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Implementation strategies influence the structure, process, and outcome of quality systems: An empirical study of hospital departments in Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. (Socialmedicinsk epidemiologi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. (Health Services Research)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. (Socialmedicinsk epidemiologi)
2009 (English)In: Quality and Safety in Healthcare, ISSN 1475-3898, E-ISSN 1470-7934, Vol. 18, no 1, 49-54 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To analyse whether the organisation of quality systems (structure, process, and outcome) is related to how these systems were implemented (implementation prerequisites, cooperation between managers and staff, and source of initiative).

Methods: A questionnaire was developed, piloted and distributed to 600 hospital departments. Questions were included to reflect implementation prerequisites (adequate resources, competence, problem-solving capacity and high expectations), cooperative implementation, source of initiative (manager, staff and purchaser), structure (resources and administration), process (culture and cooperation) and outcome (goal evaluation and competence development). The adjusted response rate was 75%. Construct validity and reliability was assessed by confirmatory factor analysis, and Cronbach alpha scores were calculated. The relationships among the variables were analysed with structural equation modelling with LISREL.

Results: Implementation prerequisites were highly related to structure (0.51) and process (0.33). Cooperative implementation was associated with process (0.26) and outcome (0.34). High manager initiative was related to structure (0.19) and process (0.17). The numbers in parentheses can be interpreted as correlations. Construct validity was good, and reliability was excellent for all factors (Cronbach alpha>0.78). The model was a good representation of reality (model fit p value = 0.082).

Conclusions: The implementation of organisationally demanding quality systems may require managers to direct and lead the process while assuring that their staff get opportunities to contribute to the planning and designing of the new system. This would correspond to a cooperative implementation strategy rather than to top-down or bottom-up strategies. The results of this study could be used to adjust implementation processes.

Place, publisher, year, edition, pages
2009. Vol. 18, no 1, 49-54 p.
National Category
Medical and Health Sciences
Research subject
Social Medicine
Identifiers
URN: urn:nbn:se:uu:diva-96707DOI: 10.1136/qshc.2007.023978ISI: 000263178200010PubMedID: 19204132OAI: oai:DiVA.org:uu-96707DiVA: diva2:171368
Available from: 2008-02-08 Created: 2008-02-08 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Quality Management in Hospital Departments: Empirical Studies of Organisational Models
Open this publication in new window or tab >>Quality Management in Hospital Departments: Empirical Studies of Organisational Models
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis was to empirically explore the organisational characteristics of quality systems of hospital departments, to develop and empirically test models for the organisation and implementation of quality systems, and to discuss the clinical implications of the findings.

Data were collected from hospital departments through interviews (n=19) and a nation-wide survey (n=386). The interviews were analysed thematically and organisational models were developed. Relationships among aspects of organisation and implementation were hypothesised and analysed with structural equation modelling.

The result was a new framework with three organisational aspects of quality systems each with two sub-aspects: structure (resources and administration), process (culture and cooperation), and outcome (evaluation of goal achievement and development of competence).

Strong positive relationships were confirmed among structure, process, and outcome. Quality systems could therefore be classified into three organisational degrees. For instance, quality systems of high organisational degree often had adequate resources and administration as well as positive organisational cultures and high cooperation among different professions.

Advanced designs required quality systems of high organisational degrees. Examples of such designs were coordination between departments, random check ups, and accreditation.

The organisationally demanding quality systems had been implemented through cooperative implementation, that is, directed by managers while at the same time giving opportunities for staff to participate in planning and designing.

The results can be useful to managers, quality coordinators, and clinicians when they describe, develop, implement, and evaluate the effectiveness and efficiency of quality systems in hospital departments.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 75 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 309
Keyword
Social medicine, Quality Management, Organisational Models, Hospital Departments, Socialmedicin
Identifiers
urn:nbn:se:uu:diva-8428 (URN)978-91-554-7082-1 (ISBN)
Public defence
2008-03-03, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 13:15
Opponent
Supervisors
Available from: 2008-02-08 Created: 2008-02-08 Last updated: 2010-12-30Bibliographically approved

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Kunkel, StefanRosenqvist, UrbanWesterling, Ragnar

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