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The role of professional logics in quality register use: a realist evaluation
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.ORCID iD: 0000-0002-3164-8462
Department of Management and Engineering, HELIX Competence Centre, Linköping University, Linköping, Sweden.
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).ORCID iD: 0000-0002-2480-1641
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Futurum, Academy for Health and Care Region Jönköping County, Ryhov County Hospital, Jönköping, Sweden.ORCID iD: 0000-0003-1176-8173
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2020 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 20, p. 1-11, article id 107Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Springer, 2020. Vol. 20, p. 1-11, article id 107
Keywords [en]
Quality registers, Programme, Clinical practice, Professional logics, Realist evaluation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:hj:diva-47780DOI: 10.1186/s12913-020-4944-xISI: 000514610400002PubMedID: 32046710Scopus ID: 2-s2.0-85079338390Local ID: GOA HHJ 2020OAI: oai:DiVA.org:hj-47780DiVA, id: diva2:1393180
Funder
Swedish Association of Local Authorities and RegionsAvailable from: 2020-02-14 Created: 2020-02-14 Last updated: 2020-03-05Bibliographically approved

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Norman, Ann-CharlottNordin, AnnikaAndersson-Gäre, BoelAlgurén, Beatrix

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Health Care Service and Management, Health Policy and Services and Health Economy

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