Contingency and paradoxes in management practices-development plan as a case.

PURPOSE: As part of a national plan to govern professional and organizational development in Norwegian specialist healthcare, the country's hospital clinics are tasked with constructing development plans. Using the development plan as a case, the paper analyzes how managers navigate and legitimize the planning process among central actors and deals with the contingency of decisions in such strategy work. DESIGN/METHODOLOGY/APPROACH: This study applies a qualitative research design using a case study method. The material consists of public documents, observations and single interviews, covering the process of constructing a development plan at the clinical level. FINDINGS: The findings suggest that the development plan was shaped through a multilevel translation process consisting of different contending rationalities. At the clinical level, the management had difficulties in legitimizing the process. The underlying tension between top-down and bottom-up steering challenged involvement and made it difficult to manage the contingency of decisions. PRACTICAL IMPLICATIONS: The findings are relevant to public sector managers working on strategy documents and policymakers identifying challenges that might hinder the fulfillment of political intentions. ORIGINALITY/VALUE: This paper draws on a case from Norway; however, the findings are of general interest. The study contributes to the academic discussion on how to consider both the health authorities' perspective and the organizational perspective to understand the manager's role in handling the contingency of decisions and managing paradoxes in the decision-making process.

Healthcare-associated infections must stop: a breakthrough project aimed at reducing healthcare-associated infections in an intensive-care unit.

BACKGROUND: Healthcare-associated infections are a problem for the Swedish healthcare system. In order to reduce the risk of acquiring healthcare-associated infections, the intensive-care unit attended a breakthrough project in 2004-2005, with the aims of studying methods of increasing patient safety and systematically improving treatment outcomes. The intensive-care unit had no system for registering infections, and the authors wanted to ascertain the prevalence of healthcare-associated infections, and register and prevent them. OBJECTIVES: 40% reduction in healthcare-associated infections in ventilated patients. 100% of staff to implement basic hygiene routines. DESIGN: The method used was the Breakthrough Series, originally designed by the Institute for Healthcare Improvement in Boston, Massachusetts, USA. The method aims to bridge the gap between what is known and what is done, spreading best-practice methods even faster. Many ideas for changes are tested on a small scale, with the basic rule that the small changes combine to create large changes that lead towards the final goal. RESULTS: The frequency of healthcare-associated infections in ventilated patients was reduced by 43%. Compliance with the basic hygiene routines improved greatly, from 72% on initial measurement to 98% today. CONCLUSION: In order to reduce the risk of acquiring healthcare-associated infections and to increase patient safety, a continuous, systematic effort involving continual measurement and review is necessary.