Most patients with symptomatic acute myocardial infarction (AMI), the leading cause of death in western industrialized nations, use the emergency department (ED) as their point of entry. Yet, one identified barrier to early recognition of patients with AMI is ED overcrowding. In this paper, the author presents a quality improvement model that applies Lean Six Sigma guidelines to the clinical setting.
This paper reports a pilot study and three case studies to examine aimed at studying if a quality system, according to the ISO 9000 quality standard, can be visualised, exploring how the visualisation should be designed in order to support continuous improvements and evaluating the design process for development of prototypes. By discussing with the research team, three companies in southern Sweden set up design teams to establish principles for visualisations of their quality systems on their intranets. Together with one of the researchers, the design teams created and evaluated computer supported prototypes and exchanged ideas between the teams via the Internet. The results show that quality systems can be adequately visualised and that the companies preferred descriptions of the physical plant layout containing symbols that connect to further information by hyperlinks. A quality system based on computer supported visualisation will make the quality system more understandable and have better possibilities to engage personnel in the quality work; it will be faster, easier, and more interesting to use than systems with only paper documents. The use of design teams with access to each other's prototypes via the Internet supported the design process by stimulating generation of ideas and solutions to visualise a quality system.
This article presents a case study describing the development, structure and operation of a comprehensive system for managing conflicts in a Norwegian city hospital. This was done in an effort to further develop the dispute mechanisms available in the hospital and to strengthen the management skills of clinical leaders and managers in general. By changing the ways managers and professionals handle their disputes, the hospital hopes to reduce the cost of conflicts and realize its benefits. The new conflict management system includes new procedures for managers and professionals to process disputes. The design process of the new system was framed according to an action research approach characterized by creating change through dialogue and the use of local expertise.
Construction and renovation projects in health care facilities are a risk for certain patients, particularly those who are immunocompromised. A proactive approach must be taken to limit construction-related nosocomial infections. This requires having a multidisciplinary team, supported by administration, to plan and implement preventive measures throughout the duration of the construction project. The ICP should be an active team member in all phases of the project. The ICP plays a major role by providing education to personnel; ensuring that preventive measures are identified, initiated, and maintained; and carrying out surveillance for infections in patients. By ensuring that the appropriate preventive measures are in place and clear lines of communication exist among the personnel, patient safety will be enhanced.
During the past 15 years, there have been many initiatives to improve the integration between different welfare agencies. This study is describing and analysing the co-operation between agencies involved in a rehabilitation project in Sweden, and discussing such inter-agency co-operation as a strategy for provision of complex welfare services.
The study is based on a process evaluation, where the co-operation between the agencies was followed and documented during the time of the project. Different kinds of data were collected through interviews, focus groups and diaries. The contents of these data were analysed in order to evaluate the process of co-operation. In addition, there was also an evaluation of the effects of the co-operation, based on official documents, statistics, etc.
The evaluation shows that it was possible to co-operate across the organizational boundaries of the different agencies, but there were obstacles related to organizational and cultural differences of the agencies, divided loyalties of the officials and limited resources available to deal with the complex needs of the clients. At the same time, the commitment and the relations between the officials were facilitating the co-operation.
Based on the evaluation of this project, it seems that co-operation could be an effective strategy to deal with clients who need services from different welfare agencies. At the same time, however, it is clear that inter-agency co-operation requires a lot of time and energy and should therefore be used with caution.
This article examines a specific management reform at three hospitals in a Danish county. Management reform at the hospital level implies a decentralization of responsibility and power to the departmental level. Along with increased responsibility and power, departments get the message: keep your budgets and keep your output level. This preliminary analysis indicates that departmental budgets can be a way of containing costs in clinical departments. Non-staff expenditures especially are subjected to reductions. The system still seems to 'favour' doctors and nurses, but less than in a system with traditional budgetary institutions. The behaviour of the top-management teams shows that the output constraint is not seriously meant. Departments are allowed to reduce capacity, with declining output, with the knowledge of the top-management team. The declining output makes it easier to departments ceteris paribus to keep within their budgets. And that makes it easier for the top-management team to keep the overall hospital budget. The obligation to keep the overall hospital budget is thus an important criterion of success in the eyes of the political masters of hospitals.
To investigate the occurrence of the word ;;effectiveness'' in the political-administrative decision-making minutes in specialized healthcare as presented to board and council meetings by top management teams.
The occurrence and intended use of ;;effectiveness'' were identified from all council and board meeting minutes (n = 190) of five Finnish university hospital districts in 2001 and 2006. Data were collected from the Internet pages of the hospital districts. For analysis, deductive content analysis combining qualitative and quantitative methodologies was used.
The word ;;effectiveness'' occurred in the planning, organization and evaluation of service activities and in the definitions and justifications for the goal states of research and development work. Although objectives were justified by effectiveness, the occurrence and use of the term were not grounded on proven effectiveness but rather represented an ideal being pursued. Use of the word ;;effectiveness'' increased from 2001 to 2006, particularly in the political-administrative decision-making of large hospital districts. This article gives useful information regarding the benefits of effectiveness in political-administrative decision-making.
Healthcare is under pressure to increase effectiveness, which is manifested by rhetoric presentations of the term in the political-administrative decision-making in specialized healthcare. There is a need for focused collection and systematic follow-up of easily available effectiveness information in healthcare.
Rosabeth Moss Kanter's model of organizational empowerment was used to examine the effects of a multidisciplinary teamwork project initiated in preparation for a 1995 Canadian Council on Health Services Accreditation survey. Kanter maintains that work structures such as teams foster opportunities to learn and grow, provide access to information, support and resources, empower employees, and result in increased work satisfaction and effectiveness. Staff who participated on multidisciplinary teams to prepare for the accreditation survey (n = 210) and a random sample of staff who did not participate on the teams (n = 348) were surveyed to ascertain their perceptions of work-related empowerment and job satisfaction. Consistent with Kanter's propositions, members participating on teams had higher empowerment scores and perceived access to empowerment structures to be more important than members not participating on these teams. Overall, perceived access to empowerment structures was found to be significantly lower than perceived importance of access to the empowerment structures. The results of this study support the use of multidisciplinary teams as one work redesign strategy for enhancing work effectiveness in the health care environment.
A clear aim is key for the success of improvement projects, yet many fail already at this stage. We studied how clinical teams and managers at a university hospital in Sweden identified problems and defined aims as they initiated 24 process improvement projects. Categorizing and comparing problems at 3 stages of problem definition, we found that the majority of problems fell into 1 of 3 categories: information issues, poor procedures, and waiting times. Going through these stages, managers and clinical teams prioritized waiting-time problems. We show how managers can ask such teams to quickly identify problems suited for improvement projects through this step-wise, facts-based approach. We conclude that they can add their management perspective when giving specific assignments, to harness the combined benefits of both a bottom-up and a top-down approach to improvement.