Quality of health care : Patient and staff perspectives : a study of changes 1992-1996 with special reference to diagnosis related groups

Abstract: By the early 90s, some Swedish county councils initiated market-oriented steering mechanisms to meet increasing demands for cost efficiency. Among these was the County Council of Gävleborg. The U.S. Diagnosis Related Groups-system (DRG) was used as an output measure for delivered somatic inpatient care within the new organization. The main purpose of the thesis is to evaluate to what extent changes in thequality of care could be identified as a result of the DRG-intervention. The primary perspective was patient experiences of received care and their quality of life after discharge. Another perspective was the staff view of the current care situation including their working conditions. In addition, a medical record review was performed to examine changes before vs after the intervention. The results demonstrated a decrease of the quality of care as seen from the patient perspective. Staff became gradually moredissatisfied with their work performance and experienced increasing unhealth. The medical record review demonstrated no pre-post differences. Previously stated DRG goals were partially fulfilled and the DRG-intervention was gradually implemented. Other presumed causal variables were: other reforms, restrained resources, Styr93, quality assurance activities, and organizational changes within the county council. The conclusions are that implemented changes in health care have negatively affected patient experiences of received care, but not their quality of life after discharge. Staff working conditions were not satisfactory and demand increased future attention.

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