Quality Improvement in Healthcare

Abstract: ABSTRACTThe Swedish healthcare system, although being one of the more efficientcare systems in the world with good medical outcomes at a moderate cost,faces tremendous future challenges. An ageing population with morepatients suffering from multiple diseases together with accelerating medicotechnical developments is putting increasing pressure on the system. The quality and safety of the system has also been called into question.Improvement science, where quality improvement theories and practices arecontinuously being translated to a healthcare context, has emerged as onepossible solution to these challenges. However, there is need for a furthertheoretical and practical development of the field.The purpose of the thesis is to explore quality improvement initiatives inhealthcare systems, suggesting alternative ways of improving quality andefficiency in healthcare organizations. The empirical material draws onleveraging events during two long-term improvement initiatives in thehealthcare system of Skaraborg in the Western region of Sweden. Theauthor, working as a development director at the Skaraborg hospital group(SkaS), played a major role in both cases as an inside action researcher. Thefirst case addresses a decade of development efforts that sought to improvecare for elderly people in West Skaraborg. The second case explores howquality management ideas at SkaS were used to improve quality, efficiencyand safety in hospital care from 2006 to 2008.The results of the research draw special attention to the importance ofmoving beyond the established static, linear step-for-step models for qualityimprovement, instead embracing a more open and processual view onimprovement. The thesis proposes that practices and theories from theaction research (AR) field in this respect are useful complements to theemerging field of improvement science. AR practices entail an approach thatenhances joint learning and reflection in iterative action-reflection cycles.Further, drawing from the vast repertoire of AR practices, cognitive,structural, networking, and procedural learning mechanisms are vitalingredients for quality improvement in complex healthcare systems.Learning mechanisms connect all parts of the system but they also supportindividual and organizational learning and action through new vocabularies,frameworks and concepts, procedures and tools.