Quality improvement in a publicly provided long-term care system: the case of Norway

Objective. To explore the extent to which quality improvement activities are implemented in the Norwegian long-term care system for older people, and to determine if variations in the extent and scope of quality improvement activities are associated with the characteristics of the first-line care leaders, the sector or the size of the municipality. Design. A cross-sectional telephone survey supplemented with information from public records and official municipal websites. Data were organized according to six total quality management components, and a sum score was developed to measure quality improvement. Variations in the extent of quality improvement activities were analysed using multivariate analysis. Setting. Thirty-two Norwegian municipalities stratified according to region and population size. Participants. Sixty-four first-line leaders in nursing homes and home-based care. Main outcome measure. A sum score has been used as a measure of quality improvement activities. Results. The unit’s quality improvement activities varied by quality improvement components and by municipality. The technical component that requires training in tools and techniques was low; the general components as ‘leader’s involvement ’ and ‘employee participation ’ were more common. The size of the populations of the municipalities showed a significant independent association with the scope of quality activities. Conclusions. The six quality improvement components varied from high to extremely low, and the large municipalities had more quality activities than small- or medium-sized municipalities