Table 2 Categorization of changes implemented in individual clinical pathways and at the organizational level with illustrative examples
Situation (n = 53) | Problem definitiona | Responsea | Primary locus of responsibility for the work | Kind of work | Decision-making processa |
|---|---|---|---|---|---|
Simple 18 (34%) | Clear 38 (72%) Unnecessary visits by pregnant patients with suspected intrahepatic cholestasis because patients were seen more acutely than evidence suggests is warranted. | Clear 6 (11%) To use recently developed regional guidelines to reduce unnecessary admissions due to trauma in pregnancy. | Manager 3 (6%) Managers were responsible for introducing the new guideline on “trauma in pregnancy” in the electronic guideline collection. | Technical 3 (6%) To implement the new guideline on “Trauma in pregnancy”. | Sense Categorize Respond 2 (4%) |
Complicated 20 (38%) | Requires learning 47 (89%) Developing networked, cross-sectional collaborations with interprofessional teams able to design individualized treatment plans for newborns who had lost weight. | Manager and staff 13 (24%) Redesigning the physical space of the new obstetrics clinic by merging four units. Managers held the responsibility for changing the physical space and organizational structures and staff was responsible for developing and testing the new workflows and new patient pathways. | Technical and adaptive 32 (60%) Reduce admissions due to postpartum hemorrhage. The technical work involved raising the limit for how much bleeding could be accepted without having to admit the patient for further observation. This change was based on the realization that the previous limits were based on insufficient evidence. The adaptive work involve changing the “better safe than sorry” culture. | Sense Analyze Respond 4 (8%) | |
Complex 15 (28%) | Requires learning 15 (28%) How to redesign the physical space of the new obstetrics clinic that arose from the merger of four units to improve patient flow and coordination and collaboration across organizational and professional silos. | Staff > manager 37 (70%) Responsibility for development of the group B streptococcal (GBS) test to prevent unnecessary administration of IV-antibiotics and the subsequent unnecessary admission for observation was held by a senior physician. | Adaptive 18 (34%) Iterative approach to redesign the physical space and the flow of patients and staff in the obstetrical unit. | Probe Sense Respond 0 (0%) |