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

Siri Wiig*, Glenn Robert, Janet E. Anderson, Elina Pietikainen, Teemu Reiman, Luigi Macchi, Karina Aase

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)


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.

Original languageEnglish
Article numberN/A
Pages (from-to)134-144
Number of pages11
JournalReliability engineering & system safety
Issue numberN/A
Publication statusPublished - May 2014


  • Patient safety
  • Quality improvement
  • Quality and safety models
  • Healthcare organizations
  • Hospitals


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