Purpose The purpose of this paper is to address how adult development (AD) theories can contribute to quality improvement (QI). Design/methodology/approach A theoretical analysis and discussion on how personal development empirical findings can relate to QI and Deming's four improvement knowledge domains. Findings AD research shows that professionals have qualitatively diverse ways of meaning-making and ways to approach possibilities in improvement efforts. Therefore, professionals with more complex meaning-making capacities are needed to create successful transformational changes and learning, with the recognition that system knowledge is a developmental capacity. Practical implications In QI and improvement science there is an assumption that professionals have the skills and competence needed for improvement efforts, but AD theories show that this is not always the case, which suggests a need for facilitating improvement initiatives, so that everyone can contribute based on their capacity. Originality/value This study illustrates that some competences in QI efforts are a developmental challenge to professionals, and should be considered in practice and research.
Rationale, aim, and objective: This study aimed to explore programme theories of a national quality register. A programme theory is a bundle of assumptions underpinning how and why an improvement initiative functions. The purpose was to examine and establish programme theories of a national quality register widely used in Sweden: Senior alert. The paper reports on how programme theories among change recipients emerge in relation to the established programme theory of the initiator. Methods: A qualitative approach and a longitudinal research design were used. To develop programme theories among change recipients, individual semistructured interviews were conducted. Three sets of interviews were conducted in the period of 2011 to 2013, totalling 22 interviews. In addition, 4 participant observations were made. To develop the initiator's programme theory, an iterative multistage collaboration process between the researchers and the initiator was used. A directed content analysis was used to analyse data. Findings: The initiator and change recipients described similar programme logics, but differing programme theories. With time, change recipients' programme theories emerged. Their programme theories converged and became more like the programme theory of the initiator. Conclusions: This study has demonstrated the importance of making both the initiator's and change recipients' programme theories explicit. To learn about conditions for improvement initiatives, comparisons between their programme theories are valuable. Differences in programme theories provide information on how initiators can customize support for their improvement initiatives. Similar programme logics can be underpinned by different programme theories, which can be deceptive. Programme theories emerge over time and need to be understood as dynamic phenomena.
The aim of this study was to describe health care- and social service professionals' experiences of a quality-improvement program implemented in the south of Sweden. The focus of the program was to develop inter-professional collaboration to improve care and service to people with psychiatric disabilities in ordinary housing. Focus group interviews and a thematic analysis were used. The result was captured as themes along steps in process. (I) Entering the quality-improvement program: Lack of information about the program, The challenge of getting started, and Approaching the resources reluctantly. (II) Doing the practice-based improvement work: Facing unprepared workplaces, and Doing twice the work. (III) Looking backevaluation over 1 year: Balancing theoretical knowledge with practical training, and Considering profound knowledge as an integral part of work. The improvement process in clinical practice was found to be both time and energy consuming, yet worth the effort. The findings also indicate that collaboration across organizational boundaries was broadened, and the care and service delivery were improved.
BACKGROUND: Pursuing the vision 'for a good life in an attractive region,' the Region Jönköping County (RJC) in Sweden oversees public health and health-care services for its 360 000 residents. For more than three decades, RJC has applied 'quality as strategy,' which has included increasing involvement of patients, family and friends and citizens. This practice has evolved, coinciding with the growing recognition of co-production as a fundamental feature in health-care services. This study views co-production as an umbrella term including different methods, initiatives and organizational levels. When learning about co-production in health-care services, it can be helpful to approach it as a dynamic and reflective process. OBJECTIVE: This study aims to describe the examples of key developmental steps toward co-production as a system property and to highlight 'lessons learned' from a Swedish health system's journey. METHOD: This qualitative descriptive study draws on interviews with key stakeholders and on documents, such as local policy documents, project reports, meeting protocols and presentations. Co-production initiatives were defined as strategies, projects, quality improvement (QI) programs or other efforts, which included persons with patient experience and/or their next of kin (PPE). We used directed manifest content analysis to identify initiatives, timelines and methods and inductive conventional content analysis to capture lessons learned over time. RESULTS: The directed content analyses identified 22 co-production initiatives from 1997 until today. Methods and approaches to facilitate co-production included development of personas, storytelling, person-centered care approaches, various co-design methods, QI interventions, harnessing of PPEs in different staff roles, and PPE-driven improvement and networks. The lessons learned included the following aspects of co-production: relations and structure; micro-, meso- and macro-level approaches; attitudes and roles; drivers for development; diversity; facilitating change; new perspectives on current work; consequences; uncertainties; theories and outcomes; and regulations and frames. CONCLUSIONS: Co-production evolved as an increasingly significant aspect of services in the RJC health system. The initiatives examined in this study provide a broad overview and understanding of some of the RJC co-production journey, illustrating a health system's approach to co-production within a context of long-standing application of QI and microsystem theories. The main lessons include the constancy of direction, the strategy for improvement, engaged leaders, continuous learning and development from practical experience, and the importance of relationships with national and international experts in the pursuit of system-wide health-care co-production.
