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Evaluation of quality improvement programmes.

https://arctichealth.org/en/permalink/ahliterature187346
Source
Qual Saf Health Care. 2002 Sep;11(3):270-5
Publication Type
Article
Date
Sep-2002
Author
J. Øvretveit
D. Gustafson
Author Affiliation
Nordic School of Public Health, Karolinska Institute, Sweden. jovret@aol.com
Source
Qual Saf Health Care. 2002 Sep;11(3):270-5
Date
Sep-2002
Language
English
Publication Type
Article
Keywords
Evidence-Based Medicine
Health Services Research - methods
Hospital Administration - methods - standards
Humans
Management Audit
Program Evaluation - methods
Research Design - standards
Sweden
Total Quality Management
Abstract
In response to increasing concerns about quality, many countries are carrying out large scale programmes which include national quality strategies, hospital programmes, and quality accreditation, assessment and review processes. Increasing amounts of resources are being devoted to these interventions, but do they ensure or improve quality of care? There is little research evidence as to their effectiveness or the conditions for maximum effectiveness. Reasons for the lack of evaluation research include the methodological challenges of measuring outcomes and attributing causality to these complex, changing, long term social interventions to organisations or health systems, which themselves are complex and changing. However, methods are available which can be used to evaluate these programmes and which can provide decision makers with research based guidance on how to plan and implement them. This paper describes the research challenges, the methods which can be used, and gives examples and guidance for future research. It emphasises the important contribution which such research can make to improving the effectiveness of these programmes and to developing the science of quality improvement.
Notes
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PubMed ID
12486994 View in PubMed
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Explaining process orientation failure and success in health care--three case studies.

https://arctichealth.org/en/permalink/ahliterature279819
Source
J Health Organ Manag. 2015;29(6):638-53
Publication Type
Article
Date
2015
Author
Stefan Hellman
Gustaf Kastberg
Sven Siverbo
Source
J Health Organ Manag. 2015;29(6):638-53
Date
2015
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Decision Theory
Delivery of Health Care - economics - methods - organization & administration
Emergency Service, Hospital - economics - organization & administration - standards
Health Plan Implementation - economics - methods - organization & administration
Hip Fractures - therapy
Hospital Administration - methods - standards
Humans
Interinstitutional Relations
Interviews as Topic
Longitudinal Studies
Organizational Case Studies
Organizational Culture
Organizational Innovation
Personnel, Hospital - psychology
Process Assessment (Health Care) - economics - methods - organization & administration
Stroke - therapy
Sweden
Abstract
In order to improve cooperation and collaboration between units, clinics and departments, many health care organizations (HCOs) have introduced process orientation. Several studies indicate problems in realizing these ambitions. The purpose of this paper is to explain and understand the success and failure of process orientation in HCOs.
The authors conducted three case studies and applied Actor-Network Theory as an analytic lens.
The realization of process orientation is hindered by neglect or resistance from physicians, who find the process targets to be of low medical priority. However, the authors also see that medical priorities are no stable entities but are susceptible to negotiations. Over time, process organization, process mapping, process measurement activities and the acting of enroled actors may have impact on medical priorities.
Contrary to previous research, the findings indicate that New Public Management may not be the main obstacle against processes, that accounting figures may not be hard to disregard and that the role of leadership is not paramount.
PubMed ID
26394249 View in PubMed
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Reporting of sentinel events in Swedish hospitals: a comparison of severe adverse events reported by patients and providers.

https://arctichealth.org/en/permalink/ahliterature129184
Source
Jt Comm J Qual Patient Saf. 2011 Nov;37(11):495-501
Publication Type
Article
Date
Nov-2011
Author
Annica Ohrn
Johan Elfström
Christer Liedgren
Hans Rutberg
Author Affiliation
Department of Medical and Health Sciences, Linköping University, Sweden. annica.ohrn@lio.se
Source
Jt Comm J Qual Patient Saf. 2011 Nov;37(11):495-501
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Cross Infection - epidemiology - etiology
Female
Hospital Administration - methods - standards
Hospital Mortality
Humans
Infant
Infant, Newborn
Insurance Claim Review
Male
Malpractice - statistics & numerical data
Mandatory Reporting
Medical Audit
Medical Errors - adverse effects - statistics & numerical data
Middle Aged
Sentinel Surveillance
Sweden
Wounds and Injuries - epidemiology - etiology
Young Adult
Abstract
Mandatory and voluntary reporting of adverse events is common in health care organizations but a more accurate understanding of the extent of patient injury may be obtained if additional sources are used. Patients in Sweden may file a claim for economic compensation from the national insurance system if they believe they have sustained an injury. The extent and pattern of reporting of serious adverse events in a mandatory national reporting system was compared with the reporting of adverse events on the basis of patient claims.
Regional sentinel event reports were compared with malpractice claims data between 1996 and 2003. A sample consisting of 113 patients with deaths or serious injuries was selected from the malpractice claims data source. The medical records of these patients were reviewed by three chief medical officers.
Of the deaths or injuries associated with the 113 patients-25 deaths, 37 with more than 30% disability, and 51 with 16/o-30% disability-23 (20%) had been reported by chief medical officers to the National Board of Health and Welfare as sentinel events. Most adverse events were found in orthopedic surgery, and orthopedic injuries had more serious consequences. None of the patient injuries caused by infections were reported as sentinel events. Individual errors were more frequent in cases reported as sentinel events.
Adverse events causing severe harm are underreported to a great extent in Sweden despite the existence of a mandatory reporting system; physicians often consider them to be complications. Health care organizations should consider using a portfolio of tools-including incident reporting, medical record review, and analysis of patient claims-to gain a comprehensive picture of adverse events.
Notes
Comment In: Jt Comm J Qual Patient Saf. 2011 Nov;37(11):49422132660
PubMed ID
22132661 View in PubMed
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