Objective: To systematically review the literature regarding how statistical process control-with control charts as a core tool-has been applied to healthcare quality improvement, and to examine the benefits, limitations, barriers and facilitating factors related to such application. Methods: A standardised data abstraction form was used for extracting data relevant to the review questions, and the data were analysed thematically. Results: Statistical process control was applied in a wide range of settings and specialties, at diverse levels of organisation and directly by patients, using 97 different variables. The review revealed 12 categories of benefits, 6 categories of limitations, 10 categories of barriers, and 23 factors that facilitate its application and all are fully referenced in this report. Statistical process control helped different actors manage change and improve healthcare processes. It also enabled patients with, for example asthma or diabetes mellitus, to manage their own health, and thus has therapeutic qualities. Its power hinges on correct and smart application, which is not necessarily a trivial task. This review catalogues 11 approaches to such smart application, including risk adjustment and data stratification. Conclusion: Statistical process control is a versatile tool which can help diverse stakeholders to manage change in healthcare and improve patients' health.

The demand for biogas is continuously growing and the biogas substrate, such as food waste, may soon become limited and it is therefore important for biogas producers to expand the range of substrates. One way can be to use microalgae in co-digestion with sewage sludge.The present study explores the possibilities to use harvested microalgae from Lake Mälaren, as a co-substrate to sewage sludge in biogas production under mesophilic and thermophilic conditions. The aim is to investigate if codigestion of microalgae and sewage sludge is more efficient for biogas production compared using the sludge alone. The study has been carried out as a BMP-experiment (Biochemical Methane Potential) in batch fermentation bottles. The substrate was undigested sludge where 0%, 12 %, 25 % and 37 % were replaced with the cultivated microalgae. The results showed that the use of an algae/bacteria community, cultivated in prior to digestion, can serve as a biomass substrate for biogas production together with municipal wastewater sludge. Co-digestion of microalgae and sewage sludge can be more efficient for biogas production compared to using the sludge alone under mesophilic conditions. It can also be concluded that thermophilic co-digestion between the microalgae and sludge give lower biochemical methane potential.

Purpose -This study aims at empirically examining developmental trends in management practices and improvement work in healthcare organizations.Design/methodology/approach -We surveyed the managers of all primary healthcare centers (n = 1031) and clinical hospital departments (n = 1542) nationwide in the spring of 2007. The response rate was 46%. This article compares results from this survey with a study that was made in 2003. A theoretical framework based on organizational inner context, organizational outer context, external environment and outcomes form the base for the analysis. Comparisons were made using an independent two-sample t-test.Findings -A general aspect, identified empirically, is the tendency toward increased external pressure on the leaders in their improvement work. Higher management decisions, patient pressure and decisions made by policymakers have increasingly influenced and shaped the choices made by health care managers about where to focus efforts of improvement. Three different trends are empirically identified and elaborated upon in the article: Take-control logics; practice-based improvement and patient-centeredness.Practical implications -Health care leaders should carefully design new management control systems so that they support healthcare micro systems in their improvement

This research examines a subjective Bayesian model's ability to predict organizational change outcomes and sustainability of those outcomes for project teams participating in a multi-organizational improvement collaborative.

8At municipal waste water treatment plants algae could be utilized for cleaning the water 9 and in the same time produce biomass that can be used for energy utilization. By 10 anaerobic digestion the microalgae can contribute to biogas production when co-