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Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden
BACKGROUND: With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs a...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660812/ https://www.ncbi.nlm.nih.gov/pubmed/26607344 http://dx.doi.org/10.1186/s12913-015-1188-2 |
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author | Eldh, Ann Catrine Fredriksson, Mio Vengberg, Sofie Halford, Christina Wallin, Lars Dahlström, Tobias Winblad, Ulrika |
author_facet | Eldh, Ann Catrine Fredriksson, Mio Vengberg, Sofie Halford, Christina Wallin, Lars Dahlström, Tobias Winblad, Ulrika |
author_sort | Eldh, Ann Catrine |
collection | PubMed |
description | BACKGROUND: With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study. METHODS: We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR). RESULTS: In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care. CONCLUSIONS: If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-015-1188-2) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4660812 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-46608122015-11-27 Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden Eldh, Ann Catrine Fredriksson, Mio Vengberg, Sofie Halford, Christina Wallin, Lars Dahlström, Tobias Winblad, Ulrika BMC Health Serv Res Research Article BACKGROUND: With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study. METHODS: We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR). RESULTS: In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care. CONCLUSIONS: If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-015-1188-2) contains supplementary material, which is available to authorized users. BioMed Central 2015-11-25 /pmc/articles/PMC4660812/ /pubmed/26607344 http://dx.doi.org/10.1186/s12913-015-1188-2 Text en © Eldh et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Eldh, Ann Catrine Fredriksson, Mio Vengberg, Sofie Halford, Christina Wallin, Lars Dahlström, Tobias Winblad, Ulrika Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden |
title | Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden |
title_full | Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden |
title_fullStr | Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden |
title_full_unstemmed | Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden |
title_short | Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden |
title_sort | depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in sweden |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660812/ https://www.ncbi.nlm.nih.gov/pubmed/26607344 http://dx.doi.org/10.1186/s12913-015-1188-2 |
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