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Quality improvement in large healthcare organizations: Searching for system-wide and coherent monitoring and follow-up strategies

Elisabet Höög (Department of Public Health and Clinical Medicine; Epidemiology and Global Health, Umeå University, Umeå, Sweden and Department of Learning, Informatics, Management and Ethics; Medical Management Centre, Karolinska Institutet, Stockholm, Sweden)
Jack Lysholm (Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden)
Rickard Garvare (Department of Business Administration, Technology and Social Sciences, Luleå University of Technology, Luleå, Sweden)
Lars Weinehall (Department of Public Health and Clinical Medicine; Epidemiology and Global Health, Umeå University, Umeå, Sweden)
Monica Elisabeth Nyström (Department of Learning, Informatics, Management and Ethics; Medical Management Centre, Karolinska Institutet, Stockholm, Sweden)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 21 March 2016

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Abstract

Purpose

The purpose of this paper is to investigate the obstacles and challenges associated with organizational monitoring and follow-up (M & F) processes related to health care quality improvement (QI) and development.

Design/methodology/approach

A longitudinal case study of a large health care organization during a system-wide QI intervention. Content analysis was conducted of repeated interviews with key actors and archival data collected over a period of four years.

Findings

The demand for improved M & F strategies, and what and how to monitor were described by the respondents. Obstacles and challenges for achieving M & F strategies that enables system-wide and coherent development were found in three areas: monitoring, processing, and feedback and communication. Also overarching challenges were found.

Practical implications

A model of important aspects of M & F systems is presented that can be used for analysis and planning and contribute to shared cognition of such systems. Approaches for systematic analysis and follow-up of identified problems have to be developed and fully incorporated in the organization’s measurement systems. A systematic M & F needs analytic and process-oriented competence, and this study highlights the potential in an organizational function with capacity and mandate for such tasks.

Originality/value

Most health care systems are flooded with a vast amount of registers, records, and measurements. A key issue is how such data can be processed and refined to reflect the needs and the development process of the health care system and how rich data can be used for improvement purposes. This study presents key organizational actor’s view on important factors to consider when building a coherent organizational M & F strategy.

Keywords

Acknowledgements

This study was mainly funded by the Vinnvård research program in Sweden (project A2007034), with contributions from the Strategic Research Programme in Care Sciences at Karolinska Institutet and Umeå University, funded by the Swedish Research Council.

Citation

Höög, E., Lysholm, J., Garvare, R., Weinehall, L. and Nyström, M.E. (2016), "Quality improvement in large healthcare organizations: Searching for system-wide and coherent monitoring and follow-up strategies ", Journal of Health Organization and Management, Vol. 30 No. 1, pp. 133-153. https://doi.org/10.1108/JHOM-10-2013-0209

Publisher

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Emerald Group Publishing Limited

Copyright © 2016, Emerald Group Publishing Limited