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Publications (10 of 29) Show all publications
Nordin, A., Kjellström, S., Robert, G., Masterson, D. & Areskoug Josefsson, K. (2023). Measurement and outcomes of co-production in health and social care: A systematic review of empirical studies. BMJ Open, 13(9), Article ID e073808.
Open this publication in new window or tab >>Measurement and outcomes of co-production in health and social care: A systematic review of empirical studies
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2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 9, article id e073808Article, review/survey (Refereed) Published
Abstract [en]

Background: Co-production is promoted as an effective way of improving the quality of health and social care but the diversity of measures used in individual studies makes their outcomes difficult to interpret.

Objective: The objective is to explore how empirical studies in health and social care have described the outcomes of co-production projects and how those outcomes were measured.

Design and methods: A scoping review forms the basis for this systematic review. Search terms for the concepts (co-produc∗ OR coproduc∗ OR co-design∗ OR codesign∗) and contexts (health OR 'public service∗ OR "public sector") were used in: CINAHL with Full Text (EBSCOHost), Cochrane Central Register of Controlled trials (Wiley), MEDLINE (EBSCOHost), PsycINFO (ProQuest), PubMed (legacy) and Scopus (Elsevier). There was no date limit. Papers describing the process, original data and outcomes of co-production were included. Protocols, reviews and theoretical, conceptual and psychometric papers were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The Mixed Methods Appraisal Tool underpinned the quality of included papers.

Results: 43 empirical studies were included. They were conducted in 12 countries, with the UK representing >50% of all papers. No paper was excluded due to the Mixed Methods Quality Appraisal screening and 60% of included papers were mixed methods studies. The extensive use of self-developed study-specific measures hampered comparisons and cumulative knowledge-building. Overall, the studies reported positive outcomes. Co-production was reported to be positively experienced and provided important learning.

Conclusions: The lack of common approaches to measuring co-production is more problematic than the plurality of measurements itself. Co-production should be measured from three perspectives: outputs of co-production processes, the experiences of participating in co-production processes and outcomes of co-production. Both self-developed study-specific measures and established measures should be used. The maturity of this research field would benefit from the development and use of reporting guidelines.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
patient participation, quality in health care, systematic review, Empirical Research, Humans, Knowledge, Learning, MEDLINE, Social Support, article, Cinahl, Cochrane Library, controlled clinical trial (topic), empiricism, human, maturity, outcome assessment, practice guideline, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PsycINFO, public sector, Scopus, social care, theoretical study
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-62624 (URN)10.1136/bmjopen-2023-073808 (DOI)001072843300045 ()37739472 (PubMedID)2-s2.0-85172425579 (Scopus ID)GOA;;908642 (Local ID)GOA;;908642 (Archive number)GOA;;908642 (OAI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-01431
Available from: 2023-10-10 Created: 2023-10-10 Last updated: 2023-11-06Bibliographically approved
Williams, O., Lindenfalk, B. & Robert, G. (2023). New development: Mitigating and negotiating the co-creation of dis/value—Elinor Ostrom’s design principles and co-creating public value. Public Money & Management, 43(1), 45-50
Open this publication in new window or tab >>New development: Mitigating and negotiating the co-creation of dis/value—Elinor Ostrom’s design principles and co-creating public value
2023 (English)In: Public Money & Management, ISSN 0954-0962, E-ISSN 1467-9302, Vol. 43, no 1, p. 45-50Article in journal (Refereed) Published
Abstract [en]

Although Elinor Ostrom’s principles for collaborative group working could promote effective and equitable collaborative endeavours among diverse actors/stakeholders, they are largely untested in public service design and delivery. This article demonstrates how Ostrom’s principles could help to mitigate the potential for co-creating dis/value and instead support all involved to co-create systemic public value. The authors develop Ostrom’s work by proposing: an original, systemically-informed re-classification of Ostrom’s principles; that co-creation endeavours can be reconceptualized as a novel way of creating a ‘common pool resource’ and; that failure to adequately address the potential to co-create dis/value can lead to ‘tragedies of co-design’.

IMPACT

This article provides a way to promote more effective and equitable collaboration in the design and delivery of public services. Increasingly public services are designed with service users, but it is common for these provider?user endeavours to perform sub-optimally and/or to have negative outcomes. The authors offer a set of principles and a novel framework for applying them that have been designed to: firstly, mitigate the potential for sub-optimal and/or negative performance and, secondly, promote more positive processes and outcomes for provider?user collaborations. Improving provider?user collaboration in this way will ultimately lead to better design and delivery of public services.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Collaborative group working; co-creation; co-design; common pool resources; dark side; dis/value; Elinor Ostrom; systemic public value
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-56443 (URN)10.1080/09540962.2022.2066338 (DOI)000793069400001 ()2-s2.0-85132667884 (Scopus ID)HOA;intsam;811467 (Local ID)HOA;intsam;811467 (Archive number)HOA;intsam;811467 (OAI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018– 01431
Available from: 2022-05-11 Created: 2022-05-11 Last updated: 2023-02-13Bibliographically approved
Masterson, D., Areskoug Josefsson, K., Robert, G., Nylander, E. & Kjellström, S. (2022). Mapping definitions of co-production and co-design in health and social care: A systematic scoping review providing lessons for the future. Health Expectations, 25(3), 902-913
Open this publication in new window or tab >>Mapping definitions of co-production and co-design in health and social care: A systematic scoping review providing lessons for the future
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2022 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 25, no 3, p. 902-913Article, review/survey (Refereed) Published
Abstract [en]

OBJECTIVES: This study aimed to explore how the concepts of co-production and co-design have been defined and applied in the context of health and social care and to identify the temporal adoption of the terms.

METHODS: A systematic scoping review of CINAHL with Full Text, Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, PubMed and Scopus was conducted to identify studies exploring co-production or co-design in health and social care. Data regarding date and conceptual definitions were extracted. From the 2933 studies retrieved, 979 articles were included in this review.

RESULTS: A network map of the sixty most common definitions and-through exploration of citations-eight definition clusters and a visual representation of how they interconnect and have informed each other over time are presented. Additional findings were as follows: (i) an increase in research exploring co-production and co-design in health and social care contexts; (ii) an increase in the number of new definitions during the last decade, despite just over a third of included articles providing no definition or explanation for their chosen concept; and (iii) an increase in the number of publications using the terms co-production or co-design while not involving citizens/patients/service users.

CONCLUSIONS: Co-production and co-design are conceptualized in a wide range of ways. Rather than seeking universal definitions of these terms, future applied research should focus on articulating the underlying principles and values that need to be translated and explored in practice.

PATIENT AND PUBLIC CONTRIBUTION: The search strategy and pilot results were presented at a workshop in May 2019 with patient and public contributors and researchers. Discussion here informed our next steps. During the analysis phase of the review, informal discussions were held once a month with a patient who has experience in patient and public involvement. As this involvement was conducted towards the end of the review, we agreed together that inclusion as an author would risk being tokenistic. Instead, acknowledgements were preferred. The next phase involves working as equal contributors to explore the values and principles of co-production reported within the most common definitions.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
co-design, co-production, definitions, healthcare, principles, social care, systematic scoping review, values
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-56089 (URN)10.1111/hex.13470 (DOI)000772220100001 ()35322510 (PubMedID)2-s2.0-85126852610 (Scopus ID)GOA;intsam;803178 (Local ID)GOA;intsam;803178 (Archive number)GOA;intsam;803178 (OAI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-01431
Available from: 2022-03-25 Created: 2022-03-25 Last updated: 2022-09-20Bibliographically approved
Robert, G., Williams, O., Lindenfalk, B., Mendel, P., Davis, L. M., Turner, S., . . . Branch, C. (2021). Applying Elinor Ostrom’s Design Principles to Guide Co-Design in Health(care) Improvement: A Case Study with Citizens Returning to the Community from Jail in Los Angeles County. International Journal of Integrated Care, 21(1), 1-15, Article ID 7.
Open this publication in new window or tab >>Applying Elinor Ostrom’s Design Principles to Guide Co-Design in Health(care) Improvement: A Case Study with Citizens Returning to the Community from Jail in Los Angeles County
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2021 (English)In: International Journal of Integrated Care, E-ISSN 1568-4156, Vol. 21, no 1, p. 1-15, article id 7Article in journal (Refereed) Published
Abstract [en]

Introduction: Increased interest in collaborative and inclusive approaches to healthcare improvement makes revisiting Elinor Ostrom’s ‘design principles’ for enabling collective management of common pool resources (CPR) in polycentric systems a timely endeavour.

Theory and method: Ostrom proposed a generalisable set of eight core design principles for the efficacy of groups. To consider the utility of Ostrom’s principles for the planning, delivery, and evaluation of future health(care) improvement we retrospectively apply them to a recent co-design project.

Results: Three distinct aspects of co-design were identified through consideration of the principles. These related to: (1) understanding and mapping the system (2) upholding democratic values and (3) regulating participation. Within these aspects four of Ostrom’s eight principles were inherently observed. Consideration of the remaining four principles could have enhanced the systemic impact of the co-design process.

Discussion: Reconceptualising co-design through the lens of CPR offers new insights into the successful system-wide application of such approaches for the purpose of health(care) improvement.

Conclusion: The eight design principles – and the relationships between them – form a heuristic that can support the planning, delivery, and evaluation of future healthcare improvement projects adopting co-design. They may help to address questions of how to scale up and embed such approaches as self-sustaining in wider systems.

Place, publisher, year, edition, pages
Ubiquity Press, 2021
Keywords
co-design, common pool resources: co-production, healthcare improvement, case study, quality improvement
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-51884 (URN)10.5334/ijic.5569 (DOI)000637407000012 ()33613139 (PubMedID)2-s2.0-85101163874 (Scopus ID)POA;intsam;1528076 (Local ID)POA;intsam;1528076 (Archive number)POA;intsam;1528076 (OAI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018–01431
Available from: 2021-02-12 Created: 2021-02-12 Last updated: 2021-05-17Bibliographically approved
Robert, G., Sarre, S., Maben, J., Griffiths, P. & Chable, R. (2020). Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the 'Productive Ward. BMJ Quality and Safety, 29, 31-40
Open this publication in new window or tab >>Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the 'Productive Ward
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2020 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 29, p. 31-40Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The 'Productive Ward: Releasing Time to Care' programme is a quality improvement (QI) intervention introduced in English acute hospitals a decade ago to: (1) Increase time nurses spend in direct patient care. (2) Improve safety and reliability of care. (3) Improve experience for staff and patients. (4) Make changes to physical environments to improve efficiency.

OBJECTIVE: To explore how timing of adoption, local implementation strategies and processes of assimilation into day-to-day practice relate to one another and shape any sustained impact and wider legacies of a large-scale QI intervention.

DESIGN: Multiple methods within six hospitals including 88 interviews (with Productive Ward leads, ward staff, Patient and Public Involvement representatives and senior managers), 10 ward manager questionnaires and structured observations on 12 randomly selected wards.

RESULTS: Resource constraints and a managerial desire for standardisation meant that, over time, there was a shift away from the original vision of empowering ward staff to take ownership of Productive Ward towards a range of implementation 'short cuts'. Nonetheless, material legacies (eg, displaying metrics data; storage systems) have remained in place for up to a decade after initial implementation as have some specific practices (eg, protected mealtimes). Variations in timing of adoption, local implementation strategies and contextual changes influenced assimilation into routine practice and subsequent legacies. Productive Ward has informed wider organisational QI strategies that remain in place today and developed lasting QI capabilities among those meaningfully involved in its implementation.

CONCLUSIONS: As an ongoing QI approach Productive Ward has not been sustained but has informed contemporary organisational QI practices and strategies. Judgements about the long-term sustainability of QI interventions should consider the evolutionary and adaptive nature of change processes.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2020
Keywords
continuous quality improvement, healthcare quality improvement, implementation science, qualitative research, quality improvement methodologies
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-47056 (URN)10.1136/bmjqs-2019-009457 (DOI)000503868800006 ()31358685 (PubMedID)2-s2.0-85076446913 (Scopus ID)GOA;intsam;1377133 (Local ID)GOA;intsam;1377133 (Archive number)GOA;intsam;1377133 (OAI)
Available from: 2019-12-11 Created: 2019-12-11 Last updated: 2022-03-31Bibliographically approved
Metz, A., Boaz, A. & Robert, G. (2019). Co-creative approaches to knowledge production: What next for bridging the research to practice gap?. Evidence & Policy: A Journal of Research, Debate and Practice, 15(3), 331-337
Open this publication in new window or tab >>Co-creative approaches to knowledge production: What next for bridging the research to practice gap?
2019 (English)In: Evidence & Policy: A Journal of Research, Debate and Practice, ISSN 1744-2648, E-ISSN 1744-2656, Vol. 15, no 3, p. 331-337Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Policy Press, 2019
National Category
Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:hj:diva-47050 (URN)10.1332/174426419X15623193264226 (DOI)000484784700001 ()2-s2.0-85073431853 (Scopus ID)
Note

Special Issue: Co-creative approaches to knowledge production and implementation. Guest edited by Allison Metz, Annette Boaz and Glenn Robert.

Available from: 2019-12-11 Created: 2019-12-11 Last updated: 2019-12-11Bibliographically approved
Mulvale, G., Moll, S., Miatello, A., Robert, G., Larkin, M., Palmer, V. J., . . . Girling, M. (2019). Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration. Health Expectations, 22(3), 284-297
Open this publication in new window or tab >>Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration
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2019 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 22, no 3, p. 284-297Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Codesign has the potential to transform health and other public services. To avoid unintentionally reinforcing existing inequities, better understanding is needed of how to facilitate involvement of vulnerable populations in acceptable, ethical and effective codesign.

OBJECTIVE: To explore citizens' involvement in codesigning public services for vulnerable groups, identify challenges and suggest improvements.

DESIGN: A modified case study approach. Pattern matching was used to compare reported challenges with a priori theoretical propositions.

SETTING AND PARTICIPANTS: A two-day international symposium involved 28 practitioners, academics and service users from seven countries to reflect on challenges and to codesign improved processes for involving vulnerable populations.

INTERVENTION STUDIED: Eight case studies working with vulnerable and disadvantaged populations in three countries.

RESULTS: We identified five shared challenges to meaningful, sustained participation of vulnerable populations: engagement; power differentials; health concerns; funding; and other economic/social circumstances. In response, a focus on relationships and flexibility is essential. We encourage codesign projects to enact a set of principles or heuristics rather than following pre-specified steps. We identify a set of principles and tactics, relating to challenges outlined in our case studies, which may help in codesigning public services with vulnerable populations.

DISCUSSION AND CONCLUSIONS: Codesign facilitators must consider how meaningful engagement will be achieved and how power differentials will be managed when working with services for vulnerable populations. The need for flexibility and responsiveness to service user needs may challenge expectations about timelines and outcomes. User-centred evaluations of codesigned public services are needed.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
codesign, public services, vulnerable populations
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-42600 (URN)10.1111/hex.12864 (DOI)000470930200003 ()30604580 (PubMedID)2-s2.0-85066507115 (Scopus ID)GOA HHJ 2019;HHJIMPROVEIS (Local ID)GOA HHJ 2019;HHJIMPROVEIS (Archive number)GOA HHJ 2019;HHJIMPROVEIS (OAI)
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-07-14Bibliographically approved
McAllister, S., Robert, G., Tsianakas, V. & McCrae, N. (2019). Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review. International Journal of Nursing Studies, 93, 106-118
Open this publication in new window or tab >>Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review
2019 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 93, p. 106-118Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The review aimed to 1) explore the constituents of nurse-patient therapeutic engagement on acute mental health wards; 2) map factors that influence engagement to the Theoretical Domains Framework and 3) integrate results into a conceptual model of engagement to inform the development of interventions to improve engagement.

DESIGN: A systematic integrative review using an established framework specific to the integrative review methodology.

DATA SOURCES: Database searches (CINAHL, PsycINFO, BNI and Cochrane Library) and hand searching identified 3414 articles. After screening, applying eligibility criteria, and quality appraisal, 37 articles were included: n = 27 empirical research studies, n = 10 expert opinion pieces, n = 1 case study and n = 1 theoretical report.

REVIEW METHODS: Peer-reviewed empirical studies, theoretical reports or expert opinion pieces that explored therapeutic engagement as a stated aim and were conducted in acute mental health inpatient settings from the patient or nurse perspective were included. Data were extracted from the introduction, results and discussion sections of empirical research, and the complete article of theoretical and expert opinion pieces. Data were coded then grouped into subthemes and themes. Data relating to influencing factors were further categorised according to the Theoretical Domains Framework. Results were synthesised into a conceptual model of engagement.

RESULTS: Five conceptually distinct, but closely related constructs of engagement - called the "Principles of Engagement" - emerged: 1) Understanding the person and their experiences; 2) Facilitating growth; 3) Therapeutic use of self; 4) Choosing the right approach and 5) Authoritative vs. emotional containment. Influences on engagement ranged across all 14 theoretical domains of the Theoretical Domains Framework.

CONCLUSION: A holistic understanding of the essential components of engagement may make it easier for nurses to recognise what they do, and to do it well. The model can be used to generate testable hypotheses about how and where to target behavioural change interventions. The Principles of Engagement must be reflected in the development of interventions to improve engagement.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Integrative review, Intervention development, Mental health nursing, Theoretical Domains Framework, Therapeutic engagement
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nursing
Identifiers
urn:nbn:se:hj:diva-47058 (URN)10.1016/j.ijnurstu.2019.02.013 (DOI)000468710200012 ()30908958 (PubMedID)2-s2.0-85063202716 (Scopus ID)HOA HHJ 2019;HHJIMPROVEIS (Local ID)HOA HHJ 2019;HHJIMPROVEIS (Archive number)HOA HHJ 2019;HHJIMPROVEIS (OAI)
Available from: 2019-12-11 Created: 2019-12-11 Last updated: 2019-12-11Bibliographically approved
Hanna, E. & Robert, G. (2019). Ethics of limb disposal: Dignity and the medical waste stockpiling scandal. Journal of Medical Ethics, 45(9), 575-578
Open this publication in new window or tab >>Ethics of limb disposal: Dignity and the medical waste stockpiling scandal
2019 (English)In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 45, no 9, p. 575-578Article in journal (Refereed) Published
Abstract [en]

We draw on the concept of dignity to consider the ethics of the disposal of amputated limbs. The ethics of the management and disposal of human tissue has been subject to greater scrutiny and discussion in recent years, although the disposal of the limbs often remains absent from such discourses. In light of the recent UK controversy regarding failures in the medical waste disposal and the stockpiling of waste (including body parts), the appropriate handling of human tissue has been subject to further scrutiny. Although this scandal has evoked concern regarding procurement and supply chain issues, as well as possible health and safety risks from such a stockpile', the dignity of those patients' implicated in this controversy has been less widely discussed. Drawing at Foster's (2014) work, we argue that a dignity framework provides a useful lens to frame consideration of the disposal of limbs after amputation. Such a framework may be difficult to reconcile with the logic of business and the biovalue' of the medical waste, but would we argue afford more patient-centred approaches towards disposal. It may also facilitate better practices to help mitigate future stockpiling incidences. 

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
business, human dignity, human tissue, quality of health care, adult, amputation, article, drawing, drug safety, ethics, health care quality, human, incidence, limb, logic, waste disposal
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Medical Ethics
Identifiers
urn:nbn:se:hj:diva-47054 (URN)10.1136/medethics-2019-105554 (DOI)000487540700002 ()31358558 (PubMedID)2-s2.0-85070833063 (Scopus ID)GOA;intsam;1377108 (Local ID)GOA;intsam;1377108 (Archive number)GOA;intsam;1377108 (OAI)
Available from: 2019-12-11 Created: 2019-12-11 Last updated: 2022-03-31Bibliographically approved
Jones, L., Pomeroy, L., Robert, G., Burnett, S., Anderson, J. E., Morris, S., . . . Fulop, N. J. (2019). Explaining organisational responses to a board-level quality improvement intervention: Findings from an evaluation in six providers in the English National Health Service. BMJ Quality and Safety, 28(3), 198-204
Open this publication in new window or tab >>Explaining organisational responses to a board-level quality improvement intervention: Findings from an evaluation in six providers in the English National Health Service
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2019 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 28, no 3, p. 198-204Article in journal (Refereed) Published
Abstract [en]

Background: Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis' typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.

Methods: We conducted fieldwork over a 30-month period as part of an evaluation in six healthcare provider organisations in England. Our data comprised board member interviews (n=54), board meeting observations (24 hours) and relevant documents.

Results: Two organisations transformed their processes in a way that was consistent with the objectives of the intervention, and one customised the intervention with positive effects. In two further organisations, the intervention was only loosely coupled with organisational processes, and participation in the intervention stopped when it competed with other initiatives. In the final case, the intervention was corrupted to reinforce existing organisational processes (a focus on external regulatory requirements). The organisational response was contingent on the availability of 'slack' - expressed by participants as the 'space to think' and 'someone to do the doing' - and the presence of a functioning board.

Conclusions: Underperforming organisations, under pressure to improve, have little time or resources to devote to organisation-wide quality improvement initiatives. Our research highlights the need for policy-makers and regulators to extend their focus beyond the choice of intervention, to consider how the chosen intervention will be implemented in public sector hospitals, how this will vary between contexts and with what effects. We provide useful information on the necessary conditions for a board-level quality improvement intervention to have positive effects.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
governance, organizational theory, quality improvement, adult, article, England, female, field work, health care personnel, human, interview, major clinical study, male, national health service, public sector, total quality management
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-42577 (URN)10.1136/bmjqs-2018-008291 (DOI)000471848700006 ()30381330 (PubMedID)2-s2.0-85056110523 (Scopus ID)GOA;intsam;277595 (Local ID)GOA;intsam;277595 (Archive number)GOA;intsam;277595 (OAI)
Available from: 2019-01-10 Created: 2019-01-10 Last updated: 2023-02-22Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8781-6675

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