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Learning from a successful Quality ImprovementCollaborative. Why did it work? – Experience from teams and team coacheswho improved their care for children with diabetes
Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
Vise andre og tillknytning
(engelsk)Manuskript (preprint) (Annet vitenskapelig)
HSV kategori
Identifikatorer
URN: urn:nbn:se:hj:diva-28320OAI: oai:DiVA.org:hj-28320DiVA, id: diva2:871664
Tilgjengelig fra: 2015-11-16 Laget: 2015-11-16 Sist oppdatert: 2015-11-16
Inngår i avhandling
1. Learning and understanding for quality improvement under different conditions: An analysis of quality registry-based collaboratives in acute and chronic care
Åpne denne publikasjonen i ny fane eller vindu >>Learning and understanding for quality improvement under different conditions: An analysis of quality registry-based collaboratives in acute and chronic care
2015 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

The demands that are placed on healthcare systems continue to increase, but several studies show that patient care and healthcare system outcomes are not as good as they could be. To come to terms with these problems, many stakeholders turn to systematic quality improvement methods. However, research and practice also shows that change in organisations is difficult. Consequently many quality improvement projects fail. Quality Improvement Collaboratives (QICs), introduced through the use of the Breakthrough series model, represent a commonly used approach. Despite their widespread application, uncertainty remains regarding the effectiveness of QICs. In Sweden, a number of national quality registries document healthcare actions and outcomes for different patient-groups and problem-areas. While these registries have long been used for follow-up purposes and for clinical research, they have not been used extensively for systematic clinical improvement purposes. The overall aim of this thesis was to examine if, and how, QICs which are supported by national quality registries can contribute to quality improvement in the provision of healthcare. The aim was also to examine what learning and new understanding occurred in the application of QICs in different settings.

The empirical material in this thesis comes from three QICs which included participating teams from different hospitals and health centres in Sweden. Each QIC included a national quality registry: the National Quality Registry for Acute Myocardial Infarction Care (RIKS-HIA); the National Diabetes Registry (NDR); and the Swedish Paediatric Diabetes Quality Registry (SWEDIABKIDS).

The thesis draws on an interactive research approach. The data collection and analysis employed both qualitative and quantitative methods. Data fromthe National Quality Registries, final team reports, focus-group interviews, and team members’ experiences were analysed and triangulated.

The studies shows that QICs which are supported by national quality registries helped teams to close a number of gaps between ordinary clinical practice and evidence-based guidelines, thereby contributing to the provision of better care and better clinical outcomes (Study I, Study II, and Study III). Important factors for success included stakeholders’ learning andunderstanding of the organisational context; structures that supported improvement efforts; and team members’ and managers’ commitment to improvement (Study IV). Furthermore, support by an internal team coach also promoted success (Study IV).

This thesis shows how national quality registries can be used in combination with systematic improvement efforts to produce better clinical results. It concludes that different areas of QIC application pose different challenges; for example, addressing care for acute disease versus chronic disease and evaluating professionally influenced process measures versus patient dependent outcome measures. While different organizational contexts and care characteristics can pose challenges to QIC efforts, the formation of “Communities of Practice” during QICs enhanced the learning for improvement with and from others.

sted, utgiver, år, opplag, sider
Jönköping: Jönköping University, School of Health and Welfare, 2015. s. 123
Serie
Dissertation Series. School of Health and Welfare, ISSN 1654-3602 ; 65
HSV kategori
Identifikatorer
urn:nbn:se:hj:diva-28322 (URN)978-91-85835-64-5 (ISBN)
Disputas
2015-12-18, Originalet, Qulturum, Region Jönköpings län, Jönköping, 13:00 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2015-11-16 Laget: 2015-11-16 Sist oppdatert: 2015-11-20bibliografisk kontrollert

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Peterson, AnetteAndersson Gäre, BoelHedberg, BeritThor, Johan

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