Facilitators and barriers to applying a national quality registry for quality improvement in stroke care

BACKGROUND: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. METHODS: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. RESULTS: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. CONCLUSION: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.

A Discussion of Globalization Theories - Through International Consumer Perceptions

Globalization has developed more and more within the business world as well as private life during the last decades. Globalization has influenced the way companies are conducting business and their approach towards the consumers which can have an influence on their way of purchasing. Consumers nowadays have more than ever the possibility to get involved and gather experiences from abroad, as well as companies are taking advantage of this globalization. Within this thesis the following question will be discussed: Do consumers see the value companies try to create for them with an identical offer the same way in different markets? This idea is based on Theodore Levitt’s theory of globalization which comprises standardization of an offer since consumer needs are homogenizing globally. Douglas & Wind instead state that segmentation with adaptations is necessary to fulfill all consumer needs. Within this elaboration the question whether standardization is accepted and liked by the consumers is discussed and analyzed by including an empirical research. This research is based on Zeithaml’s model of the Perceived Quality Components, which was the fundamental base behind formulating the survey questions. These were submitted in Germany, the Republic of Ireland and Sweden to be able to discuss and visualize how the consumers of these different markets perceive different aspects of a company’s offer. One particular company, which is seen as doing business globally, was chosen as a test object. Based on the test object Lidl - which consumers were questioned about in the survey - it was possible to conduct a comparison of consumers’ general expectations against components of Lidl’s offer such as price, weekly specials, product range, etc. where differences and similarities between the three countries of Lidl’s fulfillment of these expectations were achieved. They were analyzed to discover to which extent globalization is present. Resulting from the comparison it was concluded that nowadays segmentation is important but developing with time globalization seems to increase in significance. Recommendations for further research about topics which were omitted due to limited resources are presented.

Shared decision-making in mental health care : a user perspective on decisional needs in community-based services

BACKGROUND: Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. OBJECTIVE: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. METHODS: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. RESULTS: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

IT support for administrative planning of clinical practice.

The administration of clinical practice placements for nursing students is a highly complex and information driven task. This demonstration is intended to give insight into the web based system KliPP (a Swedish acronym for Clinical Practice Planning) and to discuss the possibilities for further development and use.