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A gap exists between policymaking for quality improvement and the realization of these policies in practice. Using previous research on intermediaries, a conceptual model of an Intermediary for Quality Improvement (IQI) is developed. The model highlights the characteristics of structural positions, mediating approaches, and duration as a way to describe an IQI. The conceptual model is used to examine two cases in which Famna, the Swedish Association for Non-profit Health and Social Service Providers, has supported both policymaking and the implementation of policies at a provider level. The cases are the national strategy for quality improvement by open comparisons in health care and social services and a new regulation on quality management systems in health care and social services. Using the concept of an IQI deepens the understanding of how top-down and bottom-up perspectives may be managed to realize good quality of services.

1. Sustainable development in organizations / Mattias Elg ... [et al.] -- 2. Subsidiarity in the organization - a key issue to prevent psychosocial risk / François Danelliou -- 3. Lean implementation, work environment and sustainability / Jörgen Eklund, Agneta Halvarsson Lundkvist and Pernilla Lindskog -- 4. Conditions for presenteeism and production in changing organizations / Kerstin Ekberg, Maria Gustavsson and Anna-Carin Fagerlind Ståhl -- 5. Towards the collaborative hospital - harnessing the potential of enabling care processes and structures / Thim Prætorious ... [et al.] -- 6. Program steering by learning / Agneta Halvarsson Lundkvist and Henrik Kock -- 7. The role of customers in the development of public organizations / Jon Engström ... [et al.] -- 8. Developing knowledgeable practice at work / Karen Evans -- 9. Trajectories of learning in practice-based innovation - organizational roles at play in sustainable innovation management / Mervi Hasu ... [et al.] -- 10. Exploring evidence-based practice in practice - the case of social work / Gunilla Avby, Per Nilsen and Per-Erik Ellström -- 11. New forms of organizations - new ways to organize / Lena Högberg, Elisabeth Sundin and Malin Tillmar -- 12. Women small-business owners' challenge of regional gender contracts / Birgitta Sköld -- 13. Organizational formalization in new high tech ventures - a dual-actor process / Ingela Sölvell -- 14. The Nordic model in a global company situated in Norway - challenging institutional orders? / Hege Eggen Børve and Elin Kvande -- 15. The permeable university - a study of PHD student mobility and academic entrepreneurship intentions / Dzamila Bienkowska, Henry Etzkowitz and Magnus Klofsten -- 16. Understanding cluster initiatives in Europe - uniqueness and contextuality / Inessa Laur and Alain Fayolle -- 17. Theory based evaluation - a range of approaches to asses impact / Veronica Gaffey and Marielle Riché -- 18. Three approaches to impact evaluation of regional development / Evert Vedung and Staffan Bjurulf -- 19. Interactive research and on-going evaluations as joint learning processes / Lennart Svensson, Göran Brulin and Per-Erik Ellström.

Background Clinical practice improvements based on quality-register data are influenced by multiple factors. Although there is agreement that information from quality registers is valuable for quality improvement, practical ways of organising register use have been notoriously difficult to realise. The present study sought to investigate the mechanisms that lead various clinicians to use quality registers for improvement. Methods This research involves studying individuals' decisions in response to a Swedish programme focusing on increasing the use of quality registers. Through a case study, we focused on heart failure care and its corresponding register: the Swedish Heart Failure Register. The empirical data consisted of a purposive sample collected longitudinally by qualitative methods between 2013 and 2015. In total, 18 semi-structured interviews were carried out. We used realist evaluation to identify contexts, mechanisms, and outcomes. Results We identified four contexts – registration, use of output data, governance, and improvement projects – that provide conditions for the initiation of specific mechanisms. Given a professional theoretical perspective, we further showed that mechanisms are based on the logics of either organisational improvement or clinical practice. The two logics offer insights into the ways in which clinicians choose to embrace or reject certain registers' initiatives. Conclusions We identified a strong path dependence, as registers have historically been tightly linked to the medical profession's competence. Few new initiatives in the studied programme reach the clinical context. We explain this through the lack of an organisational improvement logic and its corresponding mechanisms in the context of the medical profession. Implementation programmes must understand the logic of clinical practice; that is, be integrated with the ways in which work is carried out in everyday practice. Programmes need to be better at helping core health professionals to reach the highest standards of patient care. ; Funding Agencies|Swedish Association of Local Authorities and Regions (SALAR); Jonkoping University

Purpose
– The purpose of this study is to contribute to the knowledge base on how performance measurement drives improvements in healthcare practice.


Design/methodology/approach
– The study is based on a single in-depth case study. The critical incident technique (CIT) has been applied in order to identify significant occurrences of performance measurement in terms of events, incidents, processes, and issues identified by respondents from the case organization. These critical incidents have been analysed and interpreted using a theoretical framework suggesting that performance measurement may be applied for exploratory or regulatory purposes as well as ad hoc or continuously in healthcare practice.


Findings
– The study suggests that performance measurement may be a versatile method for driving improvement in healthcare organizations. Six types of activities directly or indirectly drive improvement in the clinical department: continuous follow-up in formal arenas and meetings; improvement work; professional efforts; goal deployment; reporting based on external demands; and creating awareness in everyday clinical work. Healthcare organizations that strive to practice performance measurement as a driver for improvement need to find infrastructures in which it is being integrated into the daily life of organizational healthcare practice.


Originality/value
– The study provides an original account of the prerequisites and actions for driving improvement through performance measurement in a healthcare setting. Since the operations management perspective in healthcare is significantly lacking, the study offers a unique perspective which may be the basis for both practice development and further scholarly inquiry and theory development.

BACKGROUND:There is growing interest in applying lean thinking in healthcare, yet, there is still limited knowledge of how and why lean interventions succeed (or fail). To address this gap, this in-depth case study examines a lean-inspired intervention in a Swedish pediatric Accident and Emergency department. METHODS:We used a mixed methods explanatory single case study design. Hospital performance data were analyzed using analysis of variance (ANOVA) and statistical process control techniques to assess changes in performance one year before and two years after the intervention. We collected qualitative data through non-participant observations, semi-structured interviews, and internal documents to describe the process and content of the lean intervention. We then analyzed empirical findings using four theoretical lean principles (Spear and Bowen 1999) to understand how and why the intervention worked in its local context as well as to identify its strengths and weaknesses. RESULTS:Improvements in waiting and lead times (19-24%) were achieved and sustained in the two years following lean-inspired changes to employee roles, staffing and scheduling, communication and coordination, expertise, workspace layout, and problem solving. These changes resulted in improvement because they: (a) standardized work and reduced ambiguity, (b) connected people who were dependent on one another, (c) enhanced seamless, uninterrupted flow through the process, and (d) empowered staff to investigate problems and to develop countermeasures using a "scientific method". Contextual factors that may explain why not even greater improvement was achieved included: a mismatch between job tasks, licensing constraints, and competence; a perception of being monitored, and discomfort with inter-professional collaboration. CONCLUSIONS:Drawing on Spear and Bowen's theoretical propositions, this study explains how a package of lean-like changes translated into better care process management. It adds new knowledge regarding how lean principles can be beneficially applied in healthcare and identifies changes to professional roles as a potential challenge when introducing lean thinking there. This knowledge may enable health care organizations and managers in other settings to configure their own lean program and to better understand the reasons behind lean's success (or failure).