title: Quality improvement in large healthcare organizations.
abstract: OBJECTIVE
  The purpose of this paper is to investigate the obstacles and challenges associated with organizational monitoring and follow-up (M & F) processes related to health care quality improvement (QI) and development.
  
  
  METHODS
  A longitudinal case study of a large health care organization during a system-wide QI intervention. Content analysis was conducted of repeated interviews with key actors and archival data collected over a period of four years.
  
  
  RESULTS
  The demand for improved M & F strategies, and what and how to monitor were described by the respondents. Obstacles and challenges for achieving M & F strategies that enables system-wide and coherent development were found in three areas: monitoring, processing, and feedback and communication. Also overarching challenges were found.
  
  
  CONCLUSIONS
  A model of important aspects of M & F systems is presented that can be used for analysis and planning and contribute to shared cognition of such systems. Approaches for systematic analysis and follow-up of identified problems have to be developed and fully incorporated in the organization's measurement systems. A systematic M & F needs analytic and process-oriented competence, and this study highlights the potential in an organizational function with capacity and mandate for such tasks.
  
  
  CONCLUSIONS
  Most health care systems are flooded with a vast amount of registers, records, and measurements. A key issue is how such data can be processed and refined to reflect the needs and the development process of the health care system and how rich data can be used for improvement purposes. This study presents key organizational actor's view on important factors to consider when building a coherent organizational M & F strategy.
authors.affiliation: Department of Public Health and Clinical Medicine; Epidemiology and Global Health, Umeå University, Umeå, Sweden and Department of Learning, Informatics, Management and Ethics; Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Höög
authors.forename: Jack
authors.initials: J
authors.lastname: Lysholm
authors.forename: Rickard
authors.initials: R
authors.lastname: Garvare
authors.forename: Lars
authors.initials: L
authors.lastname: Weinehall
authors.forename: Monica Elisabeth
authors.initials: ME
authors.lastname: Nyström
mesh_terms: D000288:Administrative Personnel / Q000523:psychology; D003695:Delivery of Health Care / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D019982:Organizational Case Studies; D036301:Qualitative Research; D058996:Quality Improvement; D013548:Sweden
keywords: Change management; Monitoring and follow-up; Organizational development; Quality improvement