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Quality improvement is a leading approach to the difficult yet inevitable task of managing organizational change. The literature suggests that facilitators can help organizations apply improvement principles and tools but it is unclear how facilitators actually do this and how they develop their own skills. Using a case study design we therefore examined how facilitators worked with 93 improvement projects in over 1000 sessions at one Swedish university hospital where systematic process improvement was successfully established over a 5-year period. They facilitated improvement by providing a framework and methods' support for improvement efforts-relying on experiential learning rather than didactic teaching-while letting clinical teams and managers maintain control over the content of improvement projects. They developed extensive experience that they documented and could transfer between teams, so that each team could benefit from lessons learned elsewhere. They improved facilitation through participant feedback and systematic review and reflection regarding their own practice. We suggest that facilitators can help organizations manage change by assuming responsibility for demanding tasks related to improvement work, developing specialized skill and extensive experience regarding improvement, and transferring insights across the organization, while using a learning approach throughout including to their own work. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the outcomes and evolution over a five-year period of a Swedish university hospital quality improvement program in light of enduring uncertainty regarding the effectiveness of such programs in healthcare and how best to evaluate it., Design/methodology/approach: The paper takes the form of a case study, using data collected as part of the program, including quality indicators from clinical improvement projects and participants' program evaluations., Findings: Overall, 58 percent of the program's projects (39/67) demonstrated success. A greater proportion of projects led by female doctors demonstrated success (91 percent, n=11) than projects led by male doctors (51 percent, n=55). Facilitators at the hospital continuously adapted the improvement methods to the local context. A lack of dedicated time for improvement efforts was the participants' biggest difficulty. The dominant benefits included an increased ability to see the "bigger picture" and the improvements achieved for patients and employees., Research Limitations/implications: Quality measurement, which is important for conducting and evaluating improvement efforts, was weak with limited reliability. Nevertheless, the present study adds evidence about the effectiveness of healthcare improvement programs. Gender differences in improvement team leadership merit further study. Improvement program evaluation should assess the extent to which improvement methods are locally adapted and applied., Originality/value: This case study reports the outcomes of all improvement projects undertaken in one healthcare organization over a five-year period and provides in-depth insight into an improvement program's changeable nature.