SUMMARY This thesis addresses improvement capability at the front lines of healthcare with a focus on interprofessional health care improvement teams who provide care and improve care. The overall aim is to explore high performing clinical microsystems and evaluate interventions to cultivate health care improvement capabilities of frontline interprofessional teams. Methods Descriptive and evaluative study designs were employed in the five studies which comprise this thesis. A total of 495 interprofessional health care providers from a variety of health care contexts in the United States (Study I, II, III & IV) and Sweden (Study V) participated in the studies. The mixed methods research included qualitative observation, interviews, focus groups and surveys analyzed with qualitative manifest content analysis. The quantitative data were analyzed with statistics appropriate for non-parametric data. Findings Study I and II describe how leaders who understand health care improvement can create conditions for interprofessional teams to provide care and simultaneously improve care. Study III evaluates adapted clinical microsystem processes and tools successfully adapted in two different hospitals. Frontline staff reported that they needed help to balance providing care and improving care. Study IV and V explored and tested team coaching to help interprofessional teams to increase their improvement capabilities within improvement collaboratives. The participants perceived team coaching mostly positively and identified supportive coaching actions. In Study V an intervention with “The Team Coaching Model” was tested in Sweden and showed increased acquisition of improvement knowledge in the intervention teams compared to teams who did not receive the coaching model. Conclusions The thesis findings show leaders can help cultivate health care improvement capability by designing structures, processes and outcomes of their organizational systems to support health care improvement activities, setting clear improvement expectations of all staff, developing the knowledge of every staff member in the microsystem to know their operational processes and systems to promote action learning in their daily work, and providing help with team coaching using a Team Coaching Model.

The aim of the study was to examine adolescents’ experiences of having brachial plexus birth palsy, which is impaired arm function due to a birth injury. Psychosocial focal points were how the adolescent’s experience their lives concerning studies, spare time activities and relationships, experiences of limitations in comparison to their peers, and how they experience health care. Eight adolescents who had surgery of the injury were interviewed. Through qualitative phenomenological analysis the following meaning units were identified: ‘Me and others’; ‘Professional medical contacts and experiences’; and ‘Adjustment and strategies to solutions and obstacles’ with essences ‘Disabled or have a disability’; ‘Then and now’ and ‘Lack of references’. The result showed that the adolescents did not identify themselves as disabled, and did not focus on their arm, but wished for improved physical function. They had good support from health care, although wanted more follow-ups and more aimed information. They had adjusted well to their injury, but did not have any comparisons as they had their injury since birth. Understanding the experiences adolescents with BPBP have is essential for advancing the care of these individuals. Further research is necessary regarding the experience people with this injury have. / Syftet med studien var att studera ungdomars erfarenheter av att leva med en plexusskada, det vill säga nedsatt armfunktion på grund av en förlossningsskada, ur ett psykosocialt perspektiv med fokus på hur ungdomarna upplever sina liv beträffande studier, fritid och relationer, upplevelser av begränsningar i jämförelse med generationskamrater på grund av skadan, samt erfarenheter av sjukvården. Åtta ungdomar som opererats för skadan intervjuades. Genom kvalitativ fenomenologisk analys kunde följande meningsbärande enheter urskiljas: ’Jag och andra’; ’Professionella kontakter och erfarenheter’ och ’Anpassningar och strategier till lösningar och hinder’ där ’Funktionshindrad eller ha funktionshinder’; ’Då och nu’ samt ’Brist på referenser’ var gemensamma samtalsämnen. Resultatet visade att ungdomarna inte betraktade sig som handikappade, de fokuserade inte på sin arm i sin vardag, och önskade klara av mer fysiska aktiviteter. De upplevde gott stöd från sjukvården, men önskade uppföljningar och mer riktad information. De hade anpassat sig till skadan, men upplevde att de inte kunde jämföra med andra eftersom de haft skadan sedan födseln. Att kunna förstå ungdomars erfarenheter av att leva med en plexusskada, är nödvändigt för att förbättra vården och bemötandet för dessa individer.