Studies on healthcare quality improvement (QI) increasingly point at the importance of understanding multilevel organizational issues, especially interaction between national, hospital and clinical level. In a EU-study involving ten hospitals in five countries one hospital stood out in successful multilevel QI work, which is elaborated in this paper. It is suggested that there is a potential in using linkages and dependencies in terms of organisational development and resource support (O) and method, process and IT support (T) affecting the individual caregiver (H), to understand the nestedness and interaction between operational system levels in QI. ; Quality and Safety in European Union Hospitals (QUASER)
Introduction The increasing threat of resistant bacteria has become a progressively more important issue and a major challenge to deal with in health care systems. In 1995 the Medical Society Reference Group for Antibiotics Questions (RAF) started a Strategic Program for rational use of antibiotics and reduced antibiotic resistance called Strama. In 2006 Strama received a commission from the government and a permanent financing and on July 2010 a national Strama council was formed as an advisory body to support the Swedish Institute for Communicable Disease Control in issues regarding 1) use of antibiotics and reduced antibiotic resistance and 2) efforts to promote cross-sectorial and locally established approach includings relevant authorities, county councils, municipalities and nonprofit organizations. In May 2011 a working group within Strama was formed in hospital A on behalf of The Director of Public Health and Healthcare in the county. The Urology Unit was chosen as a pilot department as urinary infections account for more than 30 percent of all hospital-acquired infections and contributes to the overuse of antibiotics. On behalf of The Director of Public Health and Healthcare in the county, the urology clinics at the three hospitals in the county during the past year merged into a common Urology Unit as a part of the process in gaining better control of infection spread when patients move between hospitals depending on the type of treatment that each hospital is specialized on. This merger involves in itself a number of major challenges. Materials and methods A process in the Strama work related to the Urology Unit at the County Council was followed during autumn 2011 and spring 2012 by interviewing project leaders, members of the Strama group, clinicians, attending meetings, studying documents and by observations. Results and conclusions The Strama group has been working at obtaining uniform working methods and procedures as it has been varying between physicians and clinics. They have also developed ...
Objectives: Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands. Methods: An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals. Results: How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures. Conclusions: The development of hospital leaders' skills in translating external requirements into implementation plans with internal support is a complex, but crucial, task, if quality is to remain a priority during times of austerity. Increasing quality improvement skills within a hospital, developing a culture where quality improvement becomes embedded and linking cost reduction measures to improving care are all required. ; SAGE Choice article (Open Access)
