Quality improvement in Swedish health care

INTRODUCTION OF TQM/CQI CONCEPTS: Total quality management (TQM)/continuous quality improvement (CQI) principles in health care have been discussed at the national level in Sweden since about 1989, when a journal article reported the experiences of a fact-finding group visiting the United States.

Management reforms throughout Sweden have attempted to create marketlike conditions intended to expand opportunities for flexibility and experimentation, increase patients' opportunities to influence care, and create further pressure for change. A rule issued in 1994 in parliament stipulated that quality assurance and quality improvement (QI) work may be initiated without first waiting for national or international standards. A decision was taken in parliament to strengthen this rule via a legislative statute, effective January 1, 1997, to pressure the health care system into implementing quality systems.

Several national organizations are involved in finding models, methods, and tools for QI in Swedish health care, with most of the actual QI work performed at the local level. For example, a department within the Federation of Swedish County Councils focuses on health care issues and has a QI unit. The federation is developing models, methods, and tools for promoting the implementation of QI systems in health care, such as quality registers and competition for a quality award.

TQM/CQI may well provide the methods and tools for creating a system of cost-effective, evidence-based, and patient preference-driven health care.