Evolution and outcomes of a quality improvement program.
OBJECTIVE
The purpose of this paper is to examine the outcomes and evolution over a five-year period of a Swedish university hospital quality improvement program in light of enduring uncertainty regarding the effectiveness of such programs in healthcare and how best to evaluate it.


METHODS
The paper takes the form of a case study, using data collected as part of the program, including quality indicators from clinical improvement projects and participants' program evaluations.


RESULTS
Overall, 58 percent of the program's projects (39/67) demonstrated success. A greater proportion of projects led by female doctors demonstrated success (91 percent, n=11) than projects led by male doctors (51 percent, n=55). Facilitators at the hospital continuously adapted the improvement methods to the local context. A lack of dedicated time for improvement efforts was the participants' biggest difficulty. The dominant benefits included an increased ability to see the "bigger picture" and the improvements achieved for patients and employees.


CONCLUSIONS
Quality measurement, which is important for conducting and evaluating improvement efforts, was weak with limited reliability. Nevertheless, the present study adds evidence about the effectiveness of healthcare improvement programs. Gender differences in improvement team leadership merit further study. Improvement program evaluation should assess the extent to which improvement methods are locally adapted and applied.


CONCLUSIONS
This case study reports the outcomes of all improvement projects undertaken in one healthcare organization over a five-year period and provides in-depth insight into an improvement program's changeable nature.
The Medical Management Centre, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden. johan.thor@ki.se
Johan
J
Thor
Bo
B
Herrlin
Karin
K
Wittlöv
John
J
Øvretveit
Mats
M
Brommels
D005260:Female; D006748:Hospital Departments / Q000458:organization & administration; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D007857:Leadership; D008297:Male; D019982:Organizational Case Studies; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D012737:Sex Factors; D013548:Sweden; D013997:Time Factors