Logo of qualhcLink to Publisher's site
Qual Health Care. Dec 1999; 8(4): 262–265.
PMCID: PMC2483672

Management of sickness absence: a quality improvement study from Slovenia


Problem - A need to improve the communication system between general practitioners (GPs) and the national health insurance institute's (NHII) committee of experts for the referral and approval of sickness leave for patients. Design - A structured low cost quality improvement method for motivating GPs to change their current practice was developed. Background and setting - The study was done in Kranj health district in Slovenia. GPs and members of the committee of experts identified potential problems using a cause and effect diagram. The study period for baseline data collection was from November 1996 to December 1996, and the re-evaluation took place in May 1997. All GPs in Kranj health district (n=78) took part. Data were collected on 443 patients referred by GPs to the NHII committee during the first phase of the study and 590 patients during the re-evaluation phase. Key measures for improvement - Reducing the number of cases reported by members of the committee of experts as causing problems after the intervention. Feedback to GPs about the success of the process. Strategies for change - A combination of methods was used: posted feedback, a guideline on record keeping, and a guideline, called AID (analysis of incidental deviations from expected service - in Slovene: analiza izjemnih dogodkov), on processing medical documentation. Effects of change - An overall drop was observed in the number of cases that caused problems (from 44% to 26%, p<0.001). The most common problem at baseline (19.4% of the problems) was the seventh most common at the re-evaluation, then contributing only 9.2% of total problems (p=0.02). Lessons learnt - The results support a quality improvement philosophy that empowers "owners" of the process to be the key resource in managing change, and they show the importance of the inner motivation of those involved. Despite working in a country undergoing transition, medical professionals were still willing to improve their performance. Nevertheless, structures and funding are needed to foster quality improvement initiatives and implement national policy on quality in health care.

Full Text

The Full Text of this article is available as a PDF (93K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Svab I. Primary health care reform in Slovenia: first results. Soc Sci Med. 1995 Jul;41(1):141–144. [PubMed]
  • Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993 Nov 27;342(8883):1317–1322. [PubMed]
  • Wensing M, Grol R. Single and combined strategies for implementing changes in primary care: a literature review. Int J Qual Health Care. 1994 Jun;6(2):115–132. [PubMed]

Articles from Quality in Health Care : QHC are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...