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Section I. Perspectives on patient safety and quality in healthcare -- Section II. Contemporary Nordic research : macro-level issues -- Section III. Contemporary Nordic research : meso-level issues -- Section IV. Contemporary Nordic research : micro-level issues.

Contents -- List of Figures -- List of Tables -- List of Contributors -- Part 1: Introduction -- 1: Crossing Boundaries: Quality in Care Transitions -- Care Transitions on the Agenda -- The Conceptual Myriad -- 'Clinical Handovers' and 'Patient Handovers' -- 'Transitional Care' -- 'Integrated Care' and 'Continuity of Care' -- Care Transitions -- Crossing Boundaries: Patient Stories -- Eva's Admission to Hospital (Medium-Sized Teaching Hospital, Norway) -- Thelma's Discharge from Hospital (Large Teaching/Research Hospital, UK) -- Learning from Patient Stories -- Crossing Boundaries: The Research Evidence -- Towards a New Perspective? -- A Reader's Guide -- References -- 2: Studying Complex Care Transitions from a Qualitative Perspective -- Introduction -- Recruitment Process -- Challenge 1: Identifying Eligible Patients -- Challenge 2: Acute Hospital Care Settings: Motivation to Participate -- Challenge 3: Gaining Informed Written Consent -- Challenge 4: Retention of Older Patients Over Time (Post-discharge) -- Data Collection Priorities -- Challenge 1: Observational Approach Chosen -- Challenge 2: Multiple Locations and Shifting Contextual Factors -- Challenge 3: Focusing the Field Notes -- Challenge 4: Background of the Observers -- Challenge 5: Conversations with Patients -- Challenge 6: Access to Data from Primary Care Physicians -- Conclusions -- References -- 3: Studying Complex Care Transitions from a Quantitative Perspective -- Introduction -- Studying Transition Step by Step -- Designing and Planning the Study -- Specifying the Purpose and Population -- Specifying When in the Discharge Process We Can Get the Information We Need -- Development of the Instruments -- The What: Selecting the Substantial Content of the Questionnaire -- The How: Selecting the Measures of the Questionnaire -- Piloting the Questionnaire

Theoretically rooted in public service logic (PSL), this article explores managers' experiences constructing value propositions and facilitating the value creation process in a public sector environment. It reports on a qualitative study from a Norwegian municipal setting based on individual and focus group interviews supported by participant observations and relevant documents. The data were analyzed according to the guidelines of stepwise-deductive inductive analysis (SDI). The findings substantiate changes in the utilized supported housing forms and highlight urgency's pervasive effect on transition processes to supported housing for individuals with intellectual disabilities and the need for around-the-clock support. This study contributes to public management research by examining the process of constructing value propositions and the managers' efforts to contribute to the formation of more realistic expectations towards the municipality's scope and level of service among prospective service users and their families. The article contributes to the PSL discourse by providing the complementary concept of expectation–reality mitigation as a particular form of expectation management suited for the complexities and constraints of value creation in public service settings.

Abstract Background Patient involvement in health care decision making is part of a wider trend towards a more bottom-up approach to service planning and provision, and patient experience is increasingly conceptualized as a core dimension of health care quality. The aim of this multi-level study is two-fold: 1) to describe and analyze how governmental organizations expect acute hospitals to incorporate patient involvement and patient experiences into their quality improvement (QI) efforts and 2) to analyze how patient involvement and patient experiences are used by hospitals to try to improve the quality of care they provide. Methods This multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews and non-participant observation of key meetings and shadowing of staff at the meso and micro levels in two purposively sampled Norwegian hospitals. Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011–2012). Results Governmental documents and regulations at the macro level demonstrated wide-ranging expectations for the integration of patient involvement and patient experiences in QI work in hospitals. The expectations span from systematic collection of patients' and family members' experiences for the purpose of improving service quality through establishing patient-oriented arenas for ongoing collaboration with staff to the support of individual involvement in decision making. However, the extent of involvement of patients and application of patient experiences in QI work was limited at both hospitals. Even though patient involvement was gaining prominence at the meso level − and to a lesser extent at the micro level − relevant tools for measuring and using patient experiences in QI work were lacking, and available measures of patient experience were not being used meaningfully or systematically. Conclusions The relative lack of expertise in Norwegian hospitals of adapting and implementing tools and methods for improving patient involvement and patient experiences at the meso and micro levels mark a need for health care policymakers and hospital leaders to learn from experiences of other industries and countries that have successfully integrated user experiences into QI work. Hospital managers need to design and implement wider strategies to help their staff members recognize and value the contribution that patient involvement and patient experiences can make to the improvement of healthcare quality.

Background: Effective teamwork and sufficient communication are critical components essential to patient safety in today's specialized and complex healthcare services. Team training is important for an improved efficiency in inter-professional teamwork within hospitals, however the scientific rigor of studies must be strengthen and more research is required to compare studies across samples, settings and countries. The aims of the study are to translate and validate teamwork questionnaires and investigate healthcare personnel's perception of teamwork in hospitals (Part 1). Further to explore the impact of an inter-professional teamwork intervention in a surgical ward on structure, process and outcome (Part 2). Methods: To address the aims, a descriptive, and explorative design (Part 1), and a quasi-experimental interventional design will be applied (Part 2). The study will be carried out in five different hospitals (A-E) in three hospital trusts in Norway. Frontline healthcare personnel in Hospitals A and B, from both acute and non-acute departments, will be invited to respond to three Norwegian translated teamwork questionnaires (Part 1). An inter-professional teamwork intervention in line with the TeamSTEPPS recommend Model of Change will be implemented in a surgical ward at Hospital C. All physicians, registered nurses and assistant nurses in the intervention ward and two control wards (Hospitals D and E) will be invited to to survey their perception of teamwork, team decision making, safety culture and attitude towards teamwork before intervention and after six and 12 months. Adult patients admitted to the intervention surgical unit will be invited to survey their perception of quality of care during their hospital stay before intervention and after six and 12 month. Moreover, anonymous patient registry data from local registers and data from patients' medical records will be collected (Part 2). Discussion: This study will help to understand the impact of an inter-professional teamwork intervention in a surgical ward and contribute to promote healthcare personnel's team competences with an opportunity to achieve changes in work processes and patient safety.

Patient involvement in health care decision making is part of a wider trend towards a more bottom-up approach to service planning and provision, and patient experience is increasingly conceptualized as a core dimension of health care quality.The aim of this multi-level study is two-fold: 1) to describe and analyze how governmental organizations expect acute hospitals to incorporate patient involvement and patient experiences into their quality improvement (QI) efforts and 2) to analyze how patient involvement and patient experiences are used by hospitals to try to improve the quality of care they provide.

BACKGROUND: Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. METHODS: This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). RESULTS: The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided. CONCLUSION: The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts. ; This study is part of the EU FP7 project Quality and Safety in European Union Hospitals (QUASER)