Service Quality Improvement in a Clinical Directorate: leveraging opportunities for latitude in a multiplicity of constraints, perspectives, objectives under system reform

This paper reports a mapping of constraints and enablers to quality and performance improvement in a Clinical Directorate. The site in an acute academic teaching hospital broadly follows the John Hopkins/NHS tradition. Research comprised three strands which were triangulated: documents (intent and realisation), quantitative (clinical governance extent and climate), and qualitative (semi-structured interviews).

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