Improving quality of care: a continuous process of (de-)implementation

Abstract

Both underuse as well as overuse of medical services is associated with poor outcomes in healthcare. Underuse includes the failure to use effective medical interventions, where overuse refers to providing low value medical services. This could be described as services that are more likely to cause harm, waste resources or could lead to unnecessary healthcare costs. To improve quality of care and to create a sustainable healthcare system, it is essential to prevent underuse of effective medical care and to reduce the use of low value care by implementation and de-implementation initiatives. Implementation can be described as the planned process to introduce or to improve the use of medical interventions with the aim that those medical interventions are given a structural place within care practice. In de-implementation, the use of low value medical interventions is reduced or stopped on a structural basis in a planned process. The aim of this thesis was to extend the knowledge on effective strategies for de-implementation of low value care and the implementation of underused medical services in orthopedic surgery as well as in nursing practice.