Method Usefulness for Quality Improvement in Care
Doctoral thesis, 2019
Quality improvement (QI) aims to develop health and social care. Methods are central for QI by describing the care and thereby support i) planning for future care, ii) acquisition of knowledge and understanding of the current practice, and iii) prediction of the future of care from historical data. Methods for QI generally display data in a simple, graphic way, so that they are easy for practitioners to understand; however, this strong focus on simplicity may limit the understanding of care complexity and thereby reduce the support provided for QI. As QI research with a focus on methods describing care complexity is scarce, the purpose of this thesis is to explore the usefulness of methods describing care complexity for QI in care.
To fulfil this purpose, two research questions guided the analysis of the five appended papers. The first research question (What usefulness can visual methods describing care process complexity have for QI?) addresses the need to identify new methods describing care complexity where current methods are lacking. Two methods are chosen, guided by visual analytics theory: Lexis diagram and process mining. Two case studies and a literature review explore the usefulness of Lexis diagrams and process mining through visualisation of process variations at a patient and a population level, across groups and over time. The second research question (What usefulness can methods describing care organisation complexity have for QI in public procurement?) expands and explores the use of current methods describing complexity into the public care procurement context. First, the current state of QI in public care procurement is explored through an archival study, and next, a case study is conducted to explore the use of business excellence models to support QI in public care procurement. The thesis is guided by a pragmatic approach, leading to a mixed-methods approach and domain expert collaboration.
This thesis makes three main contributions. First, each method’s properties are connected to a set of evaluative and organisational benefits, revealing the possibility of and need for matching methods to the local contextual conditions and needs for QI. Subsequently, a framework for this task is presented. Second, the results on the explored methods describing care complexity yield additional understanding of variations and care systems across stakeholders compared to traditional methods used for QI in each context. Methods describing care complexity may, therefore, be useful to support QI efforts. Third, when methods describe care complexity, stakeholders might be supported in driving local QI efforts, and as the new perspectives seem to challenge their mental models, they also seem to develop their understanding of QI.
The findings and conclusions of this thesis primarily contribute to the QI research field but can also inform other research on Lexis diagrams, process mining, and public care procurement.
Chalmers, Technology Management and Economics, Service Management and Logistics
Dahlin, S. Exploring the usefulness of Lexis diagrams for quality improvement
Process Mining for Quality Improvement: Propositions for Practice and Research
Quality management in health care,; Vol. 28(2019)p. 8-14
Relationship between patient costs and patient pathways
International Journal of Health Care Quality Assurance,; Vol. 32(2019)p. 246-261
Dahlin, S., Camén, C., Eriksson, H. Exploring criteria for quality improvement in care procurement
Dahlin, S., Camén, C. The use of business excellence models to foster quality improvement in public contractual relationships
To explore their usefulness for QI, three methods describing care complexity have been studied in this thesis. Lexis diagram and process mining are taken from other research fields but are rather new to QI. They are used to visually describe the complexity of care processes. One method, the use of business excellence models, has already been demonstrated to be useful for describing the complexity of organisations but its usefulness for QI in the specific context of public care procurement is explored in this thesis. To ensure that the conclusions are relevant, the methods were explored in collaboration with practitioners.
The thesis contributes with three main conclusions. First, methods for QI may result in both evaluative and organisational benefits, which highlights the need to correctly match the method and care context. Second, the explored methods bring additional understanding of complexity compared to current methods when used in a similar setting. Third, not only do methods describing complexity support local improvement, but the new perspectives brought to the practitioners seem to develop their understanding of QI as well, which may facilitate future QI efforts.
Operationalization, evaluation and control of quality when procuring care
Forte, 2014-01-01 -- 2016-12-31.
Health Care Service and Management, Health Policy and Services and Health Economy
Innovation and entrepreneurship
Areas of Advance
Doktorsavhandlingar vid Chalmers tekniska högskola. Ny serie: 4685
Chalmers University of Technology
Vasa A, Vera Sandbergs Allé 8
Opponent: Prof. Boel Andersson Gäre, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Sverige