Thor Johan, Herrlin Bo, Wittlöv Karin, Øvretveit John, Brommels Mats
The Medical Management Centre, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
Int J Health Care Qual Assur. 2010;23(3):312-27. doi: 10.1108/09526861011029370.
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.
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.
鉴于此类医疗保健质量改进项目的有效性以及如何进行最佳评估仍存在不确定性，本文旨在研究瑞典一家大学医院的质量改进项目在五年期间的成果及演变情况。
设计/方法/途径：本文采用案例研究的形式，使用作为该项目一部分收集的数据，包括临床改进项目的质量指标和参与者对项目的评估。
总体而言，该项目58%的项目（39/67）取得了成功。由女医生领导的项目成功率（91%，n = 11）高于由男医生领导的项目（51%，n = 55）。医院的协调人员不断根据当地情况调整改进方法。参与者面临的最大困难是缺乏专门用于改进工作的时间。主要益处包括更有能力看到“全局”以及为患者和员工带来的改善。
研究局限/启示：质量测量对开展和评估改进工作很重要，但可靠性有限且较为薄弱。尽管如此，本研究为医疗保健改进项目的有效性增添了证据。改进团队领导中的性别差异值得进一步研究。改进项目评估应评估改进方法在当地的调整和应用程度。
原创性/价值：本案例研究报告了一个医疗保健组织在五年期间开展的所有改进项目的成果，并深入洞察了改进项目的多变性质。
