The Microsystem Festival 2019
- Detailed description of mini courses and seminars

The Microsystem Festival - February 26

A day consisting of two selectable streams:

1. Site visits

Welcome to the co-creative learning at the pre-festival session where we will share with you the good examples in our healthcare system that came up as a result of many years with improvement work. Shared values, competence and skills, trust, innovation, working processes, accuracy, integration and person-centeredness; all those together are quality which has been a driving force for the County's work for many years and they are still the basis for our ambition to create a resilient system for health and care and social welfare for the citizens at Jönköping County.
In the morning, you will meet the Chief Executive of Region Jönköping County Agneta Jansmyr, Chief Medical Officer Mats Bojestig and Chief Executive of learning and Innovation Göran Henriks. They will share with you some facts and their vision on leadership and improvement of health and care services in Jönköping County.
In the afternoon, you will go for site visits and see examples of improvement work where the innovative thinking, teamwork and person-centeredness were key elements to create new working processes and methods.


9.30-10.00 Registration and Morning Refreshments

10.00-12.00 Meeting with Region Jönköping County leaders

12.00-13.00 LUNCH

13.00-16.00 Site visits (one of the options below)

2. Creativity day - Set your mind free! Interactive Creative Workshop


The Microsystem Festival - February 27

Mini courses

Block A 13.15-16.45 (Afternoon Refreshments 14.30-15.00)

A1 Coaching the Art and Science of Health Care Improvement with Team Coaching

Improving health care processes and systems to result in improved outcomes, better systems and happier staff requires more than technical improvement. Discover the "art" of team coaching to improve team dynamics and find joy in providing care and improving care.

Presenters: Marjorie Godfrey (The Dartmouth Institute, USA) et al.


A2 Working through the 5 leadership behaviours

Leading change is an essential skill in today’s complex health and social care delivery. It is also a different skill from those normally taught to clinicians and managers. It starts with how we act as leaders. How we behave. This mini-course will draw on evidence from global high performing health systems and outline five behaviour YOU can practice to lead change.

Presenter: Jason Leitch (Scottish Government, UK)


A3  Gerontechnology for Sustainability

The technological transformation in society is expansive. For example, we spend more time on technical devices than the number of sleeping hours each day. A transformation like this is challenging. Warmly welcome to an interactive class where we will discuss technological challenges and learn how to use a Hackathon approach to promote early involvement of future users on micro and meso level, for sustainable development of  technology and health!

Presenters: Martina Boström (Region Jönköping County, Sweden) and Sofi Fristedt (Jönköping University, Sweden)

A4 Doing change sustainably

Things change and so do we. But how can the organization and we develop resilience in a successful way?
If you join us at this mini course you will learn about how to transform health and care by making the professionals to understand the power of variation as the platform for innovation. This makes change sustainable over time and makes Continuous Improvement to a habit.
In the seminar you will understand how Patient Compact accelerate how we can do change sustainably. You will learn about what questions are important to ask in order to encourage relationship between the patient and provider.

Presenters: Helen Bevan (National Health Service, UK), Göran Henriks and Anette Nilsson (Region Jönköping County, Sweden)


A5 Esther Boot Camp

Coaches and Citizens from the world famous Esther network Sweden including UK and Singapore will organize BOOTCAMP for you to understand and feel the power and joy of ESTHER Network with the purpose: To do What is best for

Presenters: Anna Carlbom (Design and Learning Centre for Clinical and Social Innovation, UK), Nicoline Vackerberg (Region Jönköping County, Sweden), Marie Winald Karlström (Modiga Mia, Sweden), Johan Thureson (patient representative, Sweden) and Caroline Ärleskog (TUC, Sweden)


A6 Sustainable collaboration for health

In Jönköping County there are fine examples of innovative cross-border collaboration with a health-promoting focus. In this mini course we will exchange examples of concrete interventions for different age groups by using interactive exercises in the whole group. Together we find the building blocks for sustainable cooperation that create more value as a unity for the inhabitant than the parts separately.
Presenters: Jesper Ekberg (Region Jönköping County, Sweden) et al.

The Microsystem Festival - February 28


Block B 9.15–10.15 Parallel seminars

B1 Delivering Sustainable Mental Health Services in Singapore - The Institute of Mental Health (IMH) Perspective - through Patient and Staff Focused Approaches

Some key challenges facing Singapore include rapid population growth, ageing and increasing burden of chronic diseases. Mental health and substance abuse account for approximately 11% of the burden of disease. Main challenges facing mental health care in Singapore are;
i. treatment gap
ii. low mental health literacy
iii. narrow concept of recovery and
iv. stigma.
With Institute of Mental Health (IMH) being the only tertiary psychiatric care institution in Singapore providing acute and long-term care to patients, there is an impetus to build a sustainable approach of delivering mental health in the most effective and efficient manner. IMH has rolled out patient and staff centric initiatives, by reorganising its clinical services and empowering its staff, to meet the challenges facing the mental health landscape in Singapore. IMH envisions that persons in recovery can be viewed beyond their mental health diagnosis – where people are viewed not for what they have, but for who they are. 

Presenters: Hong Choon Chua, Raphael Lim and Tina Fang (Institute of Mental Health, Singapore)

B2 Sustain balance and find abilities in your capacity 

Capacity and production management, simply put, means to plan for the maximum output that a unit can produce in a given period with the available resources. However, in order to achieve best capacity planning, one must achieve a consensus about what the available resources are, if they are available and how to place them. Like many other organisations, the health and social care sector consists of very complex organisational structures and the perception of what is what usually differs from care unit to care unit, from hospital to hospital and as well as from person to person.
This seminar will explore how different inputs and views can affect capacity and production management and what happens in a group of staff when you get facts presented that don't always coincide with the view that existed earlier.

Presenters: Lina JohannessonMaria IngebritsenMaria Malmström and Pernilla Söderberg (Region Jönköping County, Sweden) 


Going home from hospital – better integrated care! How to plan, act and make the best transition from hospital care to home care

It is important to understand how to involve the patient in a process of transition from hospital care to home care.
We have been working hard to make different professions and organizations adopt a patient’s perspective and aim at the same goal. Engaged coworkers as well as systematic analyzing and identification of development areas are the main factors of success in bringing patients home in time. Together we have put more focus on cooperation in the whole chain from hospital care to home care. From now on the focus will be held on the persons who will be kept at hospital more than three days. We also need to analyze the re-admissions within 30 days for system learning.

Presenters: Ann-Marie Thordeman and Robert Kristiansson (Uppsala County Council, Sweden)

Patient pathway from home to home - a holistic commitment to Health services in Finnmark - North of Norway

Patient pathway from home to home - a holistic commitment to Health services in Finnmark - North of Norway. A joint venture between Finnmark Hospital trust and municipal Health services in the east county. The main aim is to improve the outcome for the patient. The main drivers are "Safe discharge program", "What matters to you?", and interdiciplinary teamwork. We have had a commitment to anchoring the Project and, developing wellfunctioning teams including user representatives. Developing team together with the municipality. Creating understanding of eachothers system. We have four areas of common interest: Capacity building, prevent readmittance, patient centered healthteam, communication.

We are already getting positive results, that will be ready for sharing in january 2019.

Presenter: Kristin Pedersen (The Finnmark Hospital, Norway)

B4 Esther SimLab

What happens when we get new conditions, new working routines, new roles and at the same time are expected to collaborate more? Can we practice/simulate together with the patient i.e Esther? 
Esther SimLab is a model for training non-technical skills together with a patient representative i.e Esther. We hope to give inspiration about practical training of the non-visible "things" in health care, the important values in a personcentered care. We like to share our idea about having a model for practical training in a learning organisation, a way of working with continuous improvements and building competence and sustainability.
As a participant in this seminar you will have the opportunity to share experiences and explore new thinking together with professionals and patient representatives.

Presenters: Maria Johansson, Marcus Lidin, Patrik Blomqvist and Henrik Ånfors (Region Jönköping County, Sweden)


SustainAbility = LeadershipAbility

Leaders do not necessarily know how to lead quality improvement at the front line of care. A leadership development program demonstrates increased capability to lead improvement including awareness of self and others. To develop and to sustain improvement in the microsystem, effective, accessible and consistent leadership is necessary. Further, leadership is about relationships and the work of Schein contributes to this program. Leaders are able to learn the skills those at the front line of care find most supportive of making and sustaining improvements. Lessons learned form this interactive session.

Presenters: Marjorie Godfrey (The Dartmouth Institute, USA) et al.

Sustainable value creation with the microsystem as the driving force - lessons from a 10 years journey

Ten years ago, Bracke Diakonia, one of the largest not-for-profit health care and social service providers in Sweden, decided to build their quality strategies on microsystem thinking. Local microsystem improvement teams started to build competence and capacity for continuous improvement while management and support functions shifted focus to supporting front line units with process support, information on outcome, and patient experience. In the seminar, we will show how six success factors emerged throughput our improvement journey:
(1) Continuity and endurance,
(2) Everybody is on,
(3) Dialogue instead of control,
(4) A culture of curiosity,
(5) Feedback with data,
(6) Support at the front line.

Presenters: Thomas Schneider and Charlotte Forsberg (Bracke Diakonia, Sweden)


Improve early identification and management of adult patients with sepsis in the emergency department in the University Hospital of Northern Norway

The aim of this improvement project was that within 6 months >80% of all adult patients referred to the Emergency Department identified as sepsis, would receive antibiotics within one hour. We started an improvement project where we studied our system, our data in the Emergency Department and tested different improvement suggestions using PDSA-method. Sepsis may be hard to recognise. The most challenging part of the project was to improve the nurses and doctors’ skills to identify sepsis and to empower them to execute critical care for the patients within one hour. The most important change was implementing an emergency team in the Emergency Department and starting simulation training of the team. Within 6 months our sepsis treatment improved and we reached our goal. Our new systems in the Emergency Department are now well established and we still find new things to improve.

Presenters: Trine Olsen (University Hospital of Northern Norway)


Improving the Care of Patients with Acute Kidney Injury

The aim of a reduction of Acute Kidney Injury of 20% by June 2017 was not met, partly due to lower overall rates than expected and delay in algorithm availability to start the project. We have learnt about the barriers to team engagement and how to overcome them. How to lead a team in an area you do not work in – persistence, understanding of the local challenges to improvement work, encouragement. We now have a greater understanding of the human factors and behaviour around engagement, and we have been working with a broad team with diverse and exciting ideas. The project is now spreading through the hospital and we are learning what tools work better in each department, how practices differ and how best to adapt in each area to improve patient care.

Presenter: Fiona Duthie (National Health Service, UK)


The St. Triduana’s Story Implementing care and support planning within a House of Care framework for people with long term conditions

HoC CSP BENEFITS: PATIENTS:People like getting information beforehand, they can see results, helps make mental link & they see connection between lifestyle stuff & results (PN). It’s improved our use of more than medicine. We used to give people medicine when in fact problem was with social issues. Having this approached & then refer to Links Workers is real benefit to patient care (GP). STAFF: Reception found this process lot less work than previous appointment systems for chronic diseases (Administrator). Helps people operate at top of licence and frees time (GP). We’ve seen links between  staff groups improving (PM). PRACTICE: CSP helped with safety-combining appointments meant chance of something getting missed was less (PM). We’ve one of lowest DNA rates & number of GP appointments is going down (PM). I believe we can run successful business and be patientcentred by focusing on what matters to the person…so proud that we have a system which is both positive & sustainable (PM).

Presenter: Alison Fox (St Triduana's Medical Practice, Scotland) and William Kløverød Griffiths (Scotland’s House of Care Health, Scotland)

Together for a better health and equal care

Swedish health care system is under transformation. This transformation means moving care from specialist to primary care and from primary care to home care.  In the end, it means focusing on health promotion efforts and delivering care closer to the residents. To make this transition possible, Region Jönköping County established the programme called “Together for best possible health and equal care”. Britt-Marie and her family are fictive representatives of the inhabitants that are the core of the mindset of this transformation programme in the Region.  The programme aims to transform the care in a way that it is what the residents really need, when they need it and it is delivered  close to where they are.

Presenter: Anette Nilsson (Region Jönköpings County, Sweden)


We believe in the power of continuous learning in healthcare. Do you?

We believe in lifelong learning together with the patient. How do you fit in with the needs of the nurse and the patient? How do you ensure that current and important information is immediately available when you need it? So that you can provide the optimal care together with the patient. The Green Heart Hospital has, in collaboration with Noordhoff (publisher), devised various technical solutions for making workplace learning possible. The nurse no longer needs to retrieve information from the computer and is available on the mobile phone with clear introductory videos for both the professional and the patient.

Presenter: Jaco van der Worp (Green Hart Hospital, Netherlands)

Block C 13.30–14.30 Parallel seminars


Using a novel approach, the researcher in residence model, to evaluate system sustainability

In complex health and care environments Quality Improvement (QI) is a cornerstone in delivering high quality, sustainable systems. As well as using highly effective methodologies, such as the IHI, and approaches such as flow coaching, the rir model provides an additional positive approach to ‘improvement work’. With health and care systems increasingly testing out new models of care, where the evidence base is less developed and there is a critical need to understand context and culture as part of the change, the researcher in residence model should be considered as part of the QI toolkit. 
Research evidence often takes years to filter down to the front line. Efforts to address the implementation gap have proven to be wanting. Implementation without a developmental approach is unlikely to achieve the anticipated outcomes. The rir model is uniquely placed to address all these issues, whilst in turn developing more sustainable health and care systems.

Presenters: Susan Martin (National Health Service, UK), Rachael Campbell and Julian Elston (University of Plymouth, UK)

Patient compact for best possible health and equal care

An introduction on Patient Compact as a co-production intervention in Region Jönköping and a case study in relation to the ongoing work. 

Presenters: Sofia Persson and Magdalena Fritzson (Region Jönköping County, Sweden)

C2 Co-production – essential to achieve and maintain sustainable care

Collaborative co-production in healthcare require a relocation of power. One part of a sustainable transformation of power is patients being experts capable of making decisions and professionals shifting from ”fixers” to ”facilitators”. In order to promote Co-production on a mico level (or in a microsystem), a good response/treatment is crucial.
We welcome You to join our interactive workshop with Patrik, who has more than 30 years of experience from the transition of power in somatic care. Together, we explore how to make Co-production sustainable.

Interactive seminar

Presenters: Patrik BlomqvistMartina Boström and Annmargreth Kvarnefors (Region Jönköping County, Sweden)


A healthy working place for a healthy working life

Across European countries and workplaces, poor mental health is significant and increasing. 25 percent of European citizens will experience a mental health problem during their life time. Building healthy and sustainable working places and sustaining ability at employees and leaders is crucial in order to tackle future challenges in health- and social care. 
‘’A healthy working place for a healthy working life’’ is a collaborative between Region Jönköping County and seven municipalities in Region Jönköping in Sweden which aims to promote mental health and well-being in the workplace. The project is built on networking, collaboration and co-learning and it aims to create structure for sustainability in the improvement. 

Presenters: Agata Rukat (Region Jönköping County, Sweden) and Ylva Wikland (Region Jönköping County, Sweden)

Boston RESILIENT: Using student engagement, co-design, and community organizing to share narratives of hope from the opioid epidemic 

“Boston RESILIENT: Narratives of Hope from Boston’s Opioid Crisis” is a photojournalism project developed by medical students at Harvard Medical School in 2018. The purpose of the project was to provide people in recovery, healthcare professionals, law enforcement officers, advocates, policymakers, and educators affected by the opioid crisis an opportunity to share their perspectives with the public. The project educated students, engaged the community, and aspired to help change the narrative on substance use disorders in our community. The project resulted in a professional exhibit featuring photographs of and insights from dozens of individuals in Boston who are finding ways to tackle the opioid crisis, and was displayed at a local academic hospital. This session will take a deeper dive “behind the scenes” of the project to investigate how student and community engagement, principles of co-design, and the community organizing model led to the success of this initiative. We will share narratives of hope from amidst the epidemic and brainstorm together about how participants might apply these success factors within their own institutional and community settings to fight stigma and address substance use disorders and mental health.

Presenter: Galina Gheihman (Harvard Medical School, USA)


“We make it easy to get it right” when handling medicines. Nine nursing homes going from short term project thinking to systematic and sustainable quality improvement

In 2016, the Municipality of Copenhagen, decided on a new approach towards quality improvement to ensure sustainability and durability in the quality of care of the elderly. Starting out with nine nursing homes, a new improvement organisation was built on several levels to implement the systematic improvement methodology of the IHI. The strategy was to build capacity by learning and using the methods on one specific topic: medication. Within two years all nine nursing homes showed significant improvements in the medication handling process and the risk concerning patient safety on medication process has been reduced. Also, it appears that the improvement has been sustained. At the same time knowledge about the improvement methods has been unfolded both organisationally and concerning other quality issues. Notably the improvement team structure across organisational levels has proven a success by facilitating communication and understanding across contexts.

Presenter: Dorte Münter (Health and Care management, Municipality of Copenhagen, Denmark)

I trust my physician – Older persons' experiences regarding evaluation of their medication treatment

We explored older persons’ experiences regarding evaluation of their medications. They revealed a deep trust in physicians, apparently assuming that physicians evaluate their medications. At the same time, many lacked a comprehensive review of all medications, but indicated being unconcerned about the lack of evaluation due to
their old age. Older persons wanted to be involved in their medication treatment but seemed challenged by insufficient time at appointments, difficulties in understanding or remembering information and lack of written information. From a patient safety perspective, older persons can be one important barrier to Adverse Drug Events (ADE) if physicians support them in evaluating their medication. Older persons thus will benefit from a person-centred and regular approach to the evaluation of medications. These findings can inform the design of future interventions to avoid ADEs in the medication use process.

Presenter: Malin Holmqvist (Region Jönköping County and Jönköping University, Sweden)


From good to great! The building of multi professional teams that with effectiveness, high competence and an approach of concern, curiosity and participation can give a better support to children and adolescents with chronic diseases

It is always difficult to evaluate complex organizations and activities. Health care is complex and children and adolescents are vulnerable persons by their age. But the feeling among managers and employees is that the clinic's ongoing improvement work creates prerequisites for effective care processes as well as increased partipation and security for the children, adolescents and familis who need support from the Children's Clinic in Region Kronoberg. To work in new ways have an impact on both macro-, meso- and micro level.

Presenter: Gabriella Roström (Region Kronoberg, Sweden) 

Torbay Charts in Patient-centred Shared Decision Making

Although the concept of Shared Decision Making (SDM) has been there for many decades, it has not, for many reasons, been extensively adopted in everyday practice. Effective SDM requires an enthusiastic, open-minded medical professional, a willing patient and a good information repository or patient decision aids (PDA). Numerous PDA’s have been developed in the past and lack of user friendliness has been one of the reasons for their failure to be adopted. The components that are not captured in current PDA’s are a lack of overview of the whole disease progress, treatment options appropriate to disease stages, and the lack of inter-activeness when comparing different treatment options. The Torbay Chart addresses these issues and by having a layered approach, it allows excellent patient participation and interaction while considering all relevant options before choosing the correct one. The principles within this PDA are transferable to other conditions as this approach could be easily adapted.

Presenter: Rangaraju Ramesh (National Health Service, UK)


Reducing Harm from Acute Kidney Injury (AKI) in NHS Grampian

Following the introduction of these interventions we saw an increase in the knowledge and awareness of Acute Kidney Injury (AKI) amongst trainee doctors. There appeared to be a trend of reducing the number of AKI episodes. A key component to the success if this project has been the involvement of a multidisciplinary team and close collaboration with senior clinical and management teams. The next step will be to assess the effect of these interventions on hard outcomes of length of stay, mortality & need for acute dialysis and to sustain the improvement that we have seen thus far.

Presenter: Laura Clark (National Health Service, UK)

Adopting 'Daily Dynamic Discharges' in an acute medical ward in NHS Tayside, Scotland

The 'Daily Dynamic Discharge' (DDD) approach has helped our acute medical ward to be more proactive and prepared when planning a discharge, particular in times of increased pressure. We increased the number of weekly discharges (from a baseline median of 9 to a 14 with the DDD approach). We did not make a significant change in the number of discharge before lunchtime; this may have to do with 'external factors' such as social work and transport but there may be some gains to be made in continuing to shift the culture to get every member of staff planning and aiming for a discharge before lunch routinely.

Presenter: Dirk Habicht (National Health Service, UK)


Microsystems in Armenia: pediatric experience of university hospital - How to make a sustainable development?

Presenters: Nune Baghdasaryan (Yerevan State Medical University, Armenia)

Current collaboration between Armenia and Region Jönköping County

Presenters: Simon Rundquist, Fredrik Ingemansson and Peter Iveroth (Region Jönköping County, Sweden)


Improvement Science Day - March 1

What similarities are there between a top athlete and a clinician? 

On the third day of the Microsystemfestival, the Improvement Science Day takes part. Through interactive discussions, this day highlights how to ensure that methods for improvement science continues to be sustainable. The aim of the Improvement Science Day is therefore to emphasise a critical and educational perspective for a sustainable improvement work.
So, is there actually any similarities at all between a top athlete and a clinician? We do believe there is. 
Apart from personal matters, they are most likely to have at least one thing in common: they have probably been using a structured improvement strategy in their daily work for a while. They might think that their choices of improvement has been simple or random of its kind – but yet of importance for themself and others. However, as knowledge of improvement science increases in various sectors, a critical review of its methods is further needed.

Everyone is needed on the Improvement Science Day! 

Whether you are , researcher, quality imrovement leader, manager, clinician – or a top athletes (!) we will very much value your participation throughtout the Scientific day!
Through the wide group of participants, perspectives will be broadened and our way of understanding the complexity of research methods will contribute to increased power for improvement science and equality of health.


08.30-09.15 Registration and coffee
09.15-09.30 Micro-to-me-Wel-come!
  Why are we here, what are our expectations and what contributions can we add to the day?
-Based on the clinical microsystem festival so far, join a morning take off for a scientific approach for sustainable changes of microsystems. 
09.30–10.20 Keynote V: SHIFT-ing
  Empirical and theoretical understanding of the reality of making and sustaining improvements in complex healthcare systems
  Presenter: Julie Reed, National Institute for Health Research (NIHR)
10:30-11:30 Room with views!

Scientific approaches emphasize meta-perspectives of the quality improvement work. 
Well experienced Clinical professionals present their Master theses for improvement and leadership in health and welfare in an interactive poster walk to gain breadth.

More information to be published shortly.

11:30-12:00   Agility towards Sustainability. Reflections and introduction to the Themes.
12.00-13.00  Lunch

Four selectable themes 13.00-15.00

Theme 1: Quality improvement of postgraduate medical education: evaluation for sustainable quality

Residents predominantly learn in clinical practice. Creating a strong learning environment for all learners is essential to optimize and stimulate this learning. In the Radboudumc we have developed a system where departments are in the lead concerning the quality of learning environment. Based on the plan-do-check-act cycle departments continuously improve their educational programs. They can choose the moment for evaluation, and also how to use the different quality tools that are available. Beside this internal system, ewe have an external quality assessment every five years.

During this workshop we will focus on the following questions:

  1. What makes a stimulating (evidence-based) learning climate and (how) can it be measured?
  2. What behavior of individuals contribute to a stimulating learning climate?
  3. What are practical tips for creating a stimulating learning climate within your department?

Organization and method of presentation
After a short interactive introduction, participants will work in small groups on several tasks. Perceptions of the ‘ideal’ learning climate will be shared in small groups. We discuss different ways to look at the learning climate, and evidence based tools for measuring the quality of the learning climate. Participants are challenged to formulate items for measuring the quality of their learning climate. Finally, we present the quality system that is used in Nijmegen and share our experiences. Learning objectives Participants will learn:

Presenters: Lia Fluit and Tim Klaassen (Radboud University Medical Center Health Academy, Nijmegen, the Netherlands)

Theme 2: A Year in an Hour -  an interactive case study

A Year in an Hour -  will use a discussion-based case study to introduce delegates to the reality of navigating, negotiating and narrating the complexity of delivering improvements in healthcare.  
The session is designed for delegates at various levels of expertise in Quality Improvement (from Novices to experts in Improvement).  
The learning objectives for the session are for delegates to: 
1. Have an understanding of the practical reality of improvement initiatives. 
2. Recognise the importance of social components of change.
3. To recognise and reflect on the complex inter-dependencies of different aspects of healthcare improvement.
4. Gain knowledge to navigate, negotiate and narrate the practical reality of healthcare improvement.

Presenters: Julie Reed (NIHR London)

Theme 3: Sustainability, anticipation, and control of changes and improvements in health care

Changes and improvements to health care systems are usually guided by methods that
focus disproportionally on the implementation of change and pay less attention to the
sustainability of change.
Socio-technical systems, such as health care, do not respond passively to what happens.
Changes inevitably destabilise existing equilibria and the system dynamically tries to
compensate for that. This may easily lead to subsidiary effects that can challenge the
assumptions on which the planned changes were based. In addition to that, health care
systems are continuously subjected to multiple external and internal forces that can be
difficult to anticipate.

During this workshop we will focus on the following questions:
How appropriate are sequential approaches, such as the PDSA, for complex adaptive
What is needed to anticipate how performance conditions are likely to change during the
implementation period and what may happen as a consequence of the change?
What is the experience of how long it takes for an intended change to become firmly
established, and how realistic were the expectations when the change was planned?

Organization and method of presentation
The three invited speakers will each make a 15-20 minute presentation of the central issues
and identify critical problems. Following that the participants will discuss their own
experiences and concerns in groups. The purpose is to identify the most relevant practical
problems to be addressed in the near term, how they can be observed and how they should
be analysed.

Presenters: Erik Hollnagel, Axel Ros and Boel Andersson Gäre (Jönköping Academy)

Theme 4: Next stop – forward! Approaches to Quality improvements – reviews and practice in research

How might patient involvement in healthcare quality improvement efforts work – A realist literature review
This realist review identifies three overarching, interconnected and dependent IPTs to guide ealthcare organisations when involving patients in improving healthcare quality: tailoring, interaction and partnership, and behavioural change. They can be considered resource and reasoning mechanisms, as well as outcomes essential for QI efforts. Together they form recommendations for healthcare organisations managing QI efforts involving patients. In healthcare QI efforts, resources, reasoning and the local context are all important. To further refine the IPTs and develop a more nuanced and powerful programme theory, research on how they work at different rganisational levels, and from different stakeholder’s perspectives, is required.

Presenter: Carolina Bergerum (The University of Borås)

Quality improvement in daily work in primary care
Primary health centres (PHCs) nowadays have access to data feed-back through different sources. However, while some HCSs are constantly running improvement projects others don’t use feed-back data. A national system for the audit and feed-back, Primary Care Quality, is now introduced in Sweden. Increased knowledge aboutthe reasons behind the different use of audit and feed-back data at different PHCs would be helpful help to improve conditions for use of data for quality improvement. Focus group interviews were conducted with staff and management teams at primary care centres in Sweden during. Data was analysed using qualitative content analysis. Preliminary results are three main themes that describes different approaches to quality improvement in daily practice. Each theme represents a quality improvement strategy with specifik characteristics. The three themes can be described on an axis from simple to complicated to complex.

Presenters: Eva Arvidsson (Region Jönköping County) and Sofia Dahlin (Region Östergötland)

14.45-16.00 Discussion along with afternoon refreshments.
  What plants of today will continue to grow?