Exploring the potential of a multi-level approach to improve capability for continuous organizational improvement and learning in a Swedish healthcare region

Abstract

BackgroundEldercare and care of people with functional impairments is organized by the municipalities in Sweden. Improving care in these areas is complex, with multiple stakeholders and organizations. Appropriate strategies to develop capability for continuing organizational improvement and learning (COIL) are needed. The purpose of our study was to develop and pilot-test a flexible, multilevel approach for COIL capability building and to identify what it takes to achieve changes in key actors’ approaches to COIL. The approach, named “Sustainable Improvement and Development through Strategic and Systematic Approaches” (SIDSSA), was applied through an action-research and action-learning intervention.MethodsThe SIDSSA approach was tested in a regional research and development (R&D) unit, and in two municipalities handling care of the elderly and people with functional impairments. Our approach included a multilevel strategy, development loops of five flexible phases, and an action-learning loop. The approach was designed to support systems understanding, strategic focus, methodological practices, and change process knowledge - all of which required double-loop learning. Multiple qualitative methods, i.e., repeated interviews, process diaries, and documents, provided data for conventional content analyses.ResultsThe new approach was successfully tested on all cases and adopted and sustained by the R&D unit. Participants reported new insights and skills. The development loop facilitated a sense of coherence and control during uncertainty, improved planning and problem analysis, enhanced mapping of context and conditions, and supported problem-solving at both the individual and unit levels. The systems-level view and structured approach helped participants to explain, motivate, and implement change initiatives, especially after working more systematically with mapping, analyses, and goal setting.ConclusionsAn easily understood and generalizable model internalized by key organizational actors is an important step before more complex development models can be implemented. SIDSSA facilitated individual and group learning through action-learning and supported systems-level views and structured approaches across multiple organizational levels. Active involvement of diverse organizational functions and levels in the learning process was facilitated. However, the time frame was too short to fully test all aspects of the approach, specifically in reaching beyond the involved managers to front-line staff and patients.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3129-3) contains supplementary material, which is available to authorized users.

Aiming for quality: a global compass for national learning systems

“…Health professionals gain a deeper understanding of how their collective tasks are interdependent and impact the overall quality of health services [ 50 ]. Other common themes for promoting a culture of continuous collaboration, learning, and improvement include leadership commitment, creative problem-solving, and performance measurement [ 42 , 51 – 54 ]. The digitization of patient care facilitates real-time sharing of data and generates new knowledge for learning and improvement [ 55 ].…”

Contributions of the Simplified Competency Management Model to a Municipal Health Secretariat

“…The first stage of the SCMM also provided the institution with a description of 14 unprecedented general core competencies, which enhance the implementation of organizational goals and strategies to promote motivation, monitoring, evaluation, coordination and synchrony of efforts in different services and accelerate public management decision-making processes by sharing defined objectives ( 21 ) .…”

Sense-Making, Mutual Learning and Cognitive Shifts When Applying Systems Thinking in Public Health – Examples From Sweden Comment on "What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health"

“…These are two of many examples of visual representations that we have created together with research partners to enhance learning and shared mental models in multiple collaborative research projects over the past decades. 17,18,21 Our approach shares features with Foster-Fishman and colleagues' 27 framework for transformative systems change. In our collaborative projects we attempt to understand and visualize the different perspectives concerning the current problem situation and identify system parts and patterns to locate root causes to problems.…”