Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden

BACKGROUND: With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study. METHODS: We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR). RESULTS: In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care. CONCLUSIONS: If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process.

Learning in and through drama : The necessity to use multiple theoretical perspectives in order to understand how learning takes place in drama

The complexity of learning implies that learning seldom is about just one thing. It can be said that learning processes are interdisciplinary. Within educational contexts, learning is not limited to constructed school subjects. In drama education, learning is simultaneously about drama as aesthetic expression and content because drama always is about something. The mainly focus can be on form, content or social aspects. The different aspects are always present, but may be more or less foreground or the background depending on the purpose of education. How do development concerning understanding of form, content, and social interaction, interact in a learning process in drama? My research is based on the view that learning at the same time takes place as an individual, internal process and a socially situated, inter-subjective process. Can learning in drama imply learning that can be transferred between different situations, a transformative learning and if so, how? Transformative learning includes cognitive, affective and corporal and social action aspects and means that the individual's frames of reference are transformed, evolved, to become more insightful and flexible which implies a change of personality. It leads to an integrated knowledge that can be applied in different contexts.   In the paper that will be presented at the conference, theories about how we learn in drama will be discussed in relation to my empirical research concerning drama and learning.