Purpose – The aim of this paper is to contribute to the knowledge of who engages in quality improvement initiatives and to describe whether staff professions or gender are relevant variables.

Design/methodology/approach – This paper contains an evaluation of the participants in a specific defined strategic improvement initiative program in one county council in southeast Sweden. The improvement program was initiated by county council politicians to encourage improvement initiatives and to spread improvement skills and knowledge in the organization. The program is driven both “top down” (teaching/convincing line managers to demand improvements) and “bottom up” through improvement programs using methodology to help teams identify, plan and adopt improvements in their daily work. Data was collected from special applications (called Free Applications, FA) and from participants in the education program (called Improvement Program, IP), both of which include information about profession and 2 gender. A content analysis was made. After the first categorization of which types of improvement projects practitioners engage in, further analysis of staff disciplines, professions (hierarchy) and gender was done. The results were compared to the overall structure of staff presence in the county council.

Findings – Changes in participation occurred over time. The FA (Free Applications) part (n=202) shows a higher share of leaders and managers (35%), but their participation in the IP (Improvement Program) (n=477) fluctuated (8-26%). Physicians were more represented in the FA than in the IP. The largest single group was nurses. Overall the gender perspective reflects the conditions of the county council, but in FA the representation of women was lower. Five types of improvement projects were identified: 1) Organizational process focus; 2) Evidence and quality; 3) Competence development; 4) Process Technology; and 5) Proactive patient work. Managers were most represented in the category “Organizational process”. The largest difference was seen in the category “Proactive patient work” with the highest occurrence among women (86%) and less among men (17%) and managers (21%). The patient as a contributor taking active part was not found in either the FA or the IP.

Research limitations/implications – This study shows differences in participation between free applications and methodology-guided programs when it comes to professions and gender in the country council improvement drive. It may be useful for further research regarding how to successfully work for and implement improvements and change in healthcare environments.

Practical implications – The study will discuss and contribute to further knowledge of whether profession, hierarchy and gender have an impact (obstructive or as an asset) in performing improvement work in healthcare settings.

Originality/value - Not much has been written about who is accomplishing quality improvements in terms of profession and gender. This paper provides some valuable insights into the differences between staff categories (professions) and gender in the improvement work in Swedish healthcare.