GW4007MV – Quality and Safety
Teacher
Ian Leistikow and Marcello Aspria ()
Lecture: Fridays 14.00 – 15.45
Workgroup: 7
Teacher: XXX ()
Important!
, / 2025
Lecture 1
Structural challenge
Six challenges:
1. Structural.
2. Political.
3. Cultural.
4. Educational.
5. Emotional.
6. Physical & technological.
Structural challenge.
- Challenge around structuring, planning and
coordinating quality efforts (Bate et al.).
- Good structures are essential for organizing
quality effort; e.g. strategies, information sharing,
coordination, dedicated teams.
- However, too much focus on structure can lead to
bureaucratization, fragmentation and decoupling.
- Structure --> process --> outcome --> change
things dependent on outcome.
Structural challenge – nationwide example
Pancreaticoduodenectomie.
- Doctors said “well that’s too bad that it doesn’t go well in OTHER hospitals”.
- And also said it did not mean anything statistically significant for their hospital.
- So, nothing changed.
- Also, a lot of emotion because this surgery was “cool”.
- Low volume, highly complex surgery has lower survival rate than high volume highly
complex surgery (i.e. go to hospital where the surgery is common!)
Outcome quality indicators are not unbiased --> e.g. increase in stoma’s by not doing the complex
surgery and thus “better” outcomes (no leakages).
- Means-end decoupling.
Teacher
Ian Leistikow and Marcello Aspria ()
Lecture: Fridays 14.00 – 15.45
Workgroup: 7
Teacher: XXX ()
Important!
, / 2025
Lecture 1
Structural challenge
Six challenges:
1. Structural.
2. Political.
3. Cultural.
4. Educational.
5. Emotional.
6. Physical & technological.
Structural challenge.
- Challenge around structuring, planning and
coordinating quality efforts (Bate et al.).
- Good structures are essential for organizing
quality effort; e.g. strategies, information sharing,
coordination, dedicated teams.
- However, too much focus on structure can lead to
bureaucratization, fragmentation and decoupling.
- Structure --> process --> outcome --> change
things dependent on outcome.
Structural challenge – nationwide example
Pancreaticoduodenectomie.
- Doctors said “well that’s too bad that it doesn’t go well in OTHER hospitals”.
- And also said it did not mean anything statistically significant for their hospital.
- So, nothing changed.
- Also, a lot of emotion because this surgery was “cool”.
- Low volume, highly complex surgery has lower survival rate than high volume highly
complex surgery (i.e. go to hospital where the surgery is common!)
Outcome quality indicators are not unbiased --> e.g. increase in stoma’s by not doing the complex
surgery and thus “better” outcomes (no leakages).
- Means-end decoupling.
