Interpretive adaptability and siloization of quality in intensive care: a multi-level, qualitative analysis

Purpose Healthcare organizations increasingly rely on measurement practices to assess and improve care quality. However, how “quality” is conceptualized across different levels of the healthcare system remains unclear. This study explores perceptions of quality and quality indicators in intensive care, using two Swedish ICUs as case studies. Design/methodology/approach The study examines two general ICUs in Sweden and is based on 16 semi-structured interviews with stakeholders at operational, clinical and national levels, complemented by document analysis. The documents include materials related to ICU operational development and national guidelines for knowledge management. Findings The study identifies divergent – and at times conflicting – views on what constitutes relevant quality indicators in intensive care. It introduces two interrelated themes: interpretive adaptability, referring to the flexible meanings of quality depending on context, audience and institutional demands; and siloization of quality conceptualizations, describing how understandings of quality often evolve within professional and organizational silos, with limited cross-level communication or mutual awareness. Practical implications The findings highlight the complexity of “quality” in healthcare and call for more reflexive and inclusive dialogues around quality assurance. A more collaborative and comprehensive approach may strengthen efforts to improve care. Originality/value This study provides a unique empirical perspective on the varied meanings of quality in healthcare. It offers both theoretical and practical insights into the disconnect between formalized quality indicators and how key actors interpret and engage with the concept of quality.