Sustained improvement? Findings from an independent case study of the Jönköping quality program.

Quality methods of many types have been widely used in hospitals. Although a number of specific projects have shown evidence of improvement, there is no strong evidence of the effectiveness of organization-wide or system programs over a period of time. There is no evidence of which approaches might be more suitable for different settings, or of value for money compared, for example, to employing more doctors and nurses. Jönköping is widely known in Sweden and internationally as one long-running example of a successful systemwide improvement program. As with other programs, critics and researchers have asked for evidence of improved outcomes for patients and of the costs of the program. There are methodological challenges to providing strong evidence of these outcomes, even in small projects where it is easier to attribute outcomes to interventions, at least over the short term. However, there are ways to gather data that are more objective than participants' and consultants' reports and that are useful for assessing the value of the program and to enable others to learn from the experience of Jönköping. This article presents such data from a case study of the program carried out in 2006. It presents evidence of how the program was implemented, of some results, and of the unusual conditions that appear to have shaped or allowed the program to be carried out in the way described. There is some evidence of process improvements in a number of departments and of outcomes improvement in one department. The program is widely perceived to be of benefit and some of the explanations for this are presented.