Exploring inhibiting conditions for continual improvement in hospitals: A qualitative interview study

Abstract

Introduction: Rapid development of knowledge and technology in healthcare has contributed to systems that do not always deliver their potential benefits. The healthcare disciplines have one of the richest science bases and yet certain amounts of scientific knowledge is not being used; failing to do so can be both costly and harmful. Despite many efforts to improve care there are sometimes inconsistencies between desired and actual improvements. Some studies suggest that exploration of context and conditions for change-making may provide one missing link to creating successful improvement. Objectives: To explore nurses and doctors perspectives on the inhibiting conditions for continual improvement in the organisation by reflecting on their practice and previous experiences with improvement efforts. Methods: Qualitative semi-structured interviews with 16 strategically selected clinicians and sectional leaders from five different hospitals of varying size. A deductive thematic analysis was used to search across the data set and find repeated patterns of meaning, using the theoretical framework Knowledge domains for the improvement of health and health care . Through coding and condensing themes and sub-themes were identified and interpreted in relation to the framework. Results: Three themes regarding structural conditions were identified as inhibiting to change-making and CI: (1) dysfunctional elements of the organisational structure regarding: negative relations to administrational functions, complicated relations between the service-clinics and the hospitals, and lack of opportunities for networking and cross-sectional cooperation; (2) poor communication and how information is being conveyed between the different levels of the organisation; and (3) lack of opportunities to maintain and develop professional knowledge. Conclusion: This study provides in-depth information on context and complexity that is called for in improvement literature. The results of this study indicate that chances for successful improvements will increase by addressing these factors.