A nation-wide survey of the organisation and efficiency of public health care services for Norwegian patients with eating disorders was conducted among the heads of medical and psychiatric units (N = 261). Only the number of patients treated predicted special clinical routines or measures to increase the clinical competence, and not geographical location of institutions or the national health authorities' distribution of treatment recommendations. To improve the quality of the health care services, the informants stressed the importance of increased clinical competence, more resources enabling more patients to be treated, as well as improved cooperation between the medical and psychiatric treatment units.
Norwegian hospitals and their leaders are required by law to engage in quality assurance. We wanted to study to what extent the heads of hospital departments were actually engaged in such activities.
Data were collected by questionnaires sent to heads of hospital departments in Norway (n = 657), of whom 567 (86%) responded.
Only 23% of those interviewed prior to their appointment had been asked about experience in quality assurance, less than 30% had written instructions for their work, and only about 40% received regular follow-up from the hospital administration. The majority registered complaints and mistakes, and was engaged in teaching quality assurance. 58% of the heads of small departments and 73% of those of large departments reported that quality in general suffered because of the demands for higher clinical productivity.
Most heads of hospital departments in Norway are engaged in quality assurance work, but the study indicates that hospital administration attaches little importance to this type of work.
There is a shortage of spine surgeons in Sweden. To guarantee the legal right to healthcare, many counties must hire doctors, with increasing costs. In our new out-patient department routine, the majority of the patients are examined by a physiotherapist at their first visit. History taking and clinical and radiographic examinations are discussed in a team conference, and possible candidates for spine surgery are selected for an appointment with a spine surgeon. Furthermore, the patients were more satisfied with the new routine and management plan.
The Federation of Swedish County Councils and six medical specialties are working together in a project aiming to support and stimulate the development of patient based case registers as a tool to follow up, evaluate, develop and manage medical units. The project is based on participation on the part of the medical professions in a process-oriented way. Each case register shall be based on the individual patient, and will integrate inpatient and outpatient care, all medical professions and important procedures. In hematology the project also seeks to merge case costing data with the patient based case registers in order to facilitate more comprehensive cost analysis and comparison. This episodic perspective is useful for providers per se as well as in discussions between purchasers and providers as a method for understanding and analyzing medical services. The six specialties are hematology, obstetrics and gynecology, ophthalmology, otorhinolaryngology, dermatology and sexually transmitted diseases, and lastly psychiatry.
Conditions for learning in two Norwegian hospital departments are explored in this article. 20 in-depth interviews with physicians working on the surgical and medical departments of a large general hospital were carried out in 1994. We focus on the social aspects of learning and apply access to learning situations as an analytical perspective to explain how possibilities for learning are created in the daily activities of the two departments. Access to learning situations is created in a "zone of possibility" between the formal organisation and the more informal interpersonal networks in the hospital. The division of the department into sections is used as an example of how organisational factors determine with which areas one becomes familiar. The notion of "the good apprentice" and the relationship between initiative and invitation illuminate the significance of interpersonal factors for access to learning situations. Finally, we illustrate how time is an important but scarce resource influencing the development of shared knowledge in the department.
BACKGROUND: How to protect patients from harm is a question of universal interest. Measuring and improving safety culture in care giving units is an important strategy for promoting a safe environment for patients. The Safety Attitudes Questionnaire (SAQ) is the only instrument that measures safety culture in a way which correlates with patient outcome. We have translated the SAQ to Norwegian and validated the translated version. The psychometric properties of the translated questionnaire are presented in this article. METHODS: The questionnaire was translated with the back translation technique and tested in 47 clinical units in a Norwegian university hospital. SAQ's (the Generic version (Short Form 2006) the version with the two sets of questions on perceptions of management: on unit management and on hospital management) were distributed to 1911 frontline staff. 762 were distributed during unit meetings and 1149 through the postal system. Cronbach alphas, item-to-own correlations, and test-retest correlations were calculated, and response distribution analysis and confirmatory factor analysis were performed, as well as early validity tests. RESULTS: 1306 staff members completed and returned the questionnaire: a response rate of 68%. Questionnaire acceptability was good. The reliability measures were acceptable. The factor structure of the responses was tested by confirmatory factor analysis. 36 items were ascribed to seven underlying factors: Teamwork Climate, Safety Climate, Stress Recognition, Perceptions of Hospital Management, Perceptions of Unit Management, Working conditions, and Job satisfaction. Goodness-of-Fit Indices showed reasonable, but not indisputable, model fit. External validity indicators - recognizability of results, correlations with "trigger tool"-identified adverse events, with patient satisfaction with hospitalization, patient reports of possible maltreatment, and patient evaluation of organization of hospital work - provided preliminary validation. CONCLUSION: Based on the data from Akershus University Hospital, we conclude that the Norwegian translation of the SAQ showed satisfactory internal psychometric properties. With data from one hospital only, we cannot draw strong conclusions on its external validity. Further validation studies linking the SAQ-scores to patient outcome data should be performed.