Region of Southern Denmark

This study examines how organizational culture shapes the effectiveness and sustainability of Quality Improvement (QI) initiatives in healthcare. We conducted a qualitative embedded case study at a Danish university hospital, exploring six clinical units across surgery, internal medicine, and related specialties. Participants included managers, frontline staff, and QI facilitators. Guided by the Competing Values Framework (CVF), we analyzed how four cultural archetypes: Clan, Adhocracy, Market, and Hierarchy-influenced QI processes across initiation, execution, and evaluation phases. Data included 15 semi-structured interviews and internal QI documents. Reflexive thematic analysis combined deductive CVF-based coding with inductive insights, while researcher positionality and reflexivity were addressed through team dialogue and systematic documentation of interpretive choices. Findings show that culture shaped implementation pathways. In Clan-oriented units, staff involvement fostered ownership: "The more we involve staff in shaping the process, the more ownership they take, and the changes stick." Market cultures emphasized performance metrics but risked shallow engagement, while Hierarchy and Adhocracy cultures provided structure and innovation but faced limits in sustainability. The study demonstrates that tailoring QI strategies to cultural contexts enhances engagement and outcomes. We reflect on the CVF's limits in capturing cultural complexity and suggest complementary frameworks such as CFIR to strengthen conceptual grounding.

Nearly 5,000 out-of-hospital cardiac arrests occur annually in Denmark. Three in four take place in the patient’s home, often witnessed by relatives. In 60–70

We aimed to study how the timing of incident maternal emotional disorders is associated with male offspring’s cognitive ability in early adulthood using cognitive test data from military conscription in a population-based cohort. We linked all males (conscripts) born in Denmark 1996–2001 to parental hospital records to identify anxiety or depression (emotional disorders). Linear regression assessed the association between the timing of the first maternal diagnosis (before, during, or after birth (0–1, 1–5, 6–17 years)) and cognitive ability measured at the Danish Conscription Board Examination 2014–2019. Paternal emotional disorders served as negative controls to differentiate maternal pregnancy exposures from genetic and postnatal influences. The study included 119,387 males, with 9,959 (8.3 https://doi.org/10.17605/OSF.IO/SV7W4 ).

An integrated, people-centred approach is crucial to the development of health systems that can respond to emerging and varied upcoming health challenges. The transfer of best practices across European regions focused on digitally enabled integrated care is a promising approach, however, it is not a straightforward process. A scientific approach is essential to ensure that successful models can be expanded and sustained across diverse healthcare settings. The JADECARE approach successfully guided the design and deployment of 21 complex evidence-based practices that reached more than four million people. The process included a series of methods to enhance the implementation, monitoring, reporting and sustainability of the interventions and it consisted of five steps: (i) fragmentation of Good Practices, (ii) needs assessment of implementing sites, (iii) selection of Good Practices according to these needs (iv) adaptation of the selected Good Practices to local contexts and (v) deployment of the adapted interventions in implementation sites. JADECARE, based on implementation science theories, demonstrates that the transformative journey into digitally enabled integrated care through the replication of existing practices in new contexts is realistic.

Collaboration between General Practitioners (GPs) and specialised hospital services is essential for efficient, patient-centred care. In Denmark, GPs manage patients’ conditions and coordinate referrals to specialised services. Hospital referral triage consultants act as second-line gatekeepers, assessing the appropriate allocation of the patient or returning the referral to the GP when criteria are not met. The proportion of referrals rejected has increased, and inadequate communication between GPs and hospitals may contribute to these rejections. Understanding how triage consultants make decisions and coordinate care is critical for optimising referral pathways. This study aimed to explore the decision-making and coordination processes involved in rejected referrals from the perspective of hospital triage consultants. A qualitative design was employed using individual telephone interviews. Data were analysed following Braun and Clarke’s reflective thematic analysis. Ten hospital triage consultants participated, with 1 to 18 years of clinical experience, representing, orthopaedic surgery, urology, endocrinology, radiology, psychiatry, neurology, general medicine and haematology; four were female. Interviews lasted 21–37 min. Four themes emerged: (1) The referral process is influenced by specialisation and regulatory mandates, (2) Communication within the referral process – a remnant of the past, (3) The referral as a requested clinical task – Defining Scope and Responsibility, and (4) Selection of “the right patients” for specialised treatment. Findings indicate that triage consultants act as gatekeepers between GPs and specialist departments, balancing clinical information with departmental capacity. Structural and procedural constraints limit system flexibility. The consultants had several suggestions to improve the referral process quality and efficiency. Efficiency could be enhanced by revising legal and administrative constraints and optimising consultants’ workloads. Pathways work well for clearly defined cases, e.g., cancer-suspect cases, but poorly for patients with complex conditions requiring tailored approaches. Establishing accessible and flexible referral criteria can improve triage and the identification and prioritisation of patients with the greatest clinical needs. Improved collaboration between triage consultants, GPs, and patients, e.g., through direct contact or further correspondence, may enhance referral quality and overall patient care. These findings have identified practical strategies to strengthen hospital–primary care coordination and support resource-efficient, patient-centred pathways. Creating better opportunities for consultants to contact the GP and patient during triage of referrals. Enhancing communication through telephonic advice, video consultations, and correspondence. Improving the quality of, agreement on, and accessibility to criteria for referral acceptance. Expanding GPs’ role in coordinating complex patient care to ensure continuity. Reviewing regulative time constraints for patient management after an accepted referral. Reviewing workload and increasing efficiency while maintaining focus on high-priority cases. Creating an expansive referral strategy with fewer time constraints for patients with complex health conditions.