Academic journal article Nordic Journal of Working Life Studies

Quality Development in Health Care: Participation vs. Accreditation 1

Academic journal article Nordic Journal of Working Life Studies

Quality Development in Health Care: Participation vs. Accreditation 1

Article excerpt

Introduction

This article discusses two approaches to quality development in the Danish health care sector in relation to the introduction and use of new technologies. We compare two quality development approaches: the Danish quality model (DQM), based on accreditation, and effects-driven information technology development (EDIT), based on participatory design. We discuss how these approaches accentuate clinicians' working life, which is characterized by the constant introduction of new technologies. Accreditation is widely used within quality development in general. In the health care sector, accreditation focus on clinical processes and evidence-based standards and guidelines for these processes (WHO, 2003). Our aim is to address quality development in relation to technology implementation and use. We argue that to support technology use in work settings, accreditation needs to be supplemented with participatory design approaches (Simonsen & Robertson, 2013) that allow for local experimentation and implementation of high-quality outcomes.

The health care domain is complex, highly specialized, and subject to massive technology investments. These investments influence the relations between work organization and technology, which in turn transform each other (e.g., Berg et al., 2003). The introduction of new technologies is accompanied by standardization efforts to improve efficiency and quality in health care (e.g., Ellingsen et al., 2007; Klein, 2002). For example, during 2016-2017, the Capital Region and Region Zealand in Denmark have implemented the single largest information technology (IT) investment in the Danish health care sector to date (€400 million), replacing more than 30 IT systems with the Epic healthcare platform (Sundhedsplatform.dk) - an electronic health record system from the largest vendor of such systems in the US (epic.com). All departments, wards, and clinicians at all hospitals in the two regions are affected by this system, which will be used by 44,000 people in 20 hospitals. One of the goals has been to standardize the clinical guidelines by reducing 50,000 different guidelines to 5000 so that the 20 hospitals use the same clinical guidelines, embedded in the system, for workflow and decision support (Buchwaldt, 2014). The changes in the work organisation are dramatic. For the physicians, the Epic system replaces the traditional use of dictation (followed by transcription, recording, and coding by medical secretaries) with a process where the physicians themselves must write their clinical notes directly in Epic (see, e.g., Bansler et al., 2016). The physicians will also schedule all appointments and tests, a task that used to be handled by nurses and medical secretaries. New electronic health record systems such as Epic constitute a technological platform that over time will influence the work organization: The technology not only provides new means to record and access data, but it also constitutes a platform that may transform and support interdisciplinary and cross-departmental collaboration in the highly specialized areas that characterize the health care domain.

Once an IT system has been deployed, the subsequent process of making optimal use of the system is the responsibility of the quality-development organization. Quality development comprises efforts to improve the quality of processes and outcomes. In this article, we focus on the quality development associated with introducing new technologies in existing health care settings to change and improve clinical processes.

Our discussion is actualized by the fact that a new quality development program is needed for the health care sector in Denmark. Since 2005, Danish hospitals have used the process-oriented accreditation system DQM (ikas.dk; IKAS, 2013). The DQM is based on the principles of accreditation, national standards, and quality control via monitoring the primary and secondary care sectors. In 2015, the Danish Ministry of Health (Sundhedsministeriet, 2015) announced the abolition of the DQM within hospitals, a decision made in light of the criticism that clinicians spent too much time documenting care. …

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