My research: a PhD student explains
Camilla Frosch Holmager Sloth
The purpose of the thesis is to explore what it takes for quality improvement to become more than a project and instead become a lasting part of everyday clinical practice.
What is the title of your thesis?
Sustainable Quality Improvement in Hospitals: Relational Processes and Natural Integration in Practice.
At which department and/or research unit did you complete your PhD?
The Unit for Health Promotion, University of Southern Denmark, in collaboration with Esbjerg and Grindsted Hospital.
Who was your principal supervisor?
Charlotte Overgaard, Professor at Esbjerg and Grindsted Hospital and Head of the Unit for Health Promotion, University of Southern Denmark.
What question did you aim to answer with your thesis?
What does it take for quality improvement to become more than a project and instead become a lasting part of everyday clinical practice?
What did you find?
The thesis shows that improvement methods and formal organisational structures are not sufficient on their own. Leadership, resources, competencies and collaboration are important, but they need to be enacted in the local clinical context.
Local organisational culture shapes how improvement work is understood and carried out. At the same time, relational processes such as dialogue, coordination, involvement, local adaptation and collective learning play an important role in whether improvement becomes embedded in everyday clinical practice.
When improvement work becomes a natural part of routines, professional roles and clinical problem-solving, it indicates that the improvement has become an integrated and sustained part of practice. In the thesis, this is conceptualised as natural integration
How did you do it?
The thesis consists of three sequential and interrelated studies using different methodological approaches.
First, the existing research was systematically mapped to identify key organisational conditions that contribute to building capacity for quality improvement.
These insights were then explored in greater depth in a qualitative case study using interviews and document analysis to understand how organisational conditions are enacted in different clinical contexts.
Finally, the experiences and perspectives of quality improvement experts were explored and used to translate the combined findings into a practice-oriented framework and recommendations.
How can your research be applied (in the clinic, society, etc.)?
A key clinical contribution of the thesis is the CARE model and the associated practice-oriented recommendations (only available in Danish).
They can be used by clinical teams and leaders as a reflection framework in specific improvement processes. The recommendations can help identify where additional attention or action may be needed and what the next steps could be, for example in relation to involvement, local adaptation, leadership, learning and progress.
The aim is not to introduce another fixed model or standardised recipe, but to support dialogue about what is needed for a specific improvement initiative to work and become embedded in the local clinical context.