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Table 1 Empirically identified mechanisms that prompt the use of SwedeHF information in clinical work

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

 Mechanisms grounded in…
… organisational improvement… clinical practice
MechanismMeaningIllustrative quoteMechanismMeaningIllustrative quote
FocusPerformance improvementSwedeHFa supports feedback on performance in various forms. Feedback, then, aims to trigger improvement.“We learn from our colleagues // but [SwedeHF helps] also to lift our eyes and look up….”Individual patient’s health improvementSwedeHF data help healthcare practitioners improve the health conditions of individual patients.“It may be a bit of fun when filling in medicine doses. The first visit had the lowest doses, and when we send them out they are up to target doses.”
CompetenceImprovement competenceCompetence in improvement relates to SwedeHF measurements and how they can be embedded in improvement activities.“The development of working methods and approaches can be neglected if you only focus on the academic. You need skills in change management and quality improvement work.”Professional competenceSwedeHF has historically been tightly linked to the medical profession’s competence and the use of data is also due to the professional’s identification with the register.“The indicators we use nowadays cannot be affected by nurses. It is primarily a doctor’s action that can improve the results. But healthcare is a collective effort, so some decisions from us can be partially affected by a nurse.”
Forms of controlPart of the jobActivated as a result of SwedeHF data being part of formal job descriptions.“I sometimes do it online but that’s because… it’s pretty fast for me, because I already know what to look for. But we encountered some resistance from colleagues who thought, ‘No, not another thing to do’.”Professional authoritySwedeHF activities through the legitimisation of leaders from the professional domain (e.g., senior MDs).“Physicians are very critical of whether it will gain power or impact. // It’s their commitment that is the most important thing.”
MotivesP4Pa – IncentivesUse of the SwedeHF is motivated by financial initiatives.“If there is no financial incentive, then I do not think it can be implemented in the way we wish. As long as it’s voluntary, people can say I’m not doing it because of my workload.”Social controlSwedeHF, and its operation in clinical practice, signal to the organisation’s members that its use is important.“At a clinic, there is only one who [person] is interested; the others don’t give a damn. It is never possible to do good registry work. // The boss must signal that we prioritise registry work, then people start trying to group themselves. This atmosphere at the clinic, as far as register work is concerned, is positive.”
Development rationaleAdaptation to society’s developmentSwedeHF initiated through its role in creating transparent, resource-efficient healthcare.“To avoid things like delayed treatment and examination and so forth. So, I think it’s the beginning to make it look good. As long as you use quality indicators to control healthcare, it starts with giving feedback on some form of improvement.”Career enhancementProfessionals’ engagement in SwedeHF activity provides the potential for career enhancement.“She [resident physician] has already shown her work and she has probably also come up with suggestions for how to improve this. And I have presented it at another meeting // And we have also sent out … an email reminder to all doctors that this and that will be in the care summary.”
Type of workOrganisational improvementActivities whereby individuals carry out quality improvement-related work that is to be embedded in clinical work.“It often awakens a lot of thoughts, so there’s a lot we can do to improve it [SwedeHF] and to make the information a tool throughout the patient’s care process.”Occupational improvementFocus on everyday clinical work and the embeddedness of SwedeHF.“I say we have a form that we always review. Is it okay if we look at it? // And then it will not be as dramatic when I ask: how much do you drink?”
  1. aSwedeHF Swedish Heart Failure Register, P4P: Pay for Performance
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