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Table 3 Top-down – a coercive and demanding imposition

From: The meaning of quality work from the general practitioner's perspective: an interview study

Reasons for and against
"It (quality work) is mostly something we do because you've got to have something, since we (the organization) are supposed to have something according to the National Board of Health and Welfare."
"The power of the patients has got bigger and bigger, they feel that they have that support from ... well, I don't know where they have the support from, whether it's from the regulations of the National Board of Health and Welfare or what it is, but they have it ... I suppose it has changed a bit here. The patient's position has really been strengthened a lot."
"I suppose that's what you want (as a doctor) after all, a bit of guidance so that there's some equality."
"Just like so many other things, this is very much imposed top-down, but that doesn't change very much in practice."
"What little you can control you are very concerned about ... if something comes from outside that you suspect is supposed to control you, then there's a great risk that you'll show your claws."
"The resistance concerns time above all. You feel that it takes time away from time that you don't have."
The methods
"I think it would be more appropriate to call it a control system."
"Far too big and didn't suit our work, in primary care."
"This here (quality assurance system), our very own system that we sometimes take out to see if we fulfil ... and then we go through it and reflect, have we done this and that, does this work, have we written up, and things like that."
"We have some systematic work locally at the health centre too, you could say, for we have a quality council and we work with things here at the health centre that we perceive as important."