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Enhancing policy implementation to improve healthcare practices: The role and strategies of hybrid national-local support structures
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2018 (English)In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 33, no 4, p. E1262-E1278Article in journal (Refereed) Published
Abstract [en]

Background In this study, we followed a national initiative to enhance the use of quality indicators gathered in national quality registries (NQRs) for improvement of clinical practices in Swedish healthcare, more specifically by investigating the support strategies of regional support centers with national and local missions. The aim was to increase knowledge on the role, challenges, and strategies of support structures with mixed and complex missions in the healthcare system. Methods Documents and 25 semistructured interviews with staff at 6 regional support centers, ie, quality registry centers, formed this multiple case study. Data were analyzed using conventional content analysis. Results The centers' strategies varied from developing the NQRs to become more suitable for improvement to supporting healthcare's use of NQRs, from the use of task to process-oriented support strategies, and from taking on national responsibilities to responding to local initiatives. All quality registry centers engaged in initiatives inspired by the Breakthrough Series approach. Some used preexisting change concepts or collaborated with local development units. A main challenge was to overcome a lack of formal mandate to act in the healthcare organizations they served. Conclusions Support functions with mixed and complex missions have to use a variation of strategies to reach relevant actors and achieve changes. This study provides valuable input for policy and decision-makers on the support strategies used and challenges of support functions with complex missions situated in-between national and local levels of the healthcare system, here denoted hybrid national-local support structures.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018. Vol. 33, no 4, p. E1262-E1278
Keywords [en]
change facilitation, national quality registries, policy making, quality improvement, support structures
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:umu:diva-154858DOI: 10.1002/hpm.2617ISI: 000452874800061PubMedID: 30091487Scopus ID: 2-s2.0-85052651192OAI: oai:DiVA.org:umu-154858DiVA, id: diva2:1275049
Funder
Swedish Association of Local Authorities and RegionsAvailable from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-01-09Bibliographically approved

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Nyström, Monica E

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CiteExportLink to record
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Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf