Quality Improvement in Healthcare
Doktorsavhandling, 2013

ABSTRACT The Swedish healthcare system, although being one of the more efficient care systems in the world with good medical outcomes at a moderate cost, faces tremendous future challenges. An ageing population with more patients suffering from multiple diseases together with accelerating medicotechnical developments is putting increasing pressure on the system. The quality and safety of the system has also been called into question. Improvement science, where quality improvement theories and practices are continuously being translated to a healthcare context, has emerged as one possible solution to these challenges. However, there is need for a further theoretical and practical development of the field. The purpose of the thesis is to explore quality improvement initiatives in healthcare systems, suggesting alternative ways of improving quality and efficiency in healthcare organizations. The empirical material draws on leveraging events during two long-term improvement initiatives in the healthcare system of Skaraborg in the Western region of Sweden. The author, working as a development director at the Skaraborg hospital group (SkaS), played a major role in both cases as an inside action researcher. The first case addresses a decade of development efforts that sought to improve care for elderly people in West Skaraborg. The second case explores how quality management ideas at SkaS were used to improve quality, efficiency and safety in hospital care from 2006 to 2008. The results of the research draw special attention to the importance of moving beyond the established static, linear step-for-step models for quality improvement, instead embracing a more open and processual view on improvement. The thesis proposes that practices and theories from the action research (AR) field in this respect are useful complements to the emerging field of improvement science. AR practices entail an approach that enhances joint learning and reflection in iterative action-reflection cycles. Further, drawing from the vast repertoire of AR practices, cognitive, structural, networking, and procedural learning mechanisms are vital ingredients for quality improvement in complex healthcare systems. Learning mechanisms connect all parts of the system but they also support individual and organizational learning and action through new vocabularies, frameworks and concepts, procedures and tools.

quality improvement

Healthcare

learning mechanisms

integrated care

action research

improvement science

Vasa A
Opponent: Professor David Coghlan

Författare

Svante Lifvergren

Chalmers, Teknikens ekonomi och organisation, Industriell kvalitetsutveckling

Det svenska hälso- och sjukvårdssystemet är ett av de mer effektiva systemen i världen med goda medicinska resultat till en rimlig kostnad. Men en åldrande befolkning där alltfler patienter lider av kroniska sjukdomar tillsammans med en accelererande medicinsk-teknisk utveckling ökar hela tiden pressen på systemet. Idéer från kvalitetsutvecklingsområdet har vuxit fram som en potentiell möjlighet att hantera dessa utmaningar. Dessa idéer har också bidragit till framväxten av ett eget vetenskapligt fält – förbättringskunskap – där teorier och metoder kontinuerligt översätts till ett hälso- och sjukvårdssammanhang. Men många förbättringsprojekt misslyckas fortfarande varför det finns ett behov av att ytterligare utveckla kunskapsfältet. Syftet med denna avhandling är att undersöka olika kvalitetsutvecklingsinitiativ i hälso- och sjukvården för att därmed också föreslå alternativa angreppssätt för att förbättra kvalitet. Forskningen bygger på avgörande händelser under två långsiktiga förändringsprocesser inom delar av hälso- och sjukvårdsystemet i Skaraborg i Västra Götaland. Avhandlingens författare arbetar som utvecklingschef på Skaraborgs sjukhus och hade en central funktion som intern aktionsforskare under bägge processerna. Forskningsresultaten uppmärksammar betydelsen av att se bortom steg-för-steg modeller för kvalitetsförbättring och istället anta en mer öppen och processuell syn på förbättring där lärande och reflektion är viktiga element i förbättringsinitiativen.

The Swedish healthcare system is one of the more efficient care systems in the world with good medical outcomes at a moderate cost. Still, an ageing population with more patients suffering from chronic diseases together with accelerating medico-technical developments is putting increasing pressure on the system. Improvement science, where quality improvement theories and practices are continuously being translated to a healthcare context, has emerged as one possible solution to these challenges. However, many improvement projects fail why there is need for a further development of the knowledge field. The purpose of the thesis is thus to explore quality improvement initiatives in healthcare systems, suggesting alternative ways of improving quality. The research is based on key events during two long-term improvement initiatives in the healthcare system of Skaraborg in the Western region of Sweden. The author, working as a development director at the Skaraborg hospital group (SkaS), played a major role in both cases as an inside action researcher. The results highlight the importance of moving beyond the established step-for-step models for quality improvement. Instead, a more open and processual view on improvement is suggested where learning and reflection are key ingredients in the quality improvement efforts.

Ämneskategorier

Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi

Styrkeområden

Livsvetenskaper och teknik

ISBN

978-91-7385-945-5

Vasa A

Opponent: Professor David Coghlan