Is health care a special challenge to quality management? Insights from the Danderyd Hospital case.
A 10-year quality journey of a Swedish university hospital is described in this case study based on a variety of data sources. A series of quality initiatives were implemented according to total quality management (TQM) "best practice." Many projects were successful, but still a majority of those did not meet the staff's requirement of practical relevance, and they provoked scepticism toward instruments introduced and resistance to service-related quality definitions. The hospital's incentive structures did not reward an engagement in improvement activities. The findings are interpreted as demonstrating that the programs were viewed upon as part of a "management" rather than "professional" agenda, despite the underlying philosophy of TQM. It is suggested that applying professional practice development approaches to improvement initiatives might help to overcome the barrier thus created.
Striem
Jörgen
J
Danderyd University Hospital, SE-182 88, Stockholm, Sweden. Jorgen.Striem@sjl.ds.sll.se
Øvretveit
John
J
Brommels
Mats
M
D001291:Attitude of Health Personnel; D004649:Employee Incentive Plans; D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D019982:Organizational Case Studies; D009937:Organizational Objectives; D017064:Process Assessment, Health Care; D013192:Staff Development; D013548:Sweden; D017749:Total Quality Management / Q000379:methods / Q000458:organization & administration*