Unveiling the Mechanisms of Change: An Explanatory Case Study of Improving Hip Fracture Rehabilitation in Sweden

Management (TQM), Continuous Quality Improvement (CQI), Business Process Re-engineering (BPR), the Breakthrough Model, and lean manufacturing.However, it is unclear if any one of these approaches is more effective than others [6].Health care quality improvement projects are complex social interventions.It has been argued that such interventions can only be properly understood if the interplay between the context, content, process and outcome of the intervention is well described and evaluated [15,16].In-depth analysis is required to discover mechanisms that can tie the interventions to contextual factors and outcomes.Pawson and Tilley studied complex interventions in health and social care [17-19].They state that whether the ideas in change projects have sustainable effects or not depends on i) the individual capacities of the change agents and/or project leader, ii) the interpersonal relationship among individuals in the intervention group, and iii) the institutional balance between the organization and the wider infrastructural system.The aim of this study was to identify explanatory mechanisms of change in the context of a hip fracture rehabilitation project.The goal was to carry out an evaluation in order to produce a new Many methods and approaches have been proposed to make changes in health care to improve patient care, rehabilitation and organization [5-14], e.g., Kotter's 8-steps change model, Total Quality