ArticleBMJ open2020
Hospital managers' perspectives with implementing quality improvement measures and a new regulatory framework: a qualitative case study.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Expert narrative review on the impact of value-based healthcare on medical quality and patient safety system restructuring.BMC health services research · 2026Pooled it
- Better & systematic trauma care (BEST) in Norway: from a local quality improvement project to a national collaborative.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Hospital managers' experiences of conducting a root cause analysis: a case study following a sentinel event.Frontiers in health services · 2025Article
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- Influence of external assessment on quality and safety in surgery: a qualitative study of surgeons' perspectives.BMJ open quality · 2024Article
- External inspection approaches and involvement of stakeholders' views in inspection following serious incidents - a qualitative mixed methods study from the perspectives of regulatory inspectors.BMC health services research · 2024Article
- Managing patient safety and staff safety in nursing homes: exploring how leaders of nursing homes negotiate their dual responsibilities-a case study.Frontiers in health services · 2024Article
- Team experiences of the root cause analysis process after a sentinel event: a qualitative case study.BMC health services research · 2023Article
- Learning from experience: a qualitative study of surgeons' perspectives on reporting and dealing with serious adverse events.BMJ open quality · 2023Article
- Linking resilience and regulation across system levels in healthcare - a multilevel study.BMC health services research · 2022Article
- Association between hospital legal constructions and medical disputes: A multi-center analysis of 130 tertiary hospitals in Hunan Province, China.Frontiers in public health · 2022Article
- Resilient and responsive healthcare services and systems: challenges and opportunities in a changing world.BMC health services research · 2021Article
- Acting between guidelines and reality- an interview study exploring the strategies of first line managers in patient safety work.BMC health services research · 2021Article
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Authors and funding
4 authors.
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Abstract
A new regulatory framework to support local quality and safety efforts in hospitals was introduced to the Norwegian healthcare system in 2017. This study
designThis article reports one study level (the perspectives of hospital managers), as part of a multilevel case study. Data were collected by interviews and analysed according to qualitative content analysis.
settingThree hospitals retrieved from two regional health trusts in Norway.
participants20 hospital managers or quality advisers selected from different levels of hospital organisations.
resultsFour themes were identified in response to the study aim: (1) adaptive capacity in hospital management and practice, (2) implementation efforts and challenges with quality improvement, (3) systemic changes and (4) the potential to learn. Recent structural and cultural changes to, and development of, quality improvement systems in hospitals were discovered (3). Participants however, revealed no change in their practice solely due to the new Quality Improvement Regulation (2). Findings indicated that hospital managers are legally responsible for quality improvement implementation and participants described several benefits with the new Quality Improvement Regulation (2). This related to adaptation and flexibility to local context, and clinical autonomy as an inevitable element in hospital practice (1). Trust and a safe work environment were described as key factors to achieve adverse event reporting and support learning processes (4).
conclusionsThis study suggests that a lack of time, competence and/or motivation, impacted hospitals' implementation of quality improvement efforts. Hospital managers' autonomy and adaptive capacity to tailor quality improvement efforts were key for the new Quality Improvement Regulation to have any relevant impact on hospital practice and for it to influence quality and safety improvement activities.
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