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Purpose - In this research, hospitals with varying type, size and operational characteristics are grouped into distinct strategic groups. The competitive methods emphasised by these groups are studied. Also, the extent of effective implementation of quality improvement tools is examined. The purpose of this paper is to discuss these issues. Design/methodology/approach - Utilizing a sample of 109 hospitals, cluster analysis is used to accomplish the objective of this study. Findings - Four strategic groups of hospitals were identified. These groups tended to emphasize different competitive methods and quality improvement efforts implementation profiles. Research limitations/implications - The findings of this study have important implications for the relationship between operational performance and strategic effectiveness in a hospital operational environment. Practical implications - The findings of this research tend to emphasize the importance of patient's service and satisfaction to strategic effectiveness. Also, the findings stress the importance of clinical effectiveness at the operational level. Originality/value - This study empirically examines operational and strategic performance-related issues in a hospital operational environment.

This presentation will feature real world implementation examples from a seasoned interprofessional team working in a high needs primary care clinic. In Part 1 of our session (approx. 30 minutes), we will define implementation science and familiarize the audience with the EPIS framework (Aarons, Hurlburt, & Horwitz, 2011). We will also describe champion teams as a practical and efficient way to conduct implementation science on the clinic level. Part 2 of our session (approx. 30 min) will be dedicated to translating concepts learned in Part 1 to audience members' personal work via individual worksheets, small and large group discussion, and a question and answer period. Additionally, participants will gain access to an electronic toolkit with relevant articles, worksheets and materials to and build on ideas generated during the session and support their project implementation after the conference.

Ensuring adequate and timely follow-up is one of the essential parts of providing good patient care in a primary care setting. If the next visit is not scheduled prior to a patient leaving the clinic, it often results in them being “lost to follow-up.” This results in inadequate care, delays in treatment, and increased burden of disease. Using the currently available scheduling mechanism in our EHR is a tedious and time-consuming process that makes it difficult to arrange for follow up visits prior to the patient arriving at the checkout window after they leave the exam room. This often resulted in no appointment being scheduled at all or one much later than the provider intended. Our proposed solution to this problem was to replace the electronic scheduling mechanism with small paper “follow-up cards” that patients are given to take to the checkout desk with them. We implemented this new process in our clinic for a 3-month period and evaluated resident satisfaction with follow-up and checkout procedures before and after the change. We found that residents preferred using the card system because they felt it improved their workflow in clinic and improved efficiency of scheduling follow up visits. Given the positive reviews, it was decided to implement the follow up cards as a permanent mechanism for scheduling appointments in our clinic until a more efficient electronic system can be arranged.

Most physical rehabilitation services are not person-centered. Occupational therapy practitioners (OTPs) are vested in person-centered approaches, thereby they are optimally positioned to take leading roles in these quality improvement (QI) activities. Yet, there is a lack of OTPs-led QI activities on person-centered rehabilitation, and seminally, a lack of a QI guide informing these activities. To shape the evidence- and theory-based QI guide, we engaged a small international sample (n= 8) of potential end-users, i.e., OTPs in practice or management roles. The process involved three rounds of mixed-methods surveys, which helped in the design, refinement, and preliminary evaluation of the QI guide. Informed by theory, evidence and participants’ feedback, the final guide followed a “why, what, and how” structure. Six out of the eight participants rated the QI guide as one they are “very likely” to use. Also, the median rated value of the guide was “9” in a “0-10” scale. The QI was also well appraised by being an all-in-one resource to enable OTPs close the gap in person-centered rehabilitation practices and its improvement. The final version of the QI guide is ready to use and freely available in the Open Science Framework platform: http://osf.io/xzgpe/.

Yes / Despite many benefits offered by Health Information Technology (HIT) systems, new technology brings new and unforeseen risks to healthcare quality and patient safety if they're not properly planned, designed, implemented, and managed. This study examined health information technology-related (HIT) incidents to identify patient details-related issues, their association with contributing factors, and outcomes. Sources of information comprised retrospectively collected incident reports (n = 95) using two sampling methods, i.e., purposive and snowball sampling. The incident reports were analyzed using both the inductive method (thematic analysis) and the deductive approach using an existing framework, i.e., the International Classification for Patient Safety. The studies identified 90 incidents with 120 patient details-related issues-categorized as either information-related (48%) or documentation-related (52%) problems; around two-thirds of the 120 issues were characterized by human factors. Of the total sample, 87 contributing factors were identified, of which "medical device/system" (45%) and "documentation" (20%) were the most common contributing factors. Of 90 incidents, more than half (59%) comprised patient-related outcomes-patient inconvenience (47%) and patient harm (12%) and the remaining 41% (n = 37) included staff or organization-related outcomes. More than half of the incidents resulted in patient-related outcomes, namely patient inconvenience and patient harm, including disease risks, severe health deterioration, injury, and even patient death. Incidents associated with patient details can cause deleterious effects; therefore, characterizing them should be a routine part of clinical practice to improve the constantly changing healthcare system. / A publishing grant has been received from Linnaeus University as a part of the University Library’s research support.

An inspection approach is proposed for improving the quality of conceptual models developed in a domain specific notation. First, the process of identification of desirable properties of conceptual models in a domain specific notation is described. Intra- and interview properties are considered. Semantic properties are defined considering the conceptual modeling notation. A systematic inspection process is proposed for checking semantic properties of different types of diagrams and of the relations between these diagrams. This process is applied to two real mission space conceptual models. With the proposed inspection approach, it is possible to identify subtle semantic issues which are not identified by many of the contemporary UML CASE tools and other inspection methods.

This study aimed to explore existing quality improvement activities in primary health care setting in South Africa. Two sets of questionnaires were used to collect data from both patients and nurse managers. Findings indicated that clinics were generally acceptable and affordable to patients, but should operate for longer time-periods, that sorting of patients and long waiting times, coupled with short consultation time-periods, warranted immediate remedial actions. Only five of the fourteen listed quality initiatives were satisfactorily practised. It was concluded that despite many obstacles and difficulties as mentioned by respondents, the issue of quality-improvement in primary health care is receiving attention, but should still be improved to a greater extent. / Health Studies / M.A. (Advanced Nursing Sciences)

This study aimed to explore existing quality improvement activities in primary health care setting in South Africa. Two sets of questionnaires were used to collect data from both patients and nurse managers. Findings indicated that clinics were generally acceptable and affordable to patients, but should operate for longer time-periods, that sorting of patients and long waiting times, coupled with short consultation time-periods, warranted immediate remedial actions. Only five of the fourteen listed quality initiatives were satisfactorily practised. It was concluded that despite many obstacles and difficulties as mentioned by respondents, the issue of quality-improvement in primary health care is receiving attention, but should still be improved to a greater extent. / Health Studies / M.A. (Advanced Nursing Sciences)

Bakgrund: Kvalitetsutveckling inom vården pågår i hela världen. Internationell forskning indikerar att förbättringscoacher kan vara en framgångsfaktor i förbättringsarbetet. Det är i dag oklart hur man kan utveckla interna coacher till att stödja kontinuerliga förbättringar. Studien utvärderar ett lokalt, tvärprofessionellt coachprogam inom vård och omsorg i ett geografiskt område i Sverige med en etablerad samverkanskultur. För att främja ökad kundcentrering ingick en pensionär i programmets planeringsgrupp. Deltagarna introducerades i grundläggande förbättringskunskap och i lösningsfokuserat arbetssätt som ett sätt att bättre kunna hantera komplexiteten i vård och omsorg. Programmet utformades med åtta gemensamma träffar under perioden mars till oktober 2011.   Syfte: Att identifiera faktorer i ett lokalt coachprogram som framstår som mest väsentliga för att medarbetare i vård och omsorg ska kunna gå in i rollen som förbättringscoacher. Metod: Studien är en observerande fallstudie med inslag av aktionsforskning och en induktiv kvalitativ ansats. Deltagare i studien var blivande coacher, pensionärer, planeringsgruppen och erfarna coacher. Sju semistrukturerade intervjuer med totalt 17 personer genomfördes, samt analys av lokala dokument och fyra enkäter. Data analyserades genom en manifest kvalitativ innehållsanalys och triangulering. Resultatet validerades av samtliga deltagare i studien. Resultat: Involvering av pensionärer ansågs vara en viktig faktor eftersom det förstärkte kundfokuseringen. Deltagarna i studien poängterade att kundfokus, ett lösningsfokuserat förhållningssätt, nätverk och systemförståelse var grundläggande för utvecklingen av coachrollen. Dessa faktorer bedömdes som viktigare än de specifika förbättringsverktygen. Diskussion: De mest väsentliga faktorerna kan delas in i det som uppmuntrade till idéer, vilja, görande och uthållighet. Pensionärsinvolveringen förstärkte kundfokuseringen, och det lösningsfokuserade arbetssättet framstod som ett bra komplement till de sedvanliga förbättringsverktygen. Det vore intressant att jämföra detta program med förbättringsprogram i andra kontexter. / Background: Internal improvement coaches can support quality improvement efforts. The study is about a local interprofessional coach training program in a region in Sweden with an established culture of collaboration. The program included participants from different health care disciplines and was organized over eight days between March and October 2011. A senior citizen was involved in faculty and participated during all training sessions. The participants were introduced to basic improvement knowledge and a solution focused approach.Purpose: To explore essential elements of a local coach training program and what appears to be crucial in moving into the role of being an improvement coach.Method: The study is a mix methods case study with elements of action research and an inductive qualitative approach. Participants in the study were prospective coaches, senior citizens, the program team, and experienced coaches. Data were collected through seven semi-structured group interview sessions with a total of 17 individuals, document analysis and 4 questionnaires. Data were analyzed using a manifest content analysis and triangulation. The results were validated by all participants in the study.Results: The data suggest that the involvement of a senior citizen was essential for strengthening customer focus. Participants in the study pointed out that customer focus, developing a value base, networking skills with a solution focused approach and systems thinking were fundamental to the development of the coaching role. These factors were assessed as more important than improvement tools.Discussion: The results can be divided into those which encouraged ideas, will, execution, and endurance. Senior citizen involvement enhanced customer focus and the solution-focused approach seems to be a valuable addition to the usual improvement tools. It would be interesting to compare this program with other improvement programs or in other contexts.