complex. The use of time-series measurements is susceptible to statistical change due to process variation.

Objective: To evaluate the feasibility of using a time-series method, statistical process control, in early cognitive rehabilitation.

Unpacking the key components of a programme to improve the timeliness of hip-fracture care: a mixed-methods case study.

Background: Delay to surgery for patients with hip fracture is associated with higher incidence of post-operative complications, prolonged recovery and length of stay, and increased mortality. Therefore, many health care organisations launch improvement programmes to reduce the wait for surgery. The heterogeneous application of similar methods, and the multifaceted nature of the interventions, constrain the understanding of which method works, when, and how.

Interrupted Time Series Versus Statistical Process Control in Quality Improvement Projects.

To measure the effect of quality improvement interventions, it is appropriate to use analysis methods that measure data over time. Examples of such methods include statistical process control analysis and interrupted time series with segmented regression analysis. This article compares the use of statistical process control analysis and interrupted time series with segmented regression analysis for evaluating the longitudinal effects of quality improvement interventions, using an example study on an evaluation of a computerized decision support system.

Two different strategies to facilitate involvement in healthcare improvements: a Swedish county council initiative.

Background: From a management point of view, there are many different approaches from which to choose to engage staff members in initiatives to improve performance.

Objective: The present study evaluated how two different types of improvement strategies facilitate and encourage involvement of different professional groups in health-care organizations.

Methods/design: Empirical data of two different types of strategies were collected within an improvement project in a County Council in Sweden.

Prospects and problems of transferring quality-improvement methods from health care to social services: two case studies.

Introduction: This study examines the use of quality-improvement (QI) methods in social services. Particularly the key aspects-generalizable knowledge, interprofessional teamwork, and measurements-are studied in projects from the QI program Forum for Values in Sweden.

Methods: This is a mixed-method case study.

Evaluating a breakthrough series collaborative in a Swedish health care context.

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.

Design, application and impact of quality improvement 'theme months' in orthopaedic nursing: a mixed method case study on pressure ulcer prevention.

Background: While there is growing awareness of quality problems in healthcare systems, it remains uncertain how best to accomplish and sustain improvement over time.

Objective: To report on the design and application of quality improvement theme months in orthopaedic nursing, and evaluate the impact on pressure ulcer as an example.

Design: Retrospective mixed method case study with time series diagrams.

Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare.

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.

Framework for assessing quality of care for inflammatory bowel disease in Sweden.

Aim: To create and apply a framework for quality assessment and improvement in care for inflammatory bowel disease (IBD) patients.

Methods: A framework for quality assessment and improvement was created for IBD based on two generally acknowledged quality models. The model of Donabedian (Df) offers a logistical and productive perspective and the Clinical Value Compass (CVC) model adds a management and service perspective.

How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children's hospital, Stockholm, Sweden.

Background: There is growing interest in applying lean thinking in healthcare, yet, there is still limited knowledge of how and why lean interventions succeed (or fail). To address this gap, this in-depth case study examines a lean-inspired intervention in a Swedish pediatric Accident and Emergency department.

Methods: We used a mixed methods explanatory single case study design.

Five types of practice-based improvement ideas in health care services: an empirically defined typology.

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.

Swedish healthcare management practices and quality improvement work: development trends.

Purpose: The purpose of this paper is to empirically examine developmental trends in healthcare organisation management practice and improvement work.

Design/methodology/approach: Primary healthcare centre (n = 1,031) and clinical hospital department (n = 1,542) managers were surveyed in spring 2007 (response rate 46 per cent). This article compares results from this survey with a study in 2003.

Patient safety as perceived by Swedish leaders.

Purpose: The purpose of this paper is to survey Swedish healthcare leaders' patient safety awareness, the priority they give to safety issues and their views on suitable safety management strategies.

Design/methodology/approach: A total 623 leaders of a sample of 1,129 responded to a mail questionnaire (55 percent response rate). Descriptive statistics of the responses are presented as frequency distributions across respondent subgroups.

System characteristics of healthcare organizations conducting successful improvements.

Purpose: In a previous study, based on a survey to all clinical department and primary care center managers in Sweden, it was concluded that the prevailing general improvement strategy is characterized by: drivers for improvement are staff needs; patients and data are not as important; improvements mainly focus on administrative routines and stress management; improvements are mainly reached, by writing guidelines, and conducting meetings; the majority of managers perceive outcomes from this strategy as successful. The purpose of current research in this paper is to investigate whether there is any other improvement strategy at play in Swedish health care.

Design/methodology/approach: Data from the study of all Swedish managers were stratified into two populations based on an instrument predicting successful improvement.

Goal orientation and conflicts: Motors of change in development projects in health care service.

In this article we present parts of a larger research study, which aims at explaining how a process-oriented innovation unfolds and develops over time in Swedish health care. Through a longitudinal field study of a national and a local development project, we analyze how the flow model--a process-oriented innovation that emphasizes the sequence of activities a patient undertakes through the health care system--has been developed in Swedish health care. We propose to explain how the development projects unfold over time through the use of process theories of organizational development and change.

Challenges experienced in the development of performance measurement systems in Swedish health care.

Objectives: The purpose of this article is to investigate challenges experienced in the development of a performance measurement system in Swedish health care services.

Methods: We conducted case studies in 6 development projects focusing on the development of a common model for waiting time measurement in Swedish health care services. We studied the cases during a 2-year period using interviews, observations, and documents as information sources.

Design and implementation of a performance measurement system in Swedish health care services: a multiple case study of 6 development teams.

Performance measurement is considered to be an important part in improving and controlling contemporary organizations. Despite the increased interest in using and improving performance measurement systems, the number of researchers investigating the design and implementation process in more detail is still very small. The purpose of this article is to increase the understanding of how a performance measurement system, called the flow model, is designed and implemented by development teams in Swedish health care.