TY - JOUR
T1 - Context challenges the champion
T2 - improving hip fracture care in a Swedish university hospital
AU - Löfgren, Susanne
AU - Hansson, Johan
AU - Øvretveit, John
AU - Brommels, Mats
PY - 2012/2
Y1 - 2012/2
N2 - Purpose: The purpose of this paper is to describe and explain a clinician-led improvement of a hip fracture care process in a university hospital, and to assess the results and factors helping and hindering change implementation. Design/methodology/approach: The paper has a mixed methods case study design. Data collection was guided by a framework directing attention to the content and process of the change, its context and outcomes. Findings: Using a multiprofessional project team, beneficial changes in the early parts of the care process were achieved, but inability to change surgical staff work practices meant that the original goal of operating patients within 24 hours was not reached. After three years, top management introduced a hospital-wide process improvement programme, which "took over" the responsibility for improving hip fracture care. Research implications/limitations: A clear vision why change is needed and what needs to be done, which is well communicated by a respected clinical leader, can motivate personnel, but other influences are also needed to bring about change. Without a plan agreed and supported by top management, changes are likely to be limited to parts of the process and improvements to patient care may be minimal. These and other findings may be applicable to similar situations in other services. Originality/value: This case study is an illustration of both the strengths and the weaknesses of a "bottom-up, clinician-champion-led improvement initiative" in a complex university hospital.
AB - Purpose: The purpose of this paper is to describe and explain a clinician-led improvement of a hip fracture care process in a university hospital, and to assess the results and factors helping and hindering change implementation. Design/methodology/approach: The paper has a mixed methods case study design. Data collection was guided by a framework directing attention to the content and process of the change, its context and outcomes. Findings: Using a multiprofessional project team, beneficial changes in the early parts of the care process were achieved, but inability to change surgical staff work practices meant that the original goal of operating patients within 24 hours was not reached. After three years, top management introduced a hospital-wide process improvement programme, which "took over" the responsibility for improving hip fracture care. Research implications/limitations: A clear vision why change is needed and what needs to be done, which is well communicated by a respected clinical leader, can motivate personnel, but other influences are also needed to bring about change. Without a plan agreed and supported by top management, changes are likely to be limited to parts of the process and improvements to patient care may be minimal. These and other findings may be applicable to similar situations in other services. Originality/value: This case study is an illustration of both the strengths and the weaknesses of a "bottom-up, clinician-champion-led improvement initiative" in a complex university hospital.
KW - Clinical guidelines
KW - Medical schools
KW - Patient pathway
KW - Quality improvement
KW - Sweden
KW - Universities
UR - http://www.scopus.com/inward/record.url?scp=84856370324&partnerID=8YFLogxK
U2 - 10.1108/09526861211198281
DO - 10.1108/09526861211198281
M3 - Article
C2 - 22455177
AN - SCOPUS:84856370324
VL - 25
SP - 118
EP - 133
JO - International Journal of Health Care Quality Assurance
JF - International Journal of Health Care Quality Assurance
SN - 0952-6862
IS - 2
ER -