Staines Anthony, Thor Johan, Robert Glenn
University Lyon III, France and Fédération des hôpitaux vaudois, Prilly, Switzerland (Dr Staines); Medical Management Centre, Karolinska Institutet, Stockholm, and The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Sweden (Dr Thor); and National Nursing Research Unit, King's College, London, United Kingdom (Pr. Robert).
Qual Manag Health Care. 2015 Jan-Mar;24(1):21-37. doi: 10.1097/QMH.0000000000000048.
There is scarce evidence of organization-wide and sustained impact of quality improvement (QI) programs in health care. For 20 years, the Jönköping County Council's (Sweden) ambitious program has attracted attention from practitioners and researchers alike.
This is a follow-up case of a 2006 study of Jönköping's improvement program, triangulating data from 20 semi-structured interviews, observation and secondary analysis of internal performance data.
In 2010, clinical outcomes had clearly improved in 2 departments (pediatrics, intensive care), while process improvements were evident in many departments. In an overall index of the 20 Swedish county councils' performance, Jönköping had improved its ranking since 2006 to lead in 2010. Five key issues shaped Jönköping's improvement program since 2006: a rigorously managed succession of chief executive officer; adept management of a changing external context; clear strategic direction relating to integration; a broadened conceptualization of "quality" (incorporating clinical effectiveness, patient safety, and patient experience); and continuing investment in QI education and research. Physician involvement in formal QI initiatives had increased since 2006 but remained a challenge in 2010. A new clinical information system was being deployed but had not yet met expectations.
This study suggests that ambitious approaches can carry health care organizations beyond the sustainability threshold.
几乎没有证据表明医疗保健领域的质量改进（QI）计划能在整个组织范围内产生持续影响。20年来，瑞典延雪平郡议会的宏伟计划吸引了从业者和研究人员的关注。
这是对2006年延雪平改进计划研究的后续案例，对来自20次半结构化访谈、观察以及内部绩效数据的二次分析的数据进行三角测量。
2010年，两个科室（儿科、重症监护）的临床结果明显改善，而许多科室的流程也有明显改进。在瑞典20个郡议会的整体绩效指数中，延雪平自2006年以来提升了排名，并在2010年领先。自2006年以来，五个关键问题塑造了延雪平的改进计划：对首席执行官进行严格管理的继任；妥善应对不断变化的外部环境；与整合相关的明确战略方向；对“质量”的概念进行拓展（纳入临床疗效、患者安全和患者体验）；以及对质量改进教育和研究的持续投资。自2006年以来，医生参与正式质量改进计划的情况有所增加，但在2010年仍是一项挑战。一个新的临床信息系统正在部署，但尚未达到预期。
本研究表明，雄心勃勃的方法可以使医疗保健组织超越可持续性门槛。
