Staff acting resiliently at two hospital wards.

Purpose: The purpose of this paper is to understand how the hospital staff (nurses and physicians) at two hospital wards have coped with everyday work having leaders in conflict or longer periods without one or the other leader and whether the way the staff handled the challenges was resilient.

Design/methodology/approach: Through semi-structured interviews with the staff at the two wards, the authors analysed how the staff were working, if they had cooperation and interdisciplinary cooperation, how they would handle uncertainties and how they coped with the absence of their leaders.

Findings: The staff at both wards were handling the everyday work in a resilient way.

[Chronic obstructive lung disease management programmes do not benefit the coordination of care pathways].

Chronic obstructive lung disease (COLD) is a challenging condition for both primary and secondary health-care providers. Disease management programmes (DMP's) have been expected to lead to evident improvements in the continuum of care for COLD. The utility of a COLD management programme was evaluated in a study based on interviews among general practitioners and COLD specialists.

[Patient safety in a new perspective].

Effective health care depends on the safe and efficient functioning of a tightly coupled multitude of systems, functions, and specialised services. Both theory and practice have demonstrated how safety management that follows events becomes reduced to uncoordinated and fragmentary fire-fighting. This reactive safety management is inadequate.

[Patient deaths are not suited for monitoring quality and patient safety in hospitals].

Although some patient deaths in hospitals can be prevented if quality of care and patient safety are improved, it is not given that such deaths can be used to track improvements. Since preventable deaths only amount to about 5% of all deaths, a decline in that number will be a weak signal as far as mortality is concerned. The commonly used hospital standardised mortality ratio (HSMR) has a low signal-to-noise ratio and is therefore not suitable for monitoring.

[Hospital standardised mortality ratios do not with certainty reflect the quality of patient care].

Hospital standardised mortality ratios (HSMRs) are presumed to reflect an overall quality of patient care in hospitals. Figures for all Danish hospitals are being published quarterly on the Internet, and aggregated values are used to set goals for both regional and nationwide efforts to improve quality of care and patient safety. We have analysed the available data from 2007 through 2011 and cannot reconcile the quite substantial and often sudden changes in HSMRs with changes in quality of care, but believe that they are due to inherent noise in calculating HSMRs, e.

[Need for innovation in working with adverse events].

Patient safety has been in focus in the Danish health care for the past five years, with a mandatory reporting system for adverse events/incidents at hospitals. The incidents have been analysed with the Root Cause Analysis. This analysis is a relatively simple linear cause effect analysis, however, not suitable for the use in a complex sociotechnic health-care system.

[The case manager--from words to deeds?].

Introduction: Allocation of a case manager is now mandatory for both in- and outpatients in Denmark. Case manager allocation is reported quarterly to the regions and results are generally satisfying. Knowledge about fulfillment of the case manager role is, however, sparse.

[Clinical microsystems--a path to improved user involvement].

The idea of user involvement in the field of health care has evolved over the past 30 years. Over time the perception has changed to increasingly expect health care providers to involve users as active partners in treatment and in the development of services. Clinical microsystems is a strategy for quality improvement that has user involvement as its key element.

[Risk stratification of patients with diabetes mellitus].

Introduction: This paper discusses the optimal distribution of responsibility between general practitioners (GPs) and hospitals for follow-up of patients with chronic diseases. We investigated a set of risk stratification criteria developed to optimize specialist shared care for patients with diabetes mellitus.

Material And Methods: We included patients with diabetes from the catchment areas of four diabetes out-patient clinics in southern Denmark.