Peter Kammerlind

Swedish healthcare management practices and quality improvement work: development trends

PURPOSE The purpose of this paper is to empirically examine developmental trends in healthcare organisation management practice and improvement work. DESIGN/METHODOLOGY/APPROACH Primary healthcare centre (n = 1,031) and clinical hospital department (n = 1,542) managers were surveyed in spring 2007 (response rate 46 per cent). This article compares results from this survey with a study in 2003. A theoretical framework based on organisational inner context, organisational outer context, external environment and outcomes form the analytical base. Comparisons were made using independent two-sample t-tests. FINDINGS A general aspect, identified empirically, is the tendency toward increased external pressure on leaders in their improvement work. Higher management decisions, patient pressure and decisions made by policymakers increasingly influence and shape the choices made by healthcare managers about where to focus improvement efforts. Three different trends are empirically identified and elaborated: take-control logic; practice-based improvement; and patient-centeredness. RESEARCH LIMITATIONS/IMPLICATIONS Healthcare leaders should carefully design new management control systems that support healthcare micro systems. Findings support the general assumption that staff increasingly tend to focus organisational changes on management control. ORIGINALITY/VALUE This study extends management research with a unique survey. Through two measurements made in 2003 and 2007, several important trends about how healthcare organisations are managed and developed are identified.

Surveying improvement activities in health care on a national level--the Swedish internal collaborative strategy and its challenges.

In order to map improvement activities in Swedish health care, we surveyed the managers of all primary health care centers (n = 958) and clinical hospital departments (n = 1355), with a response rate of 46%. The majority reports that their staff view improvement work positively. The most common driver of improvement is work environment problems, whereas external drivers have less influence. Among 35 methods, the most commonly used are educational initiatives, stress management, guidelines, and leadership development, whereas accreditation is used the least. Respondents who report extensive improvement efforts indicate the greatest benefit from educational interventions, analysis of patient incidents, guidelines, and rapid cycle tests. Respondents claim that improvement initiatives yield positive results, in particular regarding the working environment, administrative routines, workflow, and communication, although only 15%–30% of respondents report having data to support their claims. Our findings indicate an introverted focus of most improvement efforts, starting with staff and administration needs. Further research is needed to understand how and why some centers and departments have managed to achieve strategic, measurable, patient-focused, systems improvements, whereas most have not.

Identification of Factors Influencing Dispersion in Split-Plot Experiments

As split-plot designs are commonly used in robust design it is important to identify factors in these designs that influence the dispersion of the response variable. In this article, the Bergman-Hynén method, developed for identification of dispersion effects in unreplicated experiments, is modified to be used in the context of split-plot experiments. The modification of the Bergman-Hynén method enables identification of factors that influence specific variance components in unreplicated two-level fractional factorial splitplot experiments. An industrial example is used to illustrate the proposed method.

Climate for Improvement and the Effects on Performance in Swedish Healthcare—a Survey in the County Council of Östergötland

In this paper, the climate for improvement in Swedish healthcare is explored via a self-assessment model. The result from a cross-sectional survey at the clinical department level in the County Council of Östergötland is presented and discussed. The underlying theoretical model consists of three parts, first a Leadership Profile Model that contains eight leadership styles. The second part concerns organizational settings based on the European model for Excellence and the Swedish Quality award model. The last part is organizational performance measured as customer and employee satisfaction. A questionnaire that covers leadership and climate for improvement has been designed and distributed to leaders at three hospitals and the Medical Laboratory units in the County Council of Östergötland. Significant positive correlations have been identified between the climate for improvement, and patient as well as employee satisfaction. These results state that clinical departments that work systematically with quality improvements have more satisfied employees and patients. The characteristics of clinical departments with a suitable climate for improvement are a focus on processes and patient involvement.

Leadership for Improvements in Swedish Health Care

In this paper, leadership in a professional and complex organization is explored via a leadership model. The Swedish Health Care System is used as the context for the suggested Leadership profile model. The Leadership profile model contains eight leadership styles that characterize different aspects of leadership. A leadership profile dominated by the leadership styles the Captain, the Strategic leader and the Team Builder characterizes leadership in the studied organizations. The result is different in comparison with results from earlier studies in private organizations. The results also indicate uniformity in leadership in the health care in Sweden with small variations between individual leaders. The leadership profile is similar for different working places, leadership levels and gender. The subordinates’ assessment of their leaders indicates the same leadership profile shape; however, with a significant difference in magnitude. A leadership dominated by the leadership styles of The Captain, The Strategic Leader and the Team Builder, indicates an effective leadership.

Design Reviews for Robustness in Product Development

Today Quality Function Deployment (QFD) is a well-known method to understand customers needs and to translate them into design attributes. This makes QFD very helpful in the product development process (PDP). This paper promotes Design Reviews (DRs) as an important part of the PDP. DR together with QFD becomes an interesting approach to achieve robustness in product development. This is especially important when product concepts are transferred between different factories, in different parts of the world, within the same company. This is illustrated with a case study in the manufacturing industry.