Interest in improvement work increases with customers' stricter requirements for quality and demand for individualized services. However, there is also a general perception that 70 percent of the improvement work fails, which may indicate that an improvement work is demanding and difficult to achieve. This study wants to highlight positive examples where activities in the health care system have succeeded in implementing improvement work and at the same time have gained a positive compliance with a new way of working.
The purpose of the study is to map and understand factors that affect the positive compliance of a new way of working. The questions on which the study were based on were:
• What are the differences and similarities between large and small improvement works?
• What factors play a role in improving a new way of working?
In order to be able to answer the study's questions, a qualitative research method was chosen. The interviews were conducted using a dialogue method, Appreciative Inquiry. In total, the respondents have reported on nine improvement works.
What has emerged is that very limited knowledge in improvement work is sufficient to carry out successful improvement work that also remained lasting over time. Furthermore, the choice of improvement work is based on the needs of the business and not on strategic choices.
What the improvement work has in common is that they have used a structured and systematic approach (PDSA improvement cycle) with interprofessional working groups and goal management during the change phase. All respondents associate change work with positive emotions and emphasize the importance of profits for a successful outcome of improvement work.
The formal leadership is very clear and takes shape in a structured and systematic way in the major improvement work throughout the change process. On the other hand, within minor improvements, leadership is informal and based on individuals' motivation, great commitment and knowledge. Commitment, participation and a sense of responsibility characterize all improvements.
In major improvement work, social capital is based on the quality of leadership, trust-building structures and systems, while in the smaller improvements it is based on individuals' abilities and knowledge.
All respondents highlight goal management and gains in improvement work as success factors. In addition, it was considered within major improvements that a working group with a mandate to change and committed and present leaders are success factors, while within minor improvements it was cooperation and feedback that were success factors.
It has been shown that motivation, improvement work based on needs, benefits, social capital, clear leadership and structures as well as systematics are factors that are necessary to achieve sustainable improvement work with positive compliance with a new way of working.mmary in English here