Mid Sweden University

Purpose: The purpose of this study is to provide a review of the impact on culture (attitudes, values and assumptions) among both healthcare professionals, as well as users, when involving users for improving quality in healthcare.

Methodology/Approach: The paper is based on an extensive, narrative literature review considering studies that included professional’s and users experiences of user involvement in quality improvement. The included articles were analyzed using an interpretive, along with a deductive, approach according to a theoretical framework.

Findings: The results indicate that there is currently limited research focusing on the impact of user involvement in quality improvement processes regarding professionals’ and users’ attitudes, values and/or assumptions. The articles identified during the study provides situations and statements, during the process of development, which can be interpreted as change in the culture. Although few articles specifically draw conclusions on user involvement as a “tool” for cultural change, the authors interpret several findings which strengthens that theory.

Research Limitation/implication: Research published in other databases could have been missed. The authors have tried to avoid this by using a snowball method reading references in identified articles.

Originality/Value of paper: The review provides a platform for both future research and the development of current practice within the area. There have been literature reviews showing obstacles and enablers when using patients, users and relatives in quality improvement work, but few which investigates cultural change.

Purpose:

The purpose of this paper is to contribute knowledge concerning the dynamics and potential cultural tensions that occur when applying user involvement and design thinking for improving quality in a healthcare setting.

Method:

The paper is based on a case study following a quality improvement project (QI) in a medium sized Swedish county council in the field of somatic care. The project involved eight healthcare professionals, one designer, four patients and two relatives. A multiple data collection method over a period of 10 months was used. It included individual interviews, e-mail correspondence and observations of workshops that covered the QI project.

Findings:

The result shows tensions between QI work and the daily clinical work of the participants. These tensions primarily concern the conflict between fast and slow processes, the problem of moving between different fields of knowledge, being a resource for the individual clinic and the system, and the participants' expectations and assumptions about roles and responsibilities in a QI project. Furthermore these findings could be interpreted as signs of a development culture in the healthcare context.

Practical Implications:

There are several practical implications. Among others, the insights can inspire how to approach and contextualize the current concepts, roles and methods of design thinking and user involvement so that they can be more easily understood and integrated into the existing culture and way of working in the healthcare sector.

Originality:

The study provides a unique insight into a case, trying to uncover what actually is going on, and perhaps why certain things are not happening at all, when user involvement and design practices are applied for improving healthcare quality.

Purpose

The purpose of this study is to explore the integration of design knowledge into healthcare organisations’ development environments, and especially the management’s reasoning in relation to the healthcare organizations’ traditional culture for improving quality.

Method

The paper is based on a qualitative interview design with development managers based at three different development sites in Sweden, who have integrated design knowledge as a method for quality improvement and innovation in healthcare organizations. The interview transcript was analysed using a content analysis together with an interpretive approach.

Findings

The results show the potential conflicts that occur after combining different bodies of knowledge when improving healthcare quality. It also provides a deeper understanding of how design knowledge and competence can create synergetic effects when integrated with other bodies of knowledge. Furthermore, these findings could be interpreted as signs of how new ways of thinking are creating challenges in the traditional way to work with quality improvement in healthcare.

Practical Implications

The narratives from the managers’ experience of new knowledge integration for improving healthcare quality, could help us create readiness and knowledge about how we prevent and/or facilitate planning and implementing design projects in a healthcare context. But also, that design plays an important role for organizations' ability to both develop and radically meet the challenges of the future.