Purpose: The purpose of this study is to provide a review of the impact on culture (attitudes, values and assumptions) among both healthcare professionals, as well as users, when involving users for improving quality in healthcare.

Methodology/Approach: The paper is based on an extensive, narrative literature review considering studies that included professional’s and users experiences of user involvement in quality improvement. The included articles were analyzed using an interpretive, along with a deductive, approach according to a theoretical framework.

Findings: The results indicate that there is currently limited research focusing on the impact of user involvement in quality improvement processes regarding professionals’ and users’ attitudes, values and/or assumptions. The articles identified during the study provides situations and statements, during the process of development, which can be interpreted as change in the culture. Although few articles specifically draw conclusions on user involvement as a “tool” for cultural change, the authors interpret several findings which strengthens that theory.

Research Limitation/implication: Research published in other databases could have been missed. The authors have tried to avoid this by using a snowball method reading references in identified articles.

Originality/Value of paper: The review provides a platform for both future research and the development of current practice within the area. There have been literature reviews showing obstacles and enablers when using patients, users and relatives in quality improvement work, but few which investigates cultural change.

Purpose

The purpose of this paper is to contribute knowledge concerning the dynamics and potential cultural tensions that occur when applying user involvement and design thinking (DT) for improving quality in a health-care setting.

Design/methodology/approach

This paper is based on a case study following a quality improvement (QI) project in a medium-sized Swedish county council in the field of somatic care. The project involved eight health-care professionals, one designer, four patients and two relatives. A multiple data collection method over a period of ten months was used. It included individual interviews, e-mail correspondence and observations of workshops that covered the QI project.

Findings

The result shows tensions between QI work and the daily clinical work of the participants. These tensions primarily concern the conflict between fast and slow processes, the problem of moving between different fields of knowledge, being a resource for the individual clinic and the system and the participants’ expectations and assumptions about roles and responsibilities in a QI project. Furthermore, these findings could be interpreted as signs of a development culture in the health-care context.

Practical implications

There are several practical implications. Among others, the insights can inspire how to approach and contextualize the current concepts, roles and methods of DT and user involvement so that they can be more easily understood and integrated into the existing culture and way of working in the health-care sector.

Originality/value

This study provides a unique insight into a case, trying to uncover what actually is going on and perhaps, why certain things are not happening at all, when user involvement and design practices are applied for improving health-care quality.

Purpose

The purpose of this study is to explore the integration of design knowledge into healthcare organisations’ development environments, and especially the management’s reasoning in relation to the healthcare organizations’ traditional culture for improving quality.

Method

The paper is based on a qualitative interview design with development managers based at three different development sites in Sweden, who have integrated design knowledge as a method for quality improvement and innovation in healthcare organizations. The interview transcript was analysed using a content analysis together with an interpretive approach.

Findings

The results show the potential conflicts that occur after combining different bodies of knowledge when improving healthcare quality. It also provides a deeper understanding of how design knowledge and competence can create synergetic effects when integrated with other bodies of knowledge. Furthermore, these findings could be interpreted as signs of how new ways of thinking are creating challenges in the traditional way to work with quality improvement in healthcare.

Practical Implications

The narratives from the managers’ experience of new knowledge integration for improving healthcare quality, could help us create readiness and knowledge about how we prevent and/or facilitate planning and implementing design projects in a healthcare context. But also, that design plays an important role for organizations' ability to both develop and radically meet the challenges of the future.

Purpose – The purpose of this paper is to explore and describe the perspectives and reasoning of seniordevelopment leaders in healthcare organizations, when reflecting on design as theory and practice in relation tomore traditional methods and tools for improving quality and support innovation.

Design/methodology/approach – The paper is based on a qualitative interview design with fivedevelopment and innovation leaders from separate healthcare regions in Sweden. They have, to varyingdegrees, applied design theory and practice for quality improvement and innovation in their organizations. Theinterview transcript was analysed using a content analysis together with an interpretive approach.

Findings – The major findings are to be found in the balancing act for leadership and organizations inhealthcare when it comes to introducing and combining different theories and practices for improving qualityand support innovation. The balance is between the change in power dynamics and pushing traditional boundaries in a complex healthcare world.

Practical implications – The narratives from the leaders’ experience of applying design theory and practicefor improving healthcare quality can help us create readiness and knowledge about how we prevent and/orfacilitate planning and implementing design theories, practices, methods and tools in a healthcare context.

Originality/value – The study provides a unique insight when it captures and illustrates five differentorganizations’ experiences when applying design for developing healthcare quality.

Purpose

Organizations are currently challenged to learn and develop quality at an increasing speed of change, as well as handle complexity. This calls for new approaches to transformational change that invite and involve organizational members and stakeholders at the scale of the whole. The purpose of this paper is therefore to explore how to establish an arena using systematic reflection with a social media tool in real time, to help organizations understand and facilitate transformational change.

Methodology

Using scientific social media for reflection and dialogue with an action research approach gives a unique real time insight into what happens in the healthcare system during transformational change - on micro, meso and macro levels. This by allowing individuals with specific roles/functions linked to a transformative process (person centered and integrated care), to reflect on strong emotional experiences and action-oriented assignments. This can be described as equipping the individuals and the organization with a sensor to feel the system and capture systemic obstacles and levers at group and organizational level.

Findings

The result could be described as a journey in two parts of four. From becoming a place for individual reflection to the arena for a joint understanding of challenges and potential levers for understanding and facilitating transformational change.

Research implications

Research in healthcare could benefit from using scientific social media and the combination of qualitative and quantitative data. Furthermore, research in healthcare could also benefit from more action research initiatives to provide knowledge just in time.

Originality/Value

This way of using reflection via a digital space to follow transformational change in healthcare is not, to our knowledge, carried out before.

Purpose

Organizations are currently challenged to learn and develop quality at an increasing speed, as well as to navigate rising levels of complexity. This calls for new approaches to facilitating learning and quality as phenomena emerging in interconnected complex ecosystems of stakeholders. This paper explores the possibilities of facilitating the emergence of learning and quality in transformation and complexity with the support of scientific social media.

Design/methodology/approach

The paper is based on a qualitative research design. Using scientific social media [SSM] for reflection and dialogue with an action research approach, it allows individuals with specific roles/functions linked to a transformative process to reflect on strong emotional experiences and action-oriented assignments. This can be described as equipping the ecosystem with sensors to capture systemic obstacles and levers.

Findings

As a result, a triad with three themes of action possibilities for facilitating emergence was identified, with the support of scientific social media: (1) creating a living arena for emergence; (2) learning for emergence and (3) leading for emergence in transformation.

Research limitations/implications

Future research could benefit from using scientific social media and combined qualitative and quantitative data to study quality and learning as emerging phenomena. Practically, organizations could use SSM for health system transformation.

Originality/value

This paper provides empirical insights and new innovative ways of conducting research when exploring complex transformational changes in healthcare and the emergence paradigm of quality management.