Applying different quality and safety models in healthcare improvement work: Boundary objects and system thinking

TY - JOUR

T1 - Applying different quality and safety models in healthcare improvement work

T2 - Boundary objects and system thinking

AU - Wiig, Siri

AU - Robert, Glenn

AU - Anderson, Janet E.

AU - Pietikainen, Elina

AU - Reiman, Teemu

AU - Macchi, Luigi

AU - Aase, Karina

PY - 2014/5

Y1 - 2014/5

N2 - A number of theoretical models can be applied to help guide quality improvement and patient safety interventions in hospitals. However there are often significant differences between such models and, therefore, their potential contribution when applied in diverse contexts. The aim of this paper is to explore how two such models have been applied by hospitals to improve quality and safety. We describe and compare the models: (1) The Organizing for Quality (OQ) model, and (2) the Design for Integrated Safety Culture (DISC) model. We analyze the theoretical foundations of the models, and show, by using a retrospective comparative case study approach from two European hospitals, how these models have been applied to improve quality and safety. The analysis shows that differences appear in the theoretical foundations, practical approaches and applications of the models. Nevertheless, the case studies indicate that the choice between the OQ and DISC models is of less importance for guiding the practice of quality and safety improvement work, as they are both systemic and share some important characteristics. The main contribution of the models lay in their role as boundary objects directing attention towards organizational and systems thinking, culture, and collaboration.

AB - A number of theoretical models can be applied to help guide quality improvement and patient safety interventions in hospitals. However there are often significant differences between such models and, therefore, their potential contribution when applied in diverse contexts. The aim of this paper is to explore how two such models have been applied by hospitals to improve quality and safety. We describe and compare the models: (1) The Organizing for Quality (OQ) model, and (2) the Design for Integrated Safety Culture (DISC) model. We analyze the theoretical foundations of the models, and show, by using a retrospective comparative case study approach from two European hospitals, how these models have been applied to improve quality and safety. The analysis shows that differences appear in the theoretical foundations, practical approaches and applications of the models. Nevertheless, the case studies indicate that the choice between the OQ and DISC models is of less importance for guiding the practice of quality and safety improvement work, as they are both systemic and share some important characteristics. The main contribution of the models lay in their role as boundary objects directing attention towards organizational and systems thinking, culture, and collaboration.

KW - Patient safety

KW - Quality improvement

KW - Quality and safety models

KW - Healthcare organizations

KW - Hospitals

KW - PATIENT SAFETY

KW - KNOWLEDGE TRANSLATION

KW - MANAGEMENT

KW - INTERVENTIONS

KW - ERGONOMICS

KW - HOSPITALS

KW - SUCCESS

KW - CONTEXT

UR - http://10.1016/j.ress.2014.01.008

U2 - 10.1016/j.ress.2014.01.008

DO - 10.1016/j.ress.2014.01.008

M3 - Article

SN - 0951-8320

VL - 125

SP - 134

EP - 144

JO - Reliability engineering & system safety

JF - Reliability engineering & system safety

IS - N/A

M1 - N/A

ER -