| Central question of the thesis: how can we describe and explore sustainability and spread of quality improvements in health care from an organization studies perspective? Background 1. Phenomenon: quality improvement in health care 2. Problem: unclear why and how quality improvements in health care are sustained and / or spread 3. Setting: evaluation research on a large quality improvement program Care for Better in the Netherlands. 4. Unit of analyses: quality improvement processes in the Care for Better program. 5. Objective: lessons to learn from the quality improvement processes in the Care for Better program in terms of sustainability and spread. Theoretical background from organization perspective There are some conceptual problems in literature on organizational change and quality improvement .Nor are these issues yet explored in the domain of health care? In particular: - it does not address effectiveness on the long run, i.e. sustainability of quality improvements -it sometimes even confuses spread and sustainability. - it neglects empirical analysis of sustainability on the operational level of a work practice. Possible solutions offered in this thesis: 1. a framework for sustainability and spread 2. some measurement instruments and field testing with improvement teams as well as on the operational level with careworkers 3. a start in the analysis of the relations between improvement projects, improvement processess and subsequent sustainability and spread. |
