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Updated: Aug 24, 2026

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Getting going together: can clinical teams and managers collaborate to identify problems and initiate improvement?
Johan Thor1, Bo Herrlin, Karin Wittlöv
1Medical Management Center, Karolinska Institute, Nobels väg 15 A, S-171 77 Stockholm, Sweden. johan.thor@cmi.ki.se
Abstract:
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.
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