title: Getting going together: can clinical teams and managers collaborate to identify problems and initiate improvement?
abstract: A clear aim is key for the success of improvement projects, yet many fail already at this stage. We studied how clinical teams and managers at a university hospital in Sweden identified problems and defined aims as they initiated 24 process improvement projects. Categorizing and comparing problems at 3 stages of problem definition, we found that the majority of problems fell into 1 of 3 categories: information issues, poor procedures, and waiting times. Going through these stages, managers and clinical teams prioritized waiting-time problems. We show how managers can ask such teams to quickly identify problems suited for improvement projects through this step-wise, facts-based approach. We conclude that they can add their management perspective when giving specific assignments, to harness the combined benefits of both a bottom-up and a top-down approach to improvement.
authors.affiliation: Medical Management Center, Karolinska Institute, Nobels väg 15 A, S-171 77 Stockholm, Sweden. johan.thor@cmi.ki.se
authors.forename: Johan
authors.initials: J
authors.lastname: Thor
authors.forename: Bo
authors.initials: B
authors.lastname: Herrlin
authors.forename: Karin
authors.initials: K
authors.lastname: Wittlöv
authors.forename: John
authors.initials: J
authors.lastname: Skår
authors.forename: Mats
authors.initials: M
authors.lastname: Brommels
authors.forename: Olle
authors.initials: O
authors.lastname: Svensson
mesh_terms: D003299:Cooperative Behavior; D003659:Decision Making, Organizational; D006620:Hip Fractures / Q000601:surgery; D006740:Hospital Administrators; D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D007324:Institutional Management Teams / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D010865:Pilot Projects; D011340:Problem Solving; D017064:Process Assessment, Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D013548:Sweden; D014850:Waiting Lists