ArticleBMC health services research2020
Enacting quality improvement in ten European hospitals: a dualities approach.
Article in BMC health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Entrepreneurship in care for elderly people with dementias: situated responses to NPM-based healthcare reforms in the Netherlands.BMC health services research · 2023Article
- Governance tensions in the healthcare sector: a contrasting case study in France.BMC health services research · 2022Article
- Balancing adaptation and innovation for resilience in healthcare - a metasynthesis of narratives.BMC health services research · 2021Article
- Talking about quality: how 'quality' is conceptualized in nursing homes and homecare.BMC health services research · 2021Article
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Authors and funding
7 authors.
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Abstract
backgroundHospitals undertake numerous initiatives searching to improve the quality of care they provide, but these efforts are often disappointing. Current models guiding improvement tend to undervalue the tensional nature of hospitals. Applying a dualities approach that is sensitive to tensions inherent to hospitals' quest for improved quality, this article aims to identify which organizational dualities managers should particularly pay attention to.
methodsA set of cross-national, multi-level case studies was conducted involving 383 semi-structured interviews and 803 h of non-participant observation of key meetings and shadowing of staff in ten purposively sampled hospitals in five European countries (England, the Netherlands, Portugal, Sweden, and Norway).
resultsSix dualities that describe the quest for improved quality, each embracing a seemingly contradictory feature were identified: plural consensus, distributed connectedness, orchestrated emergence, formalized fluidity, patient coreness, and cautious generativeness.
conclusionsWe advocate for a move from the usual sequential and project-based and systemic thinking about quality improvement to the development of meta-capabilities to balance the simultaneous operation of opposing ideas or concepts. Doing so will help hospital managers to deal with major challenges of change inherent to quality improvement initiatives.
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