title: Concurrent implementation of quality improvement programs.
abstract: OBJECTIVE
  Competing activities and projects can interfere with implementing new knowledge and approaches. The purpose, therefore, was to investigate processes and impact related to implementing two concurrent quality initiatives in a Swedish hospital. These were a regionally initiated, system-wide organizational learning programme called the Dynamic and Viable Organization (DVO) and a national initiative on stopping healthcare-associated and hospital-acquired infections (SHAI). Both undertakings aspired to increase staff competence in systematic improvement approaches.
  
  
  METHODS
  Multiple methods were applied including surveys, observations, interviews, process diaries, documents and organizational measurements. Respondents were unit managers, change facilitators and improvement team members.
  
  
  RESULTS
  Even though both initiatives shared the same improvement approach, there was no strong indication that they were strategically combined to benefit each other. The initiatives existed side by side with some coordination and some conflict. Despite absent management strategies to utilize the national SHAI initiative, positive developments in QI culture and communication were reported. The current study illustrates the inherent difficulties coordinating change initiatives, even in favourable circumstances.
  
  
  CONCLUSIONS
  This article addresses the lesser studied but common situation of coinciding and competing projects in organizations.
authors.affiliation: Karolinska Institutet, Medical Management Centre, Stockholm, Sweden.
authors.forename: Monica Elisabeth
authors.initials: ME
authors.lastname: Nyström
authors.forename: Rickard
authors.initials: R
authors.lastname: Garvare
authors.forename: Anna
authors.initials: A
authors.lastname: Westerlund
authors.forename: Lars
authors.initials: L
authors.lastname: Weinehall
mesh_terms: D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D004059:Diffusion of Innovation; D019538:Health Care Surveys; D006779:Hospitals, Public; D006801:Humans; D007407:Interviews as Topic; D019370:Observation; D058996:Quality Improvement / Q000458:organization & administration*; D013548:Sweden / Q000453:epidemiology
keywords: Change management; Hospital acquired infections; Implementation strategies; Organizational learning; Quality improvement