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A 10-year quality journey of a Swedish university hospital is described in this case study based on a variety of data sources. A series of quality initiatives were implemented according to total quality management (TQM) 'best practice.' Many projects were successful, but still a majority of those did not meet the staff's requirement of practical relevance, and they provoked scepticism toward instruments introduced and resistance to service-related quality definitions. The hospital's incentive structures did not reward an engagement in improvement activities. The findings are interpreted as demonstrating that the programs were viewed upon as part of a 'management' rather than 'professional' agenda, despite the underlying philosophy of TQM. It is suggested that applying professional practice development approaches to improvement initiatives might help to overcome the barrier thus created. [ABSTRACT FROM AUTHOR]

Health care decisions could be better informed by research evidence, but there are many areas in which there is little or inconclusive research. Pooling expert knowledge is one way to generate theories and make predictions in areas where there is little clear research evidence. This article addresses these two perspectives in parallel: (1) how to systematically build expert models that have a high predictive and explanatory value by the use of the Integrative Group Process and (2) a model to predict which quality improvement initiatives will be successful, the Swedish Organizational Change Model. The model reveals 11 factors important for successful improvement. Tests of the model conclude that it predicts a high number of successful and unsuccessful initiatives. It can thus be used to diagnose weaknesses in improvement efforts, to measure an organization's overall potential for successful improvement, and to prioritize potential initiatives under consideration. [ABSTRACT FROM AUTHOR]

Background: Both research and practice show that waiting lists are hard to reduce. Implementing complex interventions for reduced waits is an intricate and challenging process that requires special attention for surrounding factors helping and hindering the implementation. This article reports a case study of a hospital implementation of operational plans for reduced waits, with an emphasis on the process of change., Methods: A case study research design, theoretically informed by the Pettigrew and Whipp model of strategic change, was applied. Data were gathered from individual and focus group interviews with informants from different organizational levels at different times and from documents and plans., Findings: The findings revealed arrangements both helping and hindering the implementation work. Helping factors were the hospital's contemporary savings requirements and experiences from similar change initiatives. Those hindering the actions to plan and agree the changes were unclear support functions and unclear task prioritization., Conclusions and Practice Implications: One contribution of this study is to demonstrate the advantages, disadvantages, and challenges of a contextualized case study for increased understanding of factors influencing organizational change implementation. One lesson for current policy is to regard context factors that are critical for successful implementation.

Quality methods of many types have been widely used in hospitals. Although a number of specific projects have shown evidence of improvement, there is no strong evidence of the effectiveness of organization-wide or system programs over a period of time. There is no evidence of which approaches might be more suitable for different settings, or of value for money compared, for example, to employing more doctors and nurses. Jönköping is widely known in Sweden and internationally as one long-running example of a successful systemwide improvement program. As with other programs, critics and researchers have asked for evidence of improved outcomes for patients and of the costs of the program. There are methodological challenges to providing strong evidence of these outcomes, even in small projects where it is easier to attribute outcomes to interventions, at least over the short term. However, there are ways to gather data that are more objective than participants' and consultants' reports and that are useful for assessing the value of the program and to enable others to learn from the experience of Jönköping. This article presents such data from a case study of the program carried out in 2006. It presents evidence of how the program was implemented, of some results, and of the unusual conditions that appear to have shaped or allowed the program to be carried out in the way described. There is some evidence of process improvements in a number of departments and of outcomes improvement in one department. The program is widely perceived to be of benefit and some of the explanations for this are presented.