title: Sustaining improvement? The 20-year Jönköping quality improvement program revisited.
abstract: BACKGROUND
  There is scarce evidence of organization-wide and sustained impact of quality improvement (QI) programs in health care. For 20 years, the Jönköping County Council's (Sweden) ambitious program has attracted attention from practitioners and researchers alike.
  
  
  METHODS
  This is a follow-up case of a 2006 study of Jönköping's improvement program, triangulating data from 20 semi-structured interviews, observation and secondary analysis of internal performance data.
  
  
  RESULTS
  In 2010, clinical outcomes had clearly improved in 2 departments (pediatrics, intensive care), while process improvements were evident in many departments. In an overall index of the 20 Swedish county councils' performance, Jönköping had improved its ranking since 2006 to lead in 2010. Five key issues shaped Jönköping's improvement program since 2006: a rigorously managed succession of chief executive officer; adept management of a changing external context; clear strategic direction relating to integration; a broadened conceptualization of "quality" (incorporating clinical effectiveness, patient safety, and patient experience); and continuing investment in QI education and research. Physician involvement in formal QI initiatives had increased since 2006 but remained a challenge in 2010. A new clinical information system was being deployed but had not yet met expectations.
  
  
  CONCLUSIONS
  This study suggests that ambitious approaches can carry health care organizations beyond the sustainability threshold.
authors.affiliation: University Lyon III, France and Fédération des hôpitaux vaudois, Prilly, Switzerland (Dr Staines); Medical Management Centre, Karolinska Institutet, Stockholm, and The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Sweden (Dr Thor); and National Nursing Research Unit, King's College, London, United Kingdom (Pr. Robert).
authors.forename: Anthony
authors.initials: A
authors.lastname: Staines
authors.forename: Johan
authors.initials: J
authors.lastname: Thor
authors.forename: Glenn
authors.initials: G
authors.lastname: Robert
mesh_terms: D006801:Humans; D007256:Information Systems; D007857:Leadership; D009313:National Health Programs / Q000458:organization & administration* / Q000592:standards; D019982:Organizational Case Studies; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D019984:Quality Indicators, Health Care; D013548:Sweden