IntroductionThe prevailing inequities in healthcare have been well addressed in previous research, especially screening program participation, but less attention has been paid to how to overcome these inequities. This paper explores a key factor of a successful improvement project: collaboration with local doulas to raise cervical cancer screening participation by more than 40 percent in an area with a large number of foreign-born residents.MethodsData was collected through two focus group discussions with the doulas in order to design interventions and debrief after interventions had been carried out in the community. Various tools were used to analyze the verbal data and monitor the progress of the project.ResultsThree major themes emerged from the focus group discussions: barriers that prevent women from participating in the cervical cancer screening program, interventions to increase participation, and the role of the doulas in the interventions.ConclusionsThis paper suggests that several barriers make participation in cervical cancer screening program more difficult for foreign-born women in Sweden. Specifically, these barriers include lack of knowledge concerning cancer and the importance of preventive healthcare services and practical obstacles such as unavailable child care and language skills. The overarching approach to surmount these barriers was to engage persons with a shared cultural background and mother tongue as the target audience to verbally communicate information. The doulas who helped to identify barriers and plan and execute interventions gained increased confidence and a sense of pride in assisting to bridge the gap between healthcare providers and users.

This paper describes a statistically based engineering method, variation mode and effect analysis (VMEA), that facilitates an understanding of variation and highlights the product/process areas in which improvement efforts should be targeted. An industrial application is also described to illustrate how the VMEA can be used for quality improvement purposes.

The Skaraborg Hospital Group (SkaS) has implemented a variety of quality management initiatives in the last 20 years in accordance with its strategy of excelling at quality development to fulfill the needs and expectations of its patients. One such initiative is Six Sigma, which has contributed to more than 40 completed improvement projects. Using an action research approach, this article describes the lessons that were learned from the first 22 Six Sigma projects, completed between 2006 and 2008 and having a success rate of 75%. We further describe how these insights have contributed to other ongoing quality improvement activities at SkaS. In particular, the paper presents some key points not earlier described in other Six Sigma healthcare applications.

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