Background: It is required that health care professionals continuously work with patient safety and quality improvements, and the skills of registered nurses are significant in this work. However, quality improvement also requires commitment and knowledge about how to improve health care and ensure patient safety. There is a lack of studies that highlights the importance of supportive functions for this work. Nurses in clinical settings can be utilized as facilitators that make things easier for other health care professionals who are engaged in quality improvement and patient safety. In order to gain understanding about the significance and needs of nurses with a role of facilitator, it is urgent to learn from their experiences of facilitating quality improvement in health care. Aim: The aim was to study nurses’ experiences of facilitating quality improvement of nursing care, patient safety and multi-professional collaboration in health care. Method: Semi-structured qualitative interviews were performed with ten registered nurses who had experience of being in the role of facilitators. The interviews were analyzed with qualitative content analysis. Findings: In the findings, three main categories (with  a number of subcategories) were identified; raises interest for improvement, leads systematic improvement and facilitates cross-professional collaboration. The underlying meaning of these categories was explored and interpreted into three themes: encouraging others to act rather than doing for others, balancing between following and leading, and being close to reducing the fear of change. Discussion: The interviewed nurses often tended to facilitate multi-professional patient safety work with a focus on checklists, the introduction of procedures for risk assessment and monitoring of adherence to various health and safety regulations. The nurses tended less often to facilitate improvements with a focus on patient and nursing care. Facilitators can make great contributions to the clinical quality improvement work by promote for the teams to reflect on nursing content and quality, and to encourage others to act rather than do for others. Future studies about how appropriate support and enablement from the facilitators can be drafted, and how the actual process of nursing care improvement is done, are suggested. / Bakgrund: Det ställs krav på att vårdens personal fortlöpande ska verka för en god och säker vård och sjuksköterskans kompetens innebär en avgörande skillnad i detta arbete. Förbättringsarbete kräver engagemang och kunskap och för en sjuksköterska räcker det troligen inte med den professionella omvårdnadskunskapen, utan denna måste kombineras med kunskaper om hur man gör för att utveckla och förbättra vårdens innehåll. Alltför få studier lyfter fram betydelsen av stödfunktioner som kan underlätta arbetet med förbättringar av omvårdnad och patientsäkerhet. Underlättare kan vara kliniskt verksamma sjuksköterskor med uppdrag att fungera som underlättare. Det är angeläget att öka kunskapen om vilka erfarenheter de har av att underlätta för andra i förbättringsarbete för att bidra till förståelsen av den betydelse som underlättande sjuksköterskor kan ha för förbättringsarbete. Syfte: Att studera sjuksköterskors erfarenheter av att underlätta förbättringsarbete inom omvårdnad, patientsäkerhet och tvärprofessionellt samarbete. Metod: En kvalitativ ansats valdes med enskilda semistrukturerade intervjuer av tio legitimerade sjuksköterskor. För att analysera och tolka de utskrivna intervjuerna valdes kvalitativ innehållsanalys som ger möjlighet till tolkning av resultatet, på olika nivåer. Resultat: I resultatet identifierades tre kategorier (och ett antal subkategorier); väcker intresse för förbättringar, leder systematiskt förbättringsarbete och underlättar tvärprofessionellt samarbete. Den underliggandetenta meningen i dessa kategorier lyftes fram och tolkades i tre teman; uppmuntra andra att handla snarare än att göra åt andra, balansera mellan att följa och leda och vara nära för att minska rädsla för förändring. Diskussion: De intervjuade sjuksköterskorna underlättade oftast ett tvärprofessionellt patientsäkerhetsarbete med fokus på checklistor, införande av rutiner för riskbedömningar och uppföljning av följsamhet till olika hygien- och säkerhetsregler. Mer sällan underlättade sjuksköterskorna förbättringar med fokus på patienten och omvårdnaden. Underlättare kan göra stor skillnad i förbättringsarbete genom att främja teamets reflektion över omvårdnadens innehåll och kvalitet, och uppmuntra andra att handla snarare än att göra åt andra. Hur ett lämpligt stöd och möjliggörande från underlättare kan utformas liksom hur själva genomförandet av omvårdnadsförbättringar går till kan behöva undersökas i fler studier.

Background: Recent focus on quality and patient safety has underlined the need to involve patients in improving healthcare. “Experience-based Co-design” (EBCD) is an approach to capture and understand patient and staff (i. e. users) experiences, identifying so called “touch points” and then working together equally in improvement efforts. Purpose: This article elucidates patient (defined as the mother-newborn couple with next of kin) and staff experiences following improvement work carried out according to EBCD in a maternity ward and neonatal intensive care unit (NICU) in a small, acute hospital in Sweden. Method: An experience questionnaire, derived from the EBCD approach tool set, was used for continuously evaluating each event of the EBCD improvement project. Furthermore, a focus group interview with staff and in-depth interviews with mother-father couples were held in order to collect and understand the experiences of working together according to EBCD. The analysis and interpretation of the interview data was carried through using qualitative, problem-driven content analysis. Themes, categories and sub-categories presented in this study constitute the manifest and latent content of the participants’ experiences of Experience-based Co-design. Results: The analysis of the experience questionnaires, prior to the interviews, revealed mostly positive experiences of the participation. Both staff and patient participants stated generally happy, involved, safe, good and comfortable experiences following each event of the improvement project so far. Two themes emerged during the analysis of the interviews. For staff participants the improvement project was a matter of learning within the microsystem through managing practical issues, moving beyond assumptions of improvement work and gaining a new way of thinking. For patients, taking part of the improvement project was expressed as the experience of involvement in healthcare through their participation and through a sense of improving for the future. Discussion: This study confirms that, despite practical obstacles for participants, the EBCD approach to improvement work provided an opportunity for maternity ward /NICU care being explored respectfully at the experience level, by assuring the sincere sharing of useful information within the microsystem continuously, and by encouraging and supporting the equal involvement of both staff and patients. Staff and patients wanted and were able to contribute to the EBCD process of gathering information about their experiences, analyzing and responding to collected data, and engaging themselves in improving the same. Furthermore, the EBCD approach provided staff and patients the opportunity of learning within the microsystem. Nevertheless, the responsibility of the improvement work remained the responsibility of the healthcare professionals. Keywords: Quality Improvement, Maternity Care, Neonatal Intensive Care, Experience-based Co-design

Background Customer satisfaction is important for clinical microbiology laboratories and the most important service aspect is the reliability of responses. One important indicator of the quality of care is turnaround time for a sample referred to a laboratory. Aim This study describes and evaluates an improvement of the blood culture process and evaluates the staff’s experiences of the changes brought by the improvement project. Methods The blood culture process during evenings and nights was re-designed in a cooperation project between the laboratories of clinical microbiology and clinical chemistry in a mid-size Swedish county council. Typing with matrix-assisted laser desorption/ionization time of flight (MALDI ToF) and rapid antibiotic susceptibility testing were also introduced. To describe staff experi-ences semi-structured interviews were performed with twelve of the staff involved. Results The time from sampling to susceptibility testing and typing, for patients with cefotaxime resistant enterobacteriaceae, was before the improvement project on average 55 hours compared to 43 hours after closure of the project. In the qualitative content analysis four categories were found which represented the experience of the staff: patient focus, changed knowledge, cooperation and driving forces. Discussion The study of the implementation of the improvement showed that laboratory staff could handle the change well. The change from traditional biochemical typing, used for over 50 years, to MALDI ToF is indeed a paradigm shift. Nevertheless, nobody was disappointed over the fact that some of the fundamental previous microbiological laboratory work routines were laid to rest.

Background: Recent focus on quality and patient safety has underlined the need to involve patients in improving healthcare. “Experience-based Co-design” (EBCD) is an approach to capture and understand patient and staff (i. e. users) experiences, identifying so called “touch points” and then working together equally in improvement efforts. Purpose:This article elucidates patient (defined as the mother-newborn couple with next of kin) and staff experiences following improvement work carried out according to EBCD in a maternity ward and neonatal intensive care unit (NICU) in a small, acute hospital in Sweden. Method: An experience questionnaire, derived from the EBCD approach tool set, was used for continuously evaluating each event of the EBCD improvement project. Furthermore, a focus group interview with staff and in-depth interviews with mother-father couples were held in order to collect and understand the experiences of working together according to EBCD. The analysis and interpretation of the interview data was carried through using qualitative, problem-driven content analysis. Themes, categories and sub-categories presented in this study constitute the manifest and latent content of the participants’ experiences of Experience-based Co-design. Results:The analysis of the experience questionnaires, prior to the interviews, revealed mostly positive experiences of the participation. Both staff and patient participants stated generally happy, involved, safe, good and comfortable experiences following each event of the improvement project so far. Two themes emerged during the analysis of the interviews. For staff participants the improvement project was a matter of learning within the microsystem through managing practical issues, moving beyond assumptions of improvement work and gaining a new way of thinking. For patients, taking part of the improvement project was expressed as the experience of involvement in healthcare through their participation and through a sense of improving for the future. Discussion: This study confirms that, despite practical obstacles for participants, the EBCD approach to improvement work provided an opportunity for maternity ward /NICU care being explored respectfully at the experience level, by assuring the sincere sharing of useful information within the microsystem continuously, and by encouraging and supporting the equal involvement of both staff and patients. Staff and patients wanted and were able to contribute to the EBCD process of gathering information about their experiences, analyzing and responding to collected data, and engaging themselves in improving the same. Furthermore, the EBCD approach provided staff and patients the opportunity of learning within the microsystem. Nevertheless, the responsibility of the improvement work remained the responsibility of the healthcare professionals.

Syftet var att genom granskning av vetenskapliga originalartiklar undersöka patientsäkerheten vid generisk läkemedelsanvändning. Det som studerades var den eventuella problematiken, åtgärderna och patienternas egna erfarenheter av generisk användning. Den Metod som användes var en litteraturstudie där artiklar söktes i ett flertal databaser och via manuella sökningar. Sjutton artiklar inkluderades och granskades utifrån en mall för kvalitet- och resultatanalys. I Resultatet framgick att sjuksköterskor anser att osäkerhet, täta läkemedelsbyten, otydlig kommunikation, lika läkemedel till utseende och namn, samt tung arbetsbelastning är riskfaktorer som leder till medicineringsfel i form av under- och överdosering och/ eller utebliven läkemedelsdos. Patientsäkerheten påverkas även då försämrad följsamhet, biverkningar och sämre effekt är konsekvenser av generisk substitution. Åtgärder anses vara kvalificerade patient- och personal utbildningar. Tydligt uttalade ordinationer, minskat antal mediciner med lika namn och utseenden, samt dubbelkontroller och uppdatering av listor var förslag på förbättringar. Patienter hade generellt negativa attityder och erfarenheter av generika. Attityderna grundade sig främst på otrygghet och misstro. Patienter upplevde förvirring, fler eller värre biverkningar samt sämre effekt. Slutsatsen visar att det förekommer att patienter och sjuksköterskor erfar problem vid användning av generiska läkemedel och att detta får konsekvenser för patientsäkerheten. Därför bör fler problemåtgärder fastställas och tillämpas för att förhindra medicineringsfel som äventyrar patientsäkerheten.

SAMMANFATTNING Nyckelord: ApoDos, LSS, sjuksköterska, kvalitetssäkring, läkemedelsbehandling Bakgrund: I enlighet med sjuksköterskans kompetensbeskrivning och ApoDos riktlinjer, ligger ett stort ansvar på sjuksköterskan gällande uppföljning av patienters läkemedelsbehandlingar. Sjuksköterskan skall även samverka med andra aktörer i vårdkedjan och sträva efter en god informationsöverföring mellan dessa, i syfte att kvalitetssäkra vården. Syfte: Utifrån sjuksköterskans erfarenheter beskriva rutiner för uppföljning av läkemedelsbehandlingar, hos patienter med ApoDos och boende enligt LSS, samt identifiera eventuella välfungerande- och bristande rutiner. Metod: Studien har en deskriptiv design med kvalitativ ansats. Fem intervjuer genomfördes med sjuksköterskor, samtliga verksamma på LSS-boenden inom Uppsala kommun. Det inhämtade materialet analyserades enligt en reviderad version av Graneheim och Lundmans (2004) metod för innehållsanalys. Resultat: Resultatet visar att det finns vissa bristande rutiner och ett behov av bättre kommunikation samt tydligare riktlinjer för ansvarsfördelningen mellan olika aktörer vid uppföljning av patienternas läkemedelsbehandlingar. De deltagande sjuksköterskorna är dock överlag nöjda med systemet ApoDos och det finns inget som tyder på att de bristande rutinerna har ett samband med ApoDos-systemet. Konklusion: Studien visar att vissa rutiner bör ses över och omprövas samt att ett förtydligande av ansvarsfördelningen mellan sjuksköterska och läkare skulle kunna leda till förbättringar vid uppföljning av läkemedelsbehandlingar. Det krävs dock vidare studier inom området för att klarlägga ett bredare perspektiv av dessa rutiner. / ABSTRACT Keywords: multidose drug dispensing system, LSS, nurse, quality improvement, medical treatment Background: The nurse has a great responsibility regarding medical treatment follow-ups and must also seek a good interaction with other participants in the continuum of care, in order to assure the quality of care. Aim: From a nurse’s perspective describe routines for medical treatment follow-ups, regarding patients with multidose drug dispensing system and accommodations according to LSS, as well as identify possible well-functioning and deficient routines.  Method: The study has a descriptive design with qualitative approach. Five interviews were conducted with nurses, all working at accommodations according to LSS in Uppsala Municipality. The data was analyzed according to Graneheim and Lundman's (2004) method of content analysis. Results: There are some deficient routines and a need of better communication and more clear guidelines for the division of responsibilities regarding the patients’ medical treatment follow-ups. Overall, the participating nurses are content with the multidose drug dispensing system and there is nothing indicating that the deficient routines are associated with this system. Conclusions: The study shows that certain routines should be overhauled and reconsidered and that a clarification of the division of responsibilities, between nurses and doctors, could lead to improvements at medical treatment follow-ups. However, to elucidate a broader perspective of routines for medical treatment follow-ups, further studies are required.

In this study, the effect of inspection error on the product mix and quality projects selection in a manufacturing environment where rework and inspection errors exist is examined. It is assumed that the products (items) for which rework is necessary are reprocessed at a separate work center and 100% inspection is performed for the products both after rework and processing operations. Markov chain approach is used to compute yield and rework rates. In addition, nominal-the-best type of a quality loss function is used in computing quality loss due to products shipped to the customers. A linear programming (LP) model is developed to support the product mix and quality improvement project selection decisions. The use of LP model is demonstrated on an example problem. The results obtained under different experimental conditions are compared with solutions of a naive QI project selection method, improving the least capable process. The analysis shows that developed LP model is relatively better than process capability approach. Besides, according to the results obtained under different experimental conditions, the factors that have significant effect on throughput and QI project selection are being determined.

Today&rsquo / s competitive environments and heightened expectation of customers make it necessary to improve quality of products and processes continuously. Therefore, quality improvement is a major concern for companies. Determining improvement priorities for not only long but also short term bottom line results is a key problem in quality improvement management. In this thesis a practical decision matrix based method is developed for selecting quality improvement projects by considering throughput and quality loss in manufacturing environments with inspection error and rework. Performance of the proposed method under different experimental conditions is analyzed and results are discussed.

In this thesis, we study improvement of product quality in manufacturing industry by identifying and optimizing influential process variables that cause defects on the items produced. Real data provided by a manufacturing company from the metal casting industry were studied. Two well-known approaches, logistic regression and decision trees, were used to model the relationship between process variables and defect types. The approaches used were compared.

In today&lsquo / s world, knowledge is the most powerful factor for the success of the organizations. One of the most important resources to reach this knowledge is the huge data stored in their databases. In the analysis of this data, DM techniques are essentially used. In this thesis, firstly, a comprehensive literature review on DM techniques for the quality improvement in manufacturing is presented. Then one of these techniques is applied on a case study. In the case study, the customer quality perception data for driver seat quality is analyzed. Decision tree approach is implemented to identify the most influential variables on the satisfaction of customers regarding the comfort of the driver seat. Results obtained are compared to those of logistic regression analysis implemented in another study.