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Camilla Frosch Holmager Sloth

Camilla Frosch Holmager Sloth


Evaluation research on the practical implications of implementing and sustaining quality improvement in healthcare organizations


Denmark's population is expanding as a result of immigration, long life expectancies, and big cohorts (Svendsen, 2017). This puts a greater strain on the already overburdened healthcare system, which must now provide care for those with chronic illnesses and individuals who have several illnesses (Statistics Denmark, 2019). The healthcare sector has recently been aware of and consistent in the display and use of LEAN concepts as a strategy to enhance existing processes without adding additional resources in order to satisfy the growing demand (Fine, 2009; Aspy, 2014). The Southern Danish Improvement Model is an integrated approach to the improvement work that Region Southern Denmark has created in conjunction with the American health organization Virginia Mason Medical Center in Seattle, Washington. The concept, which is based on LEAN methods and has been used as the foundation for improvement workshops at several of the Regions hospitals since 2015, is designed to reduce waste and make continuous improvements (Kenney, 2011). Despite the fact that LEAN is widely used in the healthcare system, research and actual experience from the hospitals in the region continue to show that improvement initiatives are not implemented and maintained in a systematic manner (Burgess  & Radnor, 2013). 2013).


The current study is built on an assessment of quality advancements made in the healthcare sector. In a complex healthcare institution, the study investigates and assesses the practical implications of adopting and maintaining quality improvements. Thus, the objective is to provide new theoretical and methodological contributions that may be utilized more extensively to plan and carry out organizational development initiatives that can boost the value and quality of the patient experience. Thus, understanding what works, for whom, and under what conditions, is the project's main focus.

Research questions

Study 1: To identify and analyze relevant literature regarding the research question: What is known from the literature about the successful implementation of improvement processes in the healthcare system?

Study 2: To identify and evaluate facilitating and inhibiting factors for successful teamwork in improvement processes.

Study 3: To identify and evaluate the importance of mechanisms influencing and maintaining improvement processes.


Since 2015, The Southern Danish Improvement Model has been routinely used at Sydvestjysk Sygehus as a general research tool for clinical improvement. Initiatives and workshops that are held at Sydvestjysk Sygehus over the period of 2022–2025 serve as the project's official data foundation.

The project's evaluation strategy will be centered on the idea of realistic evaluation, which is a catch-all term for evaluation theories and models that are motivated by expectations of and understanding of how an intervention leads to change, and is carried out by understanding the interaction between the intervention's context, the mechanisms it initiates, and the desired outcome.

Since the creation of a program theory is essential to this project, study 1 will serve as the foundation of the theory. The program theory will be continually modified throughout the study as a result of the outcomes being used to build and inspire the methodologies utilized in the other sub-studies. The goal of the program theory is to formulate precise, testable hypotheses concerning relationships between effort and outcomes. The project uses the notion of complex interventions, as defined by the British Medical Research Council, as its methodological foundation to address the healthcare system's shifting and frequently dynamic complexity (Skivington, 2021). The approach is beneficial for analyzing interactions between contextual elements and how they impact the intended outcome (Context-mechanism-outcome) (Short ell, Blodgett, Rundall, & Kralovec, 2016). Therefore, the project's focus is not just on the intervention's design but also on the circumstances required to make an improvement endeavor a reality.


A constant focus on the adoption of techniques that can sustain quality improvements, and which can continue to provide high-quality patient treatments has resulted from increased demand in an already complicated healthcare system (Mann, 2014). The initiative will indirectly help to enhance the success and maintenance of sophisticated healthcare interventions and better awareness of the significance of processes for results. The project's data gathering is performed in close coordination with clinical practice throughout the pertinent clinical departments at Sydvestjysk Sygehus. Thus, the outcomes of the project will take into account the input from both doctors and patients, with the final program theory being mainly modified to clinical practice and its significance for the entire healthcare system.


July 2022 – April 2026


Main supervisor: Professor Pernille Tanggaard Andersen, Professor, and head of research, Research Unit for Health Promotion, Department of Public Health, University of Southern Denmark Co-supervisor: Torben Knudsen. Clinical professor, research leader IRS, and South West Jutland Hospital Co-supervisor: Louise Schlosser Mose Postdoc, South West Jutland Hospital

Last Updated 20.10.2023