Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

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

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.

Thesis (M.H.A.)--University of Michigan, 1977.

Thesis (M.H.A.)--University of Michigan, 1977.

Bakgrund: Sjuksköterskor bär ansvaret för omvårdnadsarbetet med patienterna och förväntas agera adekvat i såväl vardagliga som komplexa situationer. För att klara av dessa situationer har de olika verktyg att använda sig av för att exempelvis kontrollera vitalparametrar samt underlätta kommunikationen. Studier visar att sjuksköterskor upplever att det är viktigt med god kommunikation och bra samarbete när patienter ska flyttas över från intensivvårdsavdelningar till vårdavdelningar. Syfte: Syftet var att beskriva sjuksköterskors upplevelser av övertagandet och omvårdnaden av patienter från intensivvårdsavdelningar samt att undersöka om sjuksköterskorna upplever att något skulle kunna förbättras. Metod: Studien genomfördes via en kvalitativ intervjustudie med deskriptiv design. Intervjuerna bestod av semi-strukturerade frågor och insamlad data analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Deltagarnas upplevelser kring övertagandet och omvårdnaden av patienterna skiljde sig och påverkades bland annat av erfarenhet. En känsla av osäkerhet, främst hos de mindre erfarna, förekom ofta inför övertagandet. Deltagarna upplevde inte omvårdnaden av dessa patienter som särskilt problematisk men det kunde ibland uppstå ovana eller komplicerade moment. Detta gjorde att de blev mer skärpta och tittade till patienten oftare. Tydligare riktlinjer för vården, korrekta ordinationer och ytterligare utbildning lyftes fram som förslag på förbättring. Slutsats: Deltagarna i studien hade varierande upplevelser kring övertagandet och omvårdnaden av patienter från olika intensivvårdsavdelningar. Patienterna från intensivvårdsavdelningarna upplevdes ofta som mera komplicerade och omvårdnadskrävande vilket ställde högre krav på deltagarnas kompetens samt att de var mer fokuserade i sitt yrkesutövande. Övertagandet och omvårdnaden gick ofta bra men hade kunnat förbättras ytterligare med avdelningsanpassade ordinationer och riktlinjer. / Background: Nurses are responsible for the nursing care of patients and are expected to act adequately in both everyday and complex situations. To cope with these situations, the nurses have different tools that they can use when checking patients’ vital signs and when communicating with other nurses. Studies show that nurses feel that it is important with good communication and cooperation when patients are being transferred from intensive care to hospital wards. Aim: The aim was to describe nurses' experiences of the takeover and care of patients from an intensive care unit and also to investigate if the nurses felt that something could be improved. Method: The study was conducted as a qualitative interview study with a descriptive design. The interviews consisted of semi-structured questions and the data was analyzed using qualitative content analysis. Results: The participants experienced differences in the takeover and care of the patients and these differences were affected by the participants’ experience. A sense of insecurity, particularly among the less experienced participants, often occurred before the takeover. The participants did not experience that the care of these patients was particularly problematic but unfamiliar or difficult moments sometimes appeared. In these moments the participants were more alert and they also observed these patients more frequently. More explicit guidelines for the care, accurate prescriptions and further training were highlighted as suggestions for improvement. Conclusion: The participants of the study had varying experiences of taking over and caring for the patients from ICU. The former ICU patients were often experienced as more complex. They also demanded more care, which required more knowledge and focus from the nurses in their daily work. The takeover and the care was often good but could have been further improved with more accurate prescriptions and guidelines.

A challenge for healthcare organizations is that operational efficiency suffers from variation in production. This is because variation in healthcare is hard to predict and the methods and IT-support tools for handling variation are suboptimal. The concept of production control can be used to describe the coordination of activities so that healthcare can be delivered on time, of adequate quality and at a reasonable cost, and thus includes the use of IT-support tools to handle variation. The objective of this report is to suggest improvements for production control in hospital departments through the development of a prototype for a new IT-support tool. In order to achieve this, a case study was conducted at the pediatric oncology department at Karolinska University Hospital (KS). The case study includes observations and interviews to investigate production control at department Q84, as well as associated roles and IT-support tools. Four IT-support tools were identified at the department, two of which were used interchangeably. Due to lack of integration between these systems and the fact that one system contained data manually synchronized from the other, handling changes required double labor. An improvement suggestion is therefore presented, consisting of a prototype which demonstrates that production control can be improved by automating the maintenance of a system at the department while fulfilling the organization’s information security policy. The development of the prototype was aligned with the lean philosophy which KS strives to adopt. Through an investigation of the production system, a role for production control and associated IT-support tools at a hospital department can be identified and analyzed and through the prototyping of an IT-support tool for production control, improvements and optimizations can be made.

A challenge for healthcare organizations is that operational efficiency suffers from variation in production. This is because variation in healthcare is hard to predict and the methods and IT-support tools for handling variation are suboptimal. The concept of production control can be used to describe the coordination of activities so that healthcare can be delivered on time, of adequate quality and at a reasonable cost, and thus includes the use of IT-support tools to handle variation. The objective of this report is to suggest improvements for production control in hospital departments through the development of a prototype for a new IT-support tool. In order to achieve this, a case study was conducted at the pediatric oncology department at Karolinska University Hospital (KS). The case study includes observations and interviews to investigate production control at department Q84, as well as associated roles and IT-support tools. Four IT-support tools were identified at the department, two of which were used interchangeably. Due to lack of integration between these systems and the fact that one system contained data manually synchronized from the other, handling changes required double labor. An improvement suggestion is therefore presented, consisting of a prototype which demonstrates that production control can be improved by automating the maintenance of a system at the department while fulfilling the organization’s information security policy. The development of the prototype was aligned with the lean philosophy which KS strives to adopt. Through an investigation of the production system, a role for production control and associated IT-support tools at a hospital department can be identified and analyzed and through the prototyping of an IT-support tool for production control, improvements and optimizations can be made.