Introdução: As infecções primárias da corrente sanguínea associadas ao cateter venoso central (IPCS) são um grande problema nas unidades de terapia intensiva (UTI) pediátricas e neonatais em todo o mundo. Evidências sugerem que a prevenção das IPCSs é crucial para o atendimento seguro ao paciente. Uma percentagem significativa (65-70%) das IPCSs são evitáveis utilizando as estratégias baseadas em evidências, incluindo os bundles. Estas medidas têm um papel bem estabelecido em pacientes adultos.O objetivo deste estudo foi avaliar, a partir de uma ampla revisão sistemática da literatura, o benefício da implementação do bundle do cateter central na prevenção das IPCSs em pacientes pediátricos e neonatais internados em UTI. Métodos: Foram pesquisadas as bases de dados Cochrane Library, Medline, Latin American and Caribbean Health Science Literature (LILACS), Centre for Reviews and Dissemination (CRD), Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), além de busca manual e literatura cinzenta entre 1 de janeiro de 2005 até 31 de dezembro de 2015. Não houve restrição dos estudos com relação ao idioma, a data ou status de publicação. Para avaliar o benefício do bundle do cateter central, foram selecionados estudos envolvendo pelo menos dois componentes (higiene de mãos, precauções de barreira máxima, antissepsia da pele, seleção adequada do sítio do cateter, revisão diária da necessidade do cateter) como medida preventiva para pacientes com cateter venoso central (CVC). O desfecho foi o número de IPCSs por 1000 cateteres-dias antes e depois da implementação do bundle. Resultados: Foram identificados inicialmente 6369 estudos, após a exclusão dos títulos duplicados e os inelegíveis, 31 estudos preencheram os critérios de elegibilidade. Os estudos foram heterogêneos tanto na composição do bundle quanto na estratégia de implementação. A mediana da densidade de incidência de IPCS foi de 5.9 por 1000 cateteres-dias (2.6-23.1) nas unidades de terapia intensiva pediátricas (UTIP) e 4.9 por 1000 cateteres-dias (2.0-24.1) nas unidades de terapia intensiva neonatais (UTIN). Após a implementação do bundle do cateter central, a densidade de incidência de IPCS variou de 0 a 14.9 por 1000 cateteres-dias (mediana de 2.1) nas UTIPs e 0.3 a 13.9 (mediana de 2.8) nas UTINs. Conclusões: As IPCSs continuam sendo um problema significativo em unidades de terapia intensiva pediátricas e neonatais, mas a implementação do bundle do cateter central pode reduzir significativamente as taxas dessas infecções. Intervenções assistenciais com as melhores práticas baseadas em evidência permitem uma redução substancial das IPCSs pela promoção de grupos ou bundles de procedimentos e tecnologias, e pela utilização de uma estratégia multimodal para a educação, formação, implementação e divulgação. / Background: Central-line-associated bloodstream infections (CLABSIs) are a major problem in neonatal and pediatric intensive care units (ICUs) worldwide. Evidence suggests that CLABSI prevention is crucial for safe patient care. A significant percentage of CLABSIs (65- 70%) are preventable using evidenced-based guidelines. Strategies to prevent these infections have included a myriad of different preventive maneuvers gathered as “bundles”. These measures have a well established role in the adult ICU setting. We aimed to assess the benefit of the implementation of central-line bundles to prevent CLABSIs in neonatal and pediatric ICU patients, populations where their actual efficacy is yet to be proven. Methods: We searched Cochrane Library, Medline, Latin American and Caribbean Health Science Literature (LILACS), Centre for Reviews and Dissemination (CRD), Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), manual search and gray literature to identify studies reporting the implementation of central-line bundles in pediatric ICU (PICU), or neonatal ICU (NICU) patients. We searched for studies published between Jan 1, 2005, and December 21, 2015, without language restriction. To evaluate the benefit of the central line bundle were selected studies involving at least two components (hand hygiene, maximal barrier precautions, skin antisepsis, optimal catheter site selection and daily review of line necessity) as a preventive measure to patients with central venous catheter (CVC). The outcome was the number of CLABSIs per 1000 catheter-days before and after implementation. Results: We initially identified 6369 records, and after excluding duplicates and those ineligible, 31 studies met the eligibility criteria. The studies reviewed were quite heterogeneous both in bundle composition and implementation strategy. Median CLABSIs incidence were 5.9 per 1000 catheter-days (range 2.6–23.1) on PICUs and 4.9 per 1000 catheter-days (range 2.0–24.1) on NICUs. After implementation of central-line bundles the CLABSI incidence ranged from 0 to 14.9 per 1000 catheter-days (median 2.1) on PICUs and 0.3 to 14.9 (median 2.8) on NICUs. Conclusions: CLABSIs remain a significant problem in neonatal and pediatric critical care units, but implementation of catheter care bundles can significantly reduce rates of these infections. Best practice interventions allow substantial CLABSI reduction by promotion of groups or bundles of procedures and technology, and by use of a multimodal strategy for education, training, implementation, and dissemination.

The study identifies how different stakeholders perceive service quality improvement initiatives in public higher education institutions in Ethiopia. For this purpose, a mixed research methodology was employed. Furthermore, secondary data were collected from a variety of literature and primary data were collected from academic staff and final year students at public higher education institutions using the SERVQUAL scale and through focus group interviews. The collected data were analysed using both descriptive and inferential statistics. The research findings indicated that all dimensions of the service quality improvement initiatives were perceived by academic staff and studentsto be verypoor. The reasons for these poor or low perceptions were: the high expectationsof the stakeholders, the government’s intention to expand, lack of adequate knowledge regarding the implementation of the BPR process, the lack of motivation by service providers, poor management and the lack of good governance by the universities, inexperienced workers, non-empowered and task specific frontline employees, the low quality of the infrastructure, non-value adding hierarchical structures and approval systems, ethical problems with some service providers, the high staff turnoverand the lack of experienced staff. In addition, at all new universities, construction is underway and as a result,there are problems such as the poor state of the dormitories, classes,bathrooms, recreation areas, lounges, TV rooms, sport fields and internet connectivity, while the libraries are not well stocked with books and periodicals either. This study has recommended that the institutions should have standardised instruments that can be used to measure the status of service quality improvement and deliveryperiodically and to identify the areas that have the highest perceived performance gap scores in order to redeploy some of the resources. It also needs to be pointed out that the service providers lack sufficient knowledge and skillsconcerning the implementation of BPR, thus training is recommended in this regard.It is further recommended that for effective implementation of the BPR process, the importance of the provision of different guiding documents, continuous monitoring of activities and top management support should be kept in mind. / Educational Leadership and Management / D. Ed. (Educational Management)

I dagens samhälle vill människor bli delaktiga och få medbestämmande. Personcentrerad vård medför att sjukvårdens strävar efter att patienten involveras och vården anpassas efter dennes behov och förutsättningar. På så sätt blir vården mer jämlik och kan utföras på ett kostnadseffektivt sätt. Vid utgångsläget på studerat sjukhus utfördes mindre gynekologiska interventioner på operationsavdelningen. Processen var resurskrävande och hade låg patientdelaktighet. Patientkontrollerad sedering (PCS) betyder att patienten styr sederingen själv. På så sätt kan både patientens delaktighet och värdet i mikrosystemet öka. Förbättringsarbetet innebar att utbilda sjuksköterskor från kvinnoklinikens mottagning att erbjuda PCS självständigt utan att anestesisjuksköterskan deltar. Då skapas möjlighet att utföra vissa interventioner på mottagningen istället för på operation. Syftet med förbättringsarbetet var att öka patientens delaktighet genom att införa patientkontrollerad sedering vid gynekologiska interventioner på kvinnoklinikens mottagning, Värnamo sjukhus. Eftersom detta arbetssätt inte är vedertaget var studiens syfte var att undersöka medarbetarnas erfarenheter av att erbjuda patientkontrollerad sedering. Förbättringsarbetet utgick från Nolans förbättringsmodell och strukturen i förbättringsrampen. Värdekompassens perspektiv och mätetal användes för att belysa effekten av förändringen, både för patienten, medarbetarna och verksamheten. Studien genomfördes med kvalitativ metod med hjälp av semistrukturerad fokusgruppintervju av medarbetare på kvinnoklinikens mottagning, Värnamo Sjukhus. Förbättringsarbetet resulterade i en funktionell sederingsmetod och ett förändrat mikrosystem för kvinnor som ska genomgå gynekologiska interventioner. Förbättringsarbetet stärkte patientens delaktighet och ökade möjligheten att bli en aktiv medspelare i sin egen vård. Samtliga värdekompassens balanserade mått påvisade att arbetssättet var välfungerande, patientsäkert och uppskattat både av patienter och medarbetare. Ytterligare effekt var att medarbetarnas kompetens ökade och att samverkan mellan klinikerna förbättrades. Studien påvisade att medarbetarna upplevde att det nya arbetssättet stärkte den personcentrerade vården. Införandet av PCS upplevdes både relationsskapande, engagerande och resurskrävande. / In modern society people prefer participation and co-determination. Person-centred care leads health care to involve the patient and the care adapts to the patient´s needs and conditions. This way the care will be more equal and can be performed in a more cost-effective way. Originally gynaecological interventions were costly performed in the operating room (OR) with lack of participation. Patient- controlled sedation (PCS) means that the patient controls the sedation itself. With this the patient's participation grows and increases value in the microsystem. The Quality improvement (QI) involved to teach nurses at the out-patient clinic (OPC) to handle PCS by themselves, without an anaesthetic nurse attending. In this way some interventions could be performed in the OPC instead of in the OR. The purpose of QI was to increase patient-participation by introducing PCS during interventions at the gynaecological OPC at Värnamo hospital. The study aimed at determining the co-worker's experiences when introducing PCS. The QI started from Nolans improvement model and the structure in the improvement ramp. The value-compass and measurements were used to evaluate the effects of the changes. The study was performed in a qualitative method with inductive approach using focus-group interview with co-workers at the gynaecological OPC. By introducing PCS in the QI women became participants in the gynaecological OPC. The QI resulted in that more interventions could safely be performed in the OPC. The new procedure makes the patient an active co-player, the competence of the co-workers rises, the collaboration between the clinics grows and the care is performed at the right level of care.  The study showed that the co-workers experienced increased patient-centered care. The QI built relationships, was engaging and demanding resources.

Delaktighet är en mänsklig rättighet och är ett centralt begrepp inom funktionshindverksamheter. Brukare har rätt att utifrån sina förutsättningar leva ett självständigt liv med hög delaktighet enligt lagen om stöd och service till vissa funktionshindrade (LSS). I LSS och de nationella målen för funktionshinderpolitiken används uttrycket full delaktighet. Personer som har ett beslut om bostad med särskild service enligt LSS skall vara delaktiga i det stöd som planers. Genomförandeplaner skall upprättas ur ett jämlikhetsperspektiv och utgå från individens behov. Bristande delaktighet i planering, genomförande och uppföljning riskerar brukarnas möjligheter till ett självständigt liv. Syftet med förbättringsarbetet var att skapa öppningar och möjligheter för brukarnas delaktighet i utformningen av sina insatser genom att tillsammans med personal använda och utveckla befintliga arbetsmetoder. Studiens syfte var att utforska nivåer av delaktighet som uppnås och hur de kan förstås utifrån Shiers delaktighetsmodell. Förbättringsarbetet genomfördes med stöd av förbättringsverktyg såsom Nolans förbättringsmodell, PDSA-hjul, fiskbensdiagram och 6P. Studien av förbättringsarbetet var en kvalitativ fallstudie. Fokusgruppsintervjuer har utförts och data analyserats med kvalitativ innehållsanalys med deduktiv ansats. Den teoretiska referensramen utgick ifrån Shiers delaktighetsmodell (2001). Förbättringsarbetet resulterade i att alla brukare var delaktiga i sin egen genomförandeplanering och därmed vid sista mättillfället hade en korrekt, individanpassad och uppdaterad genomförandeplan. Att införa veckosamtal som en del av genomförandeplaneringen fungerade för vissa brukare, men inte alla.Resultatet från studien visar att brukare och personal anser att brukarna är mer delaktiga än tidigare och att förbättringsarbetet bidragit till fler öppningar och möjligheter. Dessa öppningar handlar om att personalen lyssnar till brukarna och tar tillvara deras erfarenheter för att utforma insatserna. En slutsats är att förbättringskunskap i kombination med delaktighetsmodellen fungerade för att göra brukaren till en aktiv medskapare av sin egen vardag och mindre av en passiv mottagare av insatser. En annan slutsats är att de nya arbetssätten fungerade olika bra beroende på brukarens kommunikationsförmåga. / ” From receiver to co-creator” To increase user participation in assisted living facilities for adults through improved individual plan.  Participation is a human right and a central breakthrough in disability policy. Persons who have a decision on housing with special services according to LSS law must be involved in the support that is planned. Individual plan must be drawn up from an equality perspective and be based on the individual's needs. Lack of participation in planning and follow-up risks users’ opportunities for an independent life.The purpose of the improvement work was to create openings and opportunities for users' participation in the design of their efforts by using and developing existing working methods together with staff. The purpose of the study was to explore levels of participation that are achieved and how they can be understood based on the participation model.The improvement work was carried out with the support of improvement tools such as Nolan's improvement model, PDSA, program theory, the Ishikawa diagram and 6P. The study of the improvement work was a qualitative case study. Focus group interviews were conducted, and data were analyzed with qualitative content analysis with a deductive approach. The theoretical frame of reference was based on Shier’s participation model (2001).The results from the study show that users and staff believe that users are involved in many ways and that the improvement work has contributed to more openings and opportunities.One conclusion is that improvement knowledge in combination with the participation model was a working tool for making the user more of an active co-creator in their own everyday life and less of a passive recipient of contributions. Another conclusion is that the new working methods worked differently depending on the user's functional ability.

På grund av en ständigt föränderlig miljö där kundernas behov, krav och förväntningar varierar allt mer kan företag påfrestas gällande att bemöta dessa. Ett resultat av denna trend kan återspeglas i nya tekniska lösningar samt effektiviseringar i både produkter och tjänster. Detta medför en ökad konkurrens och därför blir kvalitetsutveckling en viktig del av effektiviseringsarbetet. Det finns ett stort fokus på kvalitetssäkring i syfte att öka konkurrensfördelar och stärka företags varumärke. Det finns dock ett stort utrymme för effektiviseringar av kvalitetsarbetet i tillverkande företag. Företag kan exempelvis utnyttja olika förbättringsverktyg och hjälpmedel i förbättringsarbetet exempelvis Sex Sigma, Lean, Orsaks-verkan-diagram samt feleffektsanalys.     Syftet med studien är att undersöka och kartlägga kvalitetssäkringsarbetet gällande utgående gods i ett tillverkande företag för att sedan presentera förbättringsförslag.     Det har genomförts en fallstudie på hissföretaget Cibes Lift Group AB. Den valda forskningsmetoden för studien är en kvalitativ fallstudie grundad på primär- och sekundärdata. Jag valde detta främst på grund av att det fanns ett behov av att samla så mycket information som möjligt för att öka min förståelse samt studiens trovärdighet.    Studiens resultat visualiserar att Cibes Lift Group AB arbetar förebyggande med kvalitetssäkring då checklistor används vilka innehåller ett antal krav som bör vara uppfyllda innan godset skickas ut till kunderna. Däremot finns det flertalet förbättringsverktyg och hjälpmedel som företaget inte tillämpar, exempelvis Sex Sigma, Orsaks-verkan-diagram, feleffektsanalys och så vidare. Således finns det mycket förbättringspotential i företagets kvalitetssäkringsarbete men även i det övriga kvalitetsarbetet. / Due to an ever-changing environment where customers' needs, requirements and expectations vary more and more, companies can be pressured to meet these. A result of this trend can be reflected in new technical solutions as well as efficiencies in both products and services. This entails increased competition and therefore quality development becomes an important part of the efficiency work. There is a strong focus on quality assurance in order to increase competitive advantages and strengthen companies' brands. However, there is a great deal of room for streamlining the quality work in manufacturing companies. Companies can use various improvement tools in the improvement work, for example Six Sigma, Lean, Cause-and-effect-diagrams and Failure mode and effect analysis. The purpose of the study is to investigate and map the quality assurance work regarding outgoing goods in a manufacturing company and then present improvement proposals. A case study has been carried out at the elevator company Cibes Lift Group AB. The chosen research method for the study is a qualitative case study based on primary and secondary data.  The results of the study visualize that Cibes Lift Group AB works preventively with quality assurance when checklists are used which contain a number of requirements that should be met before the goods are sent out to the customers. However, there are many improvement tools that the company does not apply, such as Six Sigma, Cause-and-effect-diagrams, Failure mode and effect analysis and so on. Thus, there is a lot of potential for improvement in the company's quality assurance work but also in the other quality work.

This thesis recounts my personal experience working as a volunteer medical interpreter for the Language and Culture Resource Center at East Tennessee State University. The result of my time spent volunteering as a medical interpreter, shadowing professional medical interpreters, and witnessing patient-provider interactions during interpreted sessions was an inspiration to study medical interpretation further and delve into the challenges faced by patients who require medical interpreters. During my time researching this topic, I found that the United States is severely lacking in Spanish medical interpreters—with some healthcare facilities employing no medical interpreters—even though the size of the Hispanic population is on the rise. I also found that the language and cultural barriers to the Hispanic population receiving quality healthcare are a significant reason why the Hispanic population reports a lower satisfaction with U.S. healthcare. Through years of observation and practice, I developed research questions to help guide one in discovering what areas the Hispanic population is least satisfied with in healthcare. To discern what those areas of the greatest dissatisfaction are exactly, this research study manifests in the creation of a survey designed to improve the quality of healthcare received by the Hispanic population of Northeast Tennessee by identifying some of the principal issues faced by the Hispanic population within the U.S. healthcare system. The goal of this thesis is to highlight these issues as areas of focus for healthcare providers when they care for patients specifically in interpreted appointments.

Les modèles conceptuels (MC) jouent un rôle crucial qui est celui de servir de base à l’ensemble du processus de développement d’un système d’information (SI) mais aussi de moyen de communication à la fois au sein de l’équipe de développement et avec les utilisateurs durant les premières étapes de validation. Leur qualité joue par conséquent un rôle déterminant dans le succès du système final. Des études ont montré que la majeure partie des changements que subit un SI concerne des manques ou des défaillances liés aux fonctionnalités attendues. Sachant que la définition de ses fonctionnalités incombe à la phase de l’analyse et conception dont les MC constituent les livrables, il apparaît indispensable pour une méthode de conception de veiller à la qualité des MC qu’elle produit. Notre approche vise les problèmes liés à la qualité de la modélisation conceptuelle en proposant une solution intégrée au processus de développement qui à l’avantage d’être complète puisqu’elle adresse à la fois la mesure de la qualité ainsi que son amélioration. La proposition couvre les aspects suivants: i. Formulation de critères de qualité en fédérant dans un premier temps les travaux existant sur la qualité des MC. En effet, un des manques constaté dans le domaine de la qualité des MC est l’absence de consensus sur les concepts et leurs définitions. Ce travail a été validé par une étude empirique. Ce travail a également permis d’identifier les parties non couverte par la littérature et de les compléter en proposant de nouveaux concepts ou en précisant ceux dont la définition n’était complète. ii. Définition d’un concept (pattern de qualité) permettant de capitaliser les bonnes pratiques dans le domaine de la mesure et de l’amélioration de la qualité des MC. Un pattern de qualité sert à aider un concepteur de SI dans l’identification des critères de qualité applicables à sa spécification, puis de le guider progressivement dans la mesure de la qualité ainsi que dans son amélioration. Sachant que la plupart des approches existantes s’intéresse à la mesure de la qualité et néglige les moyens de la corriger. La définition de ce concept est motivée par la difficulté et le degré d’expertise important qu’exige la gestion de la qualité surtout au niveau conceptuel où le logiciel fini n’est pas encore disponible et face à la diversité des concepts de qualité (critères et métriques) pouvant s’appliquer. iii. Formulation d’une méthode orientée qualité incluant à la fois des concepts, des guides et des techniques permettant de définir les concepts de qualité souhaités, leur mesure et l’amélioration de la qualité des MC. Cette méthode propose comme point d’entrée le besoin de qualité que doit formuler le concepteur. Il est ensuite guidée de manière flexible dans le choix des critères de qualité adaptés jusqu’à la mesure et la proposition de recommandations aidant à l’amélioration de la qualité du MC initial conformément au besoin formulé. iv. Développement d'un prototype "CM-Quality". Notre prototype met en œuvre la méthode proposée et offre ainsi une aide outillé à son application. Nous avons enfin mené deux expérimentations ; la première avait comme objectif de valider les concepts de qualité utilisés et de les retenir. La deuxième visait à valider la méthode de conception guidée par la qualité proposée / Conceptual models (CM) serve as the blueprints of information systems and their quality plays decisive role in the success of the end system. It has been witnessed that majority of the IS change-requests result due to deficient functionalities in the information systems. Therefore, a good analysis and design method should ensure that CM are correct and complete, as they are the communicating mediator between the users and the development team. Our approach targets the problems related to conceptual modeling quality by proposing a comprehensive solution. We designed multiple artifacts for different aspects of CM quality. These artifacts include the following: i. Formulation of comprehensive quality criteria (quality attributes, metrics, etc.) by federating the existing quality frameworks and identifying the quality criteria for gray areas. Most of the existing literature on CM quality evaluation represents disparate and autonomous quality frameworks proposing non-converging solutions. Thus, we synthesized (existing concepts proposed by researchers) and added the new concepts to formulate a comprehensive quality approach for conceptual models that also resulted in federating the existing quality frameworks. ii. Formulation of quality patterns to encapsulate past-experiences and good practices as the selection of relevant quality criteria (including quality attributes and metrics) with respect to a particular requirement (or goal) remains trickier for a non-expert user. These quality patterns encapsulate valuable knowledge in the form of established and better solutions to resolve quality problems in CM. iii. Designing of the guided quality driven process encompassing methods and techniques to evaluate and improve the conceptual models with respect to a specific user requirement or goal. Our process guides the user in formulating the desired quality goal, helps him/her in identifying the relevant quality patterns or quality attributes with respect to the quality goal and finally the process helps in evaluating the quality of the model and propose relevant recommendations for improvement. iv. Development of a software prototype “CM-Quality”. Our prototype implements all the above mentioned artifacts and proposes a workflow enabling its users to evaluate and improve CMs efficiently and effectively. We conducted a survey to validate the selection of the quality attributes through the above mentioned federating activity and also conducted three step detailed experiment to evaluate the efficacy and efficiency of our overall approach and proposed artifacts.

Between 2013 and 2016, 8.1% of U.S. adults 20 years and older suffered from depression, but only 29% of them sought help. This project addressed the low depression screening rate in a Federally Qualified Health Center (FQHC) that supported integrated care. The purpose of the project was to evaluate the integration of behavioral health into primary care in an FQHC through the rate of depression screenings. Two theoretical frameworks, the find-organize-clarify-understand-select/plan-do-study-act model and the Centers for Disease Control and Prevention's framework for program evaluation in public health were combined into a list of questions and data validity tests that were used to conduct the evaluation. This quality improvement (QI) project evaluated an existing QI initiative. Findings revealed that 75% of the patients seen, and not the initially reported 53%, received depression screenings, which indicated an improved outcome. Other findings were inadequate use of theoretical frameworks, poor data quality, and suboptimal effectiveness of QI team processes. The strategies and tools recommended in this project could be used by organizational leaders and QI teams to evaluate and improve QI initiatives. The project's contribution to awareness about depression through integrated care could increase patients' access to care, quality of life, and life expectancy, and positively impact social change.

Dagens hälso- och sjukvård är komplex och i konstant förändring, detta kräver att medarbetare och ledare ständigt arbetar med förbättringar, både för att kvalitetssäkra vården men också för att hushålla med begränsade resurser av såväl personal som ekonomi. För att lyckas med förbättringsarbete krävs medvetenhet och ett engagemang av hela organisationen, för att tillsammans skapa förutsättningar för ständiga förbättringar. Syftet med denna studie var att undersöka hur ständiga förbättringar bedrivs, samt vilka förutsättningar som finns för att driva förbättringsarbete enligt medarbetare och ledare inom hälso- och sjukvård. För att uppfylla studien syfte gjordes en kvalitativ fallstudie och datainsamlingen bestod av en enkätundersökning till samtliga medarbetare samt en intervjustudie där semistrukturerade intervjuer genomfördes med samtliga enhetschefer samt ett antal medarbetare inom den studerade organisationen. Resultatet analyserades genom en tematisk analys, baserade på 74 insamlade enkätsvar och totalt 10 intervjuer och presenterades utifrån sex teman med tillhörande subteman, totalt 27 stycken. Studiens teman utgjordes av att driva förbättringsarbete, att vara en engagerad ledare, motivation till förändring, hinder för förbättringsarbete, framgångsfaktorer för förbättringsarbete och att motverka förändringsmotstånd. Studiens resultat visar att motivationen och viljan till att utveckla, förändra och förbättra är påtaglig hos både medarbetare och enhetschefer. Men förbättringsarbetet förhindras av brist av ekonomiska resurser, avsaknad av helhetssyn, brist på kompetens inom förbättringsområdet samt otillräckliga personalresurser. Detta bidrar till att förbättringsarbetet inom den studerade organisationen inte drivs i holistiskt samförstånd. / Today’s healthcare is complex and under constant change. It requires employees and leaders to continuously works with improvement to ensure the quality of care and make the limited resources last, regarding both finance and staff. To succeed with this continuous drive for quality improvement, the same awareness and level of engagement must be shared across the whole organization. This study aimed to explore how employees and leaders in healthcare are executing these continuous improvements alongside the available prerequisites. To fulfill the studys aim, a qualitative casestudy was conducted and the data was collected with a survey circulated to all members of staff and an semi-structured interview study with all first- line managers and a few employees of the studied organization. The results were analyzed through a thematic evaluation of the 74 survey replies and the 10 interviews. It was presented as 6 themes with 27 associated subthemes. The results formed the themes; Driving Quality Improvement, Being an Engaged Leader, Motivation for Change, Quality Improvement Obstacles, Improvement Success Criteria and Change Resistance Avoidance. The result of the study shows that employees and first-line managers alike share a willingness and motivation for development, change and improvement. But this is hampered by a lack of economic resources, holistic views, improvement competence and staff. This contributes to why the improvement work is not operated holistically, with consensus. / <p>2022-06-05</p>

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