Getting going together: can clinical teams and managers collaborate to identify problems and initiate improvement?

Qual Manag Health Care. 2004 Apr-Jun;13(2):130-42. doi: 10.1097/00019514-200404000-00005.


A clear aim is key for the success of improvement projects, yet many fail already at this stage. We studied how clinical teams and managers at a university hospital in Sweden identified problems and defined aims as they initiated 24 process improvement projects. Categorizing and comparing problems at 3 stages of problem definition, we found that the majority of problems fell into 1 of 3 categories: information issues, poor procedures, and waiting times. Going through these stages, managers and clinical teams prioritized waiting-time problems. We show how managers can ask such teams to quickly identify problems suited for improvement projects through this step-wise, facts-based approach. We conclude that they can add their management perspective when giving specific assignments, to harness the combined benefits of both a bottom-up and a top-down approach to improvement.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cooperative Behavior*
  • Decision Making, Organizational
  • Hip Fractures / surgery
  • Hospital Administrators
  • Hospitals, University / standards*
  • Humans
  • Institutional Management Teams / organization & administration*
  • Patient Care Team / organization & administration*
  • Pilot Projects
  • Problem Solving
  • Process Assessment, Health Care / organization & administration*
  • Quality Assurance, Health Care / organization & administration*
  • Sweden
  • Waiting Lists