Healthcare quality improvement work: a professional employee perspective

Abstract

Purpose The purpose of this paper is to describe and analyze conditions that influence how employees engage in healthcare quality improvement (QI) work. Design/methodology/approach Qualitative case study based on interviews ( n=27) and observations ( n=10). Findings The main conditions that influence how employees engage in healthcare QI work are professions, work structures and working relationships. These conditions can both prevent and facilitate healthcare QI. Professions and work structures may cement existing institutional logics and thus prevent employees from engaging in healthcare QI work. However, attempts to align QI with professional logics, together with work structures that empower employees, can make these conditions increase employee engagement, which can be accomplished through positive working relationships that foster institutional work, which bridge different competing institutional logics, making it possible to overcome barriers that professions and work structures may constitute. Practical implications Understanding the conditions that influence how employees engage in healthcare QI work will make initiatives more likely to succeed. Originality/value Healthcare QI has mainly been studied from an implementer perspective, and employees have either been neglected or seen as passive resisters. Weak employee perspectives make healthcare QI research incomplete. In our research, healthcare QI work is studied closely at the actor level to understand healthcare QI from an employee perspective.

The role of professional logics in quality register use: a realist evaluation

“…The problem is that the NQR programme did not bridge this chasm. This finding is corroborated by other studies of professional work, where work structures create barriers for bridging different competing logics [17].…”

A New Professional Landscape: Entangled Institutional Logics in Two Swedish Welfare Professions

“…Even if quality control enabled other actors to challenge the autonomy of physicians (Hasselbladh & Bejerot 2017), this change has not come easily. Although most Swedish hospitals work with quality development based on improvement science from the manufacturing industry (Bergman et al 2015), with concepts such as lean production (Eriksson et al 2016) and process design (Hellström et al 2010), they are met with skepticism from the medical profession (Gadolin & Andersson 2017). Managers' and consultants' improvement efforts generally have a difficult time gaining traction if physicians are not involved.…”

“Navigation to prioritizing the patient” – first-line nurse managers’ experiences of participating in a quality improvement collaborative

“…The FLNMs emphasized that continuous improvement depends on how the staff are able to carry this out, and how, as leaders, the FLNMs can prepare the way for the staff. The perceived trust in employee competence has shown to be a prerequisite for creating constructive working relationships between managers and employees, and thus positive attitudes towards and involvement in QI work [21]. The FLNMs in this study established security for the staff to providing good care.…”

“…These statements may be related to the self-development of this QIC and the voluntary involvement, and the teaching in the general topics of improvement strategies. Several studies report that employees show restraint and consider the QI work to be useless if they feel forced to take part in it [2,4,9,21]. Other studies confirm that positive relationships and aligning QI work with professional logic [22], in conjunction with work structures that empower employees [13], influence how employees engage in QI work.…”

“…Successful improvement interventions seem to be related to the strength of the supporting evidence base of the topic, the simplicity and practicality of the intervention components, and contextual factors [11]. Generally, relationships that foster institutional work, and aligning QI work with professional logic, together with work structures that empower employees, may influence how employees engage in QI work [21]. It is suggested that more often the reason nurses and doctors get involved in QI work, it is because the work is aligned with what they perceive to be important [22].…”