Logical tensions in health care - A case study in quality improvement work

Abstract

Todays healthcare organizations face increasing challenges which has led to the interest in Quality improvement (QI) work in healthcare. Studies have found that a focus on developing care quality is one way to combat these challenges. However, previous research has given limited focus to the local context, the development of new healthcare systems for QI work and the interests and relationships of local actors on a micro-level. This paper aims to investigate how QI work is organized and practiced in a Swedish health care organization at a specific clinic. Using sociology of translation and institutional logic as theoretical foundation, it details how local actors organize QI work, what guides them and how they engage in QI practices from a micro-level perspective. Findings demonstrate how a local system for QI work is translated and organized where QI projects can be seen to go through a four-step process; QI ideas are born, anchoring and treating QI ideas, decision-making and implementation, evaluation and reporting of results, where actors experience conflicting demands derived from segmented practices and reliance upon pragmatic collaboration between actors of separate institutional logics to manage their work with QI. This paper contributes to the existing literature on institutional logics in health care by providing a descriptive example of the creation and organization of a local QI system. Moreover, access to resources with competence in project management and a understanding of quantitative techniques proved an instrumental aspect when engaging in QI work.