From: The role of professional logics in quality register use: a realist evaluation
Mechanisms grounded in… | ||||||
---|---|---|---|---|---|---|
… organisational improvement | … clinical practice | |||||
Mechanism | Meaning | Illustrative quote | Mechanism | Meaning | Illustrative quote | |
Focus | Performance improvement | SwedeHFa 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 improvement | SwedeHF 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.” |
Competence | Improvement competence | Competence 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 competence | SwedeHF 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 control | Part of the job | Activated 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 authority | SwedeHF 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.” |
Motives | P4Pa – Incentives | Use 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 control | SwedeHF, 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 rationale | Adaptation to society’s development | SwedeHF 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 enhancement | Professionals’ 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 work | Organisational improvement | Activities 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 improvement | Focus 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?” |