<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.

Patients have the potential to provide a rich source of information on both organisational aspects of safety and patient safety incidents. This project aims to develop two patient safety interventions to promote organisational learning about safety - a patient measure of organisational safety (PMOS), and a patient incident reporting tool (PIRT) - to help the NHS prevent patient safety incidents by learning more about when and why they occur. METHODS: To develop the PMOS 1) literature will be reviewed to identify similar measures and key contributory factors to error; 2) four patient focus groups will ascertain practicality and feasibility; 3) 25 patient interviews will elicit approximately 60 items across 10 domains; 4) 10 patient and clinician interviews will test acceptability and understanding. Qualitative data will be analysed using thematic content analysis.To develop the PIRT 1) individual and then combined patient and clinician focus groups will provide guidance for the development of three potential reporting tools; 2) nine wards across three hospital directorates will pilot each of the tools for three months. The best performing tool will be identified from the frequency, volume and quality of reports. The validity of both measures will be tested. 300 patients will be asked to complete the PMOS and PIRT during their stay in hospital. A sub-sample (N = 50) will complete the PMOS again one week later. Health professionals in participating wards will also be asked to complete the AHRQ safety culture questionnaire. Case notes for all patients will be reviewed. The psychometric properties of the PMOS will be assessed and a final valid and reliable version developed. Concurrent validity for the PIRT will be assessed by comparing reported incidents with those identified from case note review and the existing staff reporting scheme. In a subsequent study these tools will be used to provide information to wards/units about their priorities for patient safety. A patient panel will provide steering to the research. DISCUSSION: The PMOS and PIRT aim to provide a reliable means of eliciting patient views about patient safety. Both interventions are likely to have relevance and practical utility for all NHS hospital trusts.