Policies to foster quality improvement registries: lessons from the Swedish case

Background and objectives Multi-institutional quality improvement registries (QI registries) are a promising approach to quality improvement. They are also used for clinical research, public quality reporting and other valuable purposes. The aim of this study was to identify elements and outcomes of national policies to promote registries in Sweden and to compare them with recent policies in the USA. Methods This case study draws on previous studies of Swedish registries and on interviews, observations and document studies conducted in Sweden and the USA. Results In Sweden, registries are fostered by favourable patient data regulation and an indirect control approach combining government funding with soft regulation and professional self-governance. This enables the development of high-quality QI registries which are used for improvements by engaged clinicians, for clinical research and for decision support for practitioners and stakeholders. For example, Riks-HIA/Swedeheart achieved improved outcomes in cardiac intensive care, SCAAR/Swedeheart was used in a unique registry-based randomized trial, and the Swedish Rheumatology Quality Register provides a Web interface for patient encounters and clarifies adverse effects of biologic drugs. Still, the system has persistent limitations, especially the administrative burden on participants. In the USA, Medicare's programme for qualified clinical data registries and other recent changes mirror Swedish policies. Automated data capture is a US advantage, but uncertain funding and complex data regulations stall registry development in the USA. Conclusion The findings of this study indicate that tailor-made data regulation and a soft regulatory policy approach foster high-quality QI registries with multiple meaningful uses. These findings offer a framework for further cross-country comparative study to evaluate registry policies

Charismatic leadership in resistance to change

In Weber's writing and in leadership theory, charismatic leadership is associated with social change However, the importance and desirability of charismatic leaders in change processes can be questioned, as well as the notion that charismatic leaders are invariably proponents of change There are documented cases of charismatic leaders in religious and political contexts who have opposed ongoing change and proposed restoring tradition This paper reports oil two historical. qualitative case studies of charismatic leadership in an organizational setting, studies that demonstrate that charismatic leadership can also act in resistance to change and in defense of the Status quo The analysis indicates that the influence processes involved are basically the same as in charismatic leadership in general It suggests that impending change can challenge the interests and values of established groups and thus create a crisis that Stimulates the formation of charisma in opposition to change. (C) 2009 Elsevier Inc All rights reserve

Health care transparency in organizational perspective

Health care organizations are under increasing pressure to account for their performance to outside constituencies. This chapter reviews the background, nature, and consequences of organized efforts to enhance transparency in health care. Market reforms and quality concerns create mounting demands for public transparency, but health care quality is difficult to assess in a way that is both fair and accessible to a general audience. Public quality reporting has not been shown to improve quality of care, and there is a risk that it produces nominal rather than effective transparency. Especially when combined with economic incentives, transparency regimes tend to breed gaming, which is repeatedly ignored by systems designers. Health professionals typically react negatively, even if they also participate in and derive some benefits from transparency efforts. Future research needs to explore systematically the strategies that professionals, patients, and organizations engage in when creating and receiving public quality information

Obesity in organizational context

This article argues that obesity is an overlooked topic that deserves to be investigated in organizational studies, in line with the recent interest in embodiment. Obesity plays a pervasive role in everyday organizational life as a source of discrimination, legitimization of power differentials and widespread anxiety even for the non-obese. Obesity is also a thoroughly organized phenomenon. It is increasingly construed as a medical and societal problem and the target of massive efforts to curb the 'obesity epidemic'. These include workplace health initiatives that offer opportunities for empirical access to otherwise elusive phenomena related to obesity. To substantiate its claims, the article relates research from several fields, notably critical obesity research and empirical studies of embodiment in organizations. It points at intriguing combinations of ubiquitous social influence and failed campaigns, of subjugation and resistance, and of prejudice and critical reflection. Finally, the article indicates directions for future research, which could fruitfully apply and further develop the late-Foucauldian themes of governmentality and technologies of the self

Att väcka den som sover : om identitet och ledarskap på en anestesi- och intensivvårdsklinik

This biographical study of a department of anaesthesiology at a university hospitalfocuses on the strong, charismatic leadership exerted by the first leader of thedepartment, on how he made it a very prominent research institution, on how thestrong and distinctive research-oriented professional identity and culture of thedepartment persist, and on some present conflicts regarding the organizational unity ofanaesthesiology at the hospital. Much attention is given to the “organizational saga”,i.e. the collective narrative developed within the department about its past and itsidentity. In the context of the saga, different aspects of leadership are explained. Thefirst leader created and communicated the saga, and a main task of today’s leaders is todefend the values and identity expressed in the saga. It is argued that a charismaticleadership can be routinized in a narrative, in this case the saga. As much as thispossibility is not contradicted by Webers definition of charisma and its routinization,it is not actually developed in his writings. The study also discusses if the saga hasbeen fulfilled at the department and to what extent the identity is institutionalized.Furthermore, the study indicates that changes in stategies of control at the departmenthave accompanied changes in the principles that legitimate leadership in society ingeneral. Above all, it shows that a biographical perspective on organizations can befruitful, and that the concepts of identity and organizational saga have a highexplanatory value. Future biographical studies of hospital departments and theiridentity and narratives are recommended, and some theoretical points of departure aresuggested