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Implementation Science
Published in: Implementation Science 1/2006

Open Access 01-12-2006 | Systematic Review

Organizational interventions to implement improvements in patient care: a structured review of reviews

Authors: Michel Wensing, Hub Wollersheim, Richard Grol

Published in: Implementation Science | Issue 1/2006

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Abstract

Background

Changing the organization of patient care should contribute to improved patient outcomes as functioning of clinical teams and organizational structures are important enablers for improvement.

Objective

To provide an overview of the research evidence on effects of organizational strategies to implement improvements in patient care.

Design

Structured review of published reviews of rigorous evaluations.

Data sources

Published reviews of studies on organizational interventions.

Review methods

Searches were conducted in two data-bases (Pubmed, Cochrane Library) and in selected journals. Reviews were included, if these were based on a systematic search, focused on rigorous evaluations of organizational changes, and were published between 1995 and 2003.
Two investigators independently extracted information from the reviews regarding their clinical focus, methodological quality and main quantitative findings.

Results

A total of 36 reviews were included, but not all were high-quality reviews. The reviews were too heterogeneous for quantitative synthesis. None of the strategies produced consistent effects. Professional performance was generally improved by revision of professional roles and computer systems for knowledge management. Patient outcomes was generally improved by multidisciplinary teams, integrated care services, and computer systems. Cost savings were reported from integrated care services. The benefits of quality management remained uncertain.

Conclusion

There is a growing evidence base of rigorous evaluations of organizational strategies, but the evidence underlying some strategies is limited and for no strategy can the effects be predicted with high certainty.
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Metadata
Title
Organizational interventions to implement improvements in patient care: a structured review of reviews
Authors
Michel Wensing
Hub Wollersheim
Richard Grol
Publication date
01-12-2006
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2006
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-1-2

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