Table 1 Temporal description of the QI process and a description of the components

 Education/ training

2 days training of designated VSM taskforce and nine one day seminars with the whole staff and the creation of workgroups. Follow ups in monthly discussions in the work groups.

“Transformal leadership” training with all clinical managers led by external consultants.

Training of the VSM taskforce in methodology, scooping and workflow.

Data from audits and unit performance discussed and processed at one day seminars with all staff.

Additional overnight seminar with physicians.

Coached by external consultants.

Training of clinical managers in working in a process orientated organisation.

 Value Stream map (VSM)

Executed by the VSM taskforce

 Continuous improvement & visual management

Improvement suggestions and projects resulting from the seminars were edited for use in phase 2.

Feedback and results after the implementation were discussed with all staff at four seminars.

New improvement tasks were distributed.

Internal and external working environment audits.

Reporting of clinical and economical performance.

Internal and external working environment audits.

Reporting of of clinical and economical performance.

 Work redesign

Institution of fellowships for the education of intensivists.

Outcome of VSM and new workflow presented to all staff at four implementation meetings.

Revision of the previous VSM according to achieved results and feedback from seminars and audits.

 Teamwork

Implementation of “transformal leadership”.

Multiprofessional teams were instituted.

Expansion of the team with paramedic staff. Seminars on individual contribution and group dynamics.

Re-distribution and re- interpreting of formal mandates, leadership and responsibilities.