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Table 5 Themes, Sub-Categories and Key “take home” Points

From: Exploring links between resilience and the macro-level development of healthcare regulation- a Norwegian case study

THEME-I RATIONALE
Sub-Category Key Points
Adaptation & Flexibility The new Quality Improvement Regulation was elaborated and adapted to meet the needs from the services:
• Modernized by adding management and quality improvement
• Designed around a PDSA structure
• The obligation to delegate tasks in daily work was specified
• One new substantial provision was added: The obligation to systematically evaluate risk management and quality improvement measures (yearly)
The Quality Improvement Regulation per se is flexible in its non-detailed, regulatory design, because:
• The rules can be adapted to any hospital organization
THEME-II EXPECTATIONS
Sub-Category Key Points
Adaptation & Flexibility The Government expected hospital managers to:
• implement risk reducing- and quality improvement measures based on specific context, size, activities and risk picture
Design-wise, the Quality Improvement Regulation may be flexible as it leaves the regulatees to decide on details for implementation, but:
• this does not necessarily mean that it encourages adaptive behavior in actual hospital work practices
• it is challenging to make the Quality Improvement Regulation relevant for the right clinical level
The Government did:
• not have a clear vision of how hospital managers would adapt it to their practical work
• suspect a disconnection between what the top-level managers prioritize and what is done at the level where clinical work unfolds
Anticipation The Government expected hospital managers to:
• obtain an overview of- and reveal risk factors prior to failure