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Publications (10 of 29) Show all publications
Avby, G. & Kjellström, S. (2019). LearnOvation: an intervention to foster exploration and exploitation behaviour in health care management in daily practice. BMC Health Services Research, 19(1), Article ID 319.
Open this publication in new window or tab >>LearnOvation: an intervention to foster exploration and exploitation behaviour in health care management in daily practice
2019 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 319Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Innovation has been identified as an important engine for improving the quality, productivity and efficiency of health care. Little is known about how to stimulate innovation capacity in primary health care in general; even less is known about how specific interventions should be designed to support managements' work with practice-based innovations. Research has shown that if managers and teams are excellent at handling the challenges of production (exploitation) and development (exploration), they are better at innovation. The aim of the study is to develop a dynamic management support programme to increase innovation leadership skills in daily practice.

METHODS: The study has an interactive approach that allows the need for empirical and theoretical knowledge to emerge and merge, and a quasi-experimental cross-over design. Eight primary health care centres will participate in the study. In the first phase, the management teams at four health care centres will participate in the intervention, and the other four centres will serve as a control group. Thereafter, the units will switch places and the control group will experience the intervention. All staff at the 8 units will answer questionnaires at four points in time (before, during, after, 6 months later) to evaluate the effects of the intervention.

DISCUSSION: The study will contribute to knowledge on how to organize processes of innovation and support exploitation and exploration behaviours by co-producing and testing a tailor-made management support programme for innovation work in primary health care. An expected long-term effect is that the support system will be disseminated to other centres both within and beyond the participating organizations.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Experimental cross-over design, Exploitation, Exploration, Health care research
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-43775 (URN)10.1186/s12913-019-4152-8 (DOI)000468786300007 ()31113453 (PubMedID)2-s2.0-85066506650 (Scopus ID)GOA HHJ 2019 (Local ID)GOA HHJ 2019 (Archive number)GOA HHJ 2019 (OAI)
Available from: 2019-05-27 Created: 2019-05-27 Last updated: 2019-06-17Bibliographically approved
Karlsson, H., Avby, G. & Svendsen, T. (2019). QUAT—a Tool for Evaluating the Quality of Core Assessments in Child-Protection Investigations. British Journal of Social Work, 49(7), 1875-1892
Open this publication in new window or tab >>QUAT—a Tool for Evaluating the Quality of Core Assessments in Child-Protection Investigations
2019 (English)In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, Vol. 49, no 7, p. 1875-1892Article in journal (Refereed) Published
Abstract [en]

This article presents a quantitative tool for evaluating the documentation quality of core assessments in child-protection investigations called the Quality Assessment of the Triangle (QUAT). QUAT measures compliance with a set of quality standards for working with the Swedish adaptation of the British Integrated Children’s System (ICS), and should be viewed as an attempt to further the UK-led efforts to improve child-protection investigations by promoting research-based documentation systems. This article describes how QUAT was developed and later applied to a random sample of case files provided by the social services in Stockholm City, Sweden, to demonstrate its usability in practice. The contribution of QUAT is two-fold: first, it offers a way for managers to stimulate workplace learning by providing continuous feedback on the documentation and, second, it may help researchers to evaluate the effectiveness of interventions aiming to improve professional performance in terms of documenting child-protection investigations.

Place, publisher, year, edition, pages
Oxford University Press, 2019
Keywords
Child protection, evaluation, investigative work in child protection, quality, quantitative methods
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-42612 (URN)10.1093/bjsw/bcy122 (DOI)000496759800011 ()2-s2.0-85074641155 (Scopus ID)
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-12-05
Avby, G., Kjellström, S. & Andersson Bäck, M. (2019). Tending to innovate in Swedish primary health care: a qualitative study. BMC Health Services Research, 19(1), Article ID 42.
Open this publication in new window or tab >>Tending to innovate in Swedish primary health care: a qualitative study
2019 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 42Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Policymakers in many countries are involved in system reforms that aim to strengthen the primary care sector. Sweden is no exception. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as innovation. The study was performed in relation to the introduction of a national health care reform, and conducted in Jönköping County Council, as the region's handling of health care reforms has attracted significant national and international interest. This study employed success case method to explore what enables primary care innovations.

METHODS: Five Primary Health Care Centres (PHCCs) were purposively selected to ensure inclusion of a variety of aspects, such as size, location, ownership and regional success criteria. 48 in-depth interviews with managers and staff at the recruited PHCCs were analysed using content analyses. The COREQ checklist for qualitative studies was used to assure quality standards.

RESULTS: This study identified three types of innovations, which break with previous ways of organizing work at these PHCCs: (1) service innovation; (2) process innovation; and (3) organizational innovation. A learning-oriented culture and climate, comprising entrepreneurial leadership, cross-boundary collaboration, visible and understandable performance measurements and ability to adapt to external pressure were shown to be advantageous for innovativeness.

CONCLUSIONS: This qualitative study highlights critical features in practice that support primary care innovation. Managers need to consistently transform and integrate a policy "push" with professionals' understanding and values to better support primary care innovation. Ultimately, the key to innovation is the professionals' engagement in the work, that is, their willingness, capability and opportunity to innovate.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Culture and climate for innovation, Health care reform, Innovation, Leadership, Practice features, Primary care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-42700 (URN)10.1186/s12913-019-3874-y (DOI)000456156900007 ()30658638 (PubMedID)2-s2.0-85060149714 (Scopus ID)GOA HHJ 2019 (Local ID)GOA HHJ 2019 (Archive number)GOA HHJ 2019 (OAI)
Available from: 2019-01-22 Created: 2019-01-22 Last updated: 2019-02-20Bibliographically approved
Areskoug Josefsson, K., Avby, G., Andersson Bäck, M. & Kjellström, S. (2018). Workers’ experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study. Scandinavian Journal of Primary Health Care, 36(4), 406-414
Open this publication in new window or tab >>Workers’ experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study
2018 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 4, p. 406-414Article in journal (Refereed) Published
Abstract [en]

Objective: Staff experiences of healthy work environment (HWE) indicators at primary care units can assist in understanding why some primary care units function better than others. The aim of the study was to create increased understanding of how workers experienced HWE indicators at well-functioning primary care units.

Design: Fifty in-depth interviews with staff at six primary care units in Sweden were analysed with deductive content analysis, revisiting a systematic review of HWE indicators.

Results: The study presents additional perspectives on staff experiences of HWE indicators at well-functioning primary care units. The included primary care units (PCU) shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges. Staff at the included PCUs were encouraged to work to create and sustain a HWE, but each domain (indicator) also provided challenges that the staff and organisation needed to meet. The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work.

Conclusions: Both managers and staff are encouraged to actively work not only to create and sustain an HWE but also to promote organisational virtuousness, employee commitment, joy at work and to increase the performance at work, which is of benefit to staff, patients and society.

Key Points

  • Staff at well-functioning primary care units (PCUs) experienced healthy work environments
  • The included PCUs shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges.
  • Staff at the included PCUs were encouraged to work to create and sustain a healthy work environment, but each domain (indicator) also provided challenges that the staff and organisation needed to meet.
  • The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work.
Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Occupational health, organisational performance, primary care, joy at work
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-41684 (URN)10.1080/02813432.2018.1523987 (DOI)000450634500008 ()30259767 (PubMedID)2-s2.0-85053887192 (Scopus ID)
Funder
AFA Insurance, 130343
Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2018-12-06Bibliographically approved
Avby, G., Kjellström, S. & Andersson Bäck, M. (2017). A reform as a lever for innovation and professionalism?. In: : . Paper presented at NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden.
Open this publication in new window or tab >>A reform as a lever for innovation and professionalism?
2017 (English)Conference paper, Oral presentation only (Refereed)
Abstract [en]

Introduction: Consistently with international trends, managerial reforms and incentive systems in Sweden have been introduced to achieve quality improvement and increased efficiency in welfare services. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as service transformations or innovation.

Aim: In this study we explore how organizational performance are changing within the context of a patient choice reform in primary healthcare.

Material and Methods: This qualitative study is based on 48 semi-structured interviews with various professions (managers, physicians, nurses, physical- and occupational therapists, care administrators, and nurse assistants) at five PHCCs, conducted as part of a study designed to explore financial incentives and motivation in PHC in Sweden. The PHCCs were purposively selected to ensure the inclusion of both public and private facilities. All centers had a longstanding reputation for good leadership and high quality care. 

Results: The findings show how professional fields and traits were dissolving and changing, triggering the emergence of innovative solutions in practice. Through ongoing negotiations of professional boundaries new practices unfolded and professionalism increasingly was achieved through contextual conditions. The expanding and changing of professional boundaries as shown in the study are implied to stimulate innovative processes. Thus, the main findings suggest that innovative practices developed as a relationship between contextual conditions and professionalism. E.g. nurses and physical therapists remitted patients directly to the hospital, multiprofessional teams for patient groups with joint needs handled patients that previous needed hospital care, and nurse assistants became responsible for summing patients with minor hypertension for blood pressure controls and consultations.

Conclusions: The reform seemed to act as a lever for innovation and professionalism under certain conditions. How work is organized and managed is a contextual factor that not only affects work circumstances, but also provides conditions for innovation and professionalism. Impartial to governments’ ambitions to improve their responsiveness to the needs of citizens by altering market rules, new provider models may be of little assistance in achieving the desired effect on health sector reform outcomes if suitable contextual conditions are missing.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38454 (URN)
Conference
NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden
Note

Nordiska ministerrådets nätverk

Available from: 2018-01-11 Created: 2018-01-11 Last updated: 2018-01-15Bibliographically approved
Kjellström, S., Avby, G., Areskoug Josefsson, K., Andersson-Gäre, B. & Andersson Bäck, M. (2017). De komplexa drivkrafterna inom vård och omsorg - en fallstudie av finansiella incitament och dess konsekvenser ur ett arbetsmiljöperspektiv: Slutrapport. AFA Försäkring
Open this publication in new window or tab >>De komplexa drivkrafterna inom vård och omsorg - en fallstudie av finansiella incitament och dess konsekvenser ur ett arbetsmiljöperspektiv: Slutrapport
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2017 (Swedish)Report (Other academic)
Abstract [sv]

Olika ekonomiska drivkrafter och ersättningssystem används för att öka effektiviteten inom vård och omsorg. Forskningen visar dock att de ofta hamnar i konflikt med personalens motivation och normer. Studien har undersökt hur så kallade finansiella instrument påverkar patienters och anställdas upplevelse av arbetsmiljö och vårdkvalitet.

Place, publisher, year, edition, pages
AFA Försäkring, 2017
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-42561 (URN)
Funder
AFA Insurance
Note

Huvudförfattare: Sofia Kjellström

Available from: 2019-01-09 Created: 2019-01-09 Last updated: 2019-01-28Bibliographically approved
Andersson Bäck, M., Kjellström, S. & Avby, G. (2017). Identity work of successful primary care managers and competing institutional logics. In: : . Paper presented at EGOS 2017. 33rd EGOS Colloquium: The Good Organization: Aspirations, Interventions, Struggles, Copenhagen, July 6–8, 2017. European Group for Organizational Studies (EGOS)
Open this publication in new window or tab >>Identity work of successful primary care managers and competing institutional logics
2017 (English)Conference paper, Oral presentation with published abstract (Refereed)
Place, publisher, year, edition, pages
European Group for Organizational Studies (EGOS), 2017
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38433 (URN)
Conference
EGOS 2017. 33rd EGOS Colloquium: The Good Organization: Aspirations, Interventions, Struggles, Copenhagen, July 6–8, 2017
Note

European Group for Organizational Studies, Sub-theme 57: The Multiplicity of Institutional Logics.

Available from: 2018-01-10 Created: 2018-01-10 Last updated: 2018-09-11Bibliographically approved
Avby, G., Nilsen, P. & Ellström, P.-E. (2017). Knowledge use and learning in everyday social work practice: A study in child investigation work. Child & Family Social Work, 22(Supplement S4), 51-61
Open this publication in new window or tab >>Knowledge use and learning in everyday social work practice: A study in child investigation work
2017 (English)In: Child & Family Social Work, ISSN 1356-7500, E-ISSN 1365-2206, Vol. 22, no Supplement S4, p. 51-61Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore knowledge use and learning among social workers in everyday child investigation work. Research was undertaken in two Swedish children’s services departments. The study applied an ethnographic approach. Methods for data collection included interviews, participant observations, reflective dialogues and a documentary analysis of case files. The social workers’ knowledge sources were classified into research-based, practice-based and ordinary knowledge. The findings show that the social workers preferred practice-based knowledge, which was primarily conveyed from colleagues and previous experience, and rarely consulted knowledge from sources found outside the practice setting. Furthermore, the findings suggest that the integration of knowledge was made possible through the social workers' engagement in both a verbal and a more cognitive (tacit) reasoning activity, processes that fostered learning at work. The social workers’ learning was predominantly adaptive as they learned to handle tasks in a fairly routinized way on the basis of rules or procedures. The findings lend support to the notion that the use of different knowledge forms could potentially trigger learning in everyday social work.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Child and family social work, ethnography, reserach in practice, evidence-based practice, knowledge use, learning
National Category
Work Sciences
Identifiers
urn:nbn:se:hj:diva-31194 (URN)10.1111/cfs.12227 (DOI)000426000400006 ()2-s2.0-84925046374 (Scopus ID)
Available from: 2015-03-11 Created: 2016-08-09 Last updated: 2018-10-22Bibliographically approved
Kjellström, S., Avby, G., Andersson Bäck, M., Areskoug Josefsson, K. & Andersson-Gäre, B. (2017). Leadership as a driver for work motivation: a study of well-functioning primary healthcare centers in Sweden. In: : . Paper presented at NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden.
Open this publication in new window or tab >>Leadership as a driver for work motivation: a study of well-functioning primary healthcare centers in Sweden
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2017 (English)Conference paper, Oral presentation only (Refereed)
Abstract [en]

Introduction: Little is known about how, why, or under which circumstances work motivation is formed and linked to reforms and interventions.

Aim: The aim of this study is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives.

Material & method: Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. Forty-three interviews were completed with different medical professions and qualitative deductive content analysis was conducted.

Results: Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers’ positive management was due to a unique combination of factors, such as clear direction of goals, a culture of nonhierarchical collaboration, and systematic quality improvement work. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. The units expressed a collective capacity to produce direction, alignment and commitment.

Conclusions: The design of the reforms and leadership are essential preconditions for work motivation. Leaders need to consistently translate and integrate reforms with the professionals’ drives and values. This is done by encouraging participation through teamwork, time for structured reflection and quality improvement work. The values of the study consist of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms, and how professionals collectively produce leadership.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy Work Sciences
Identifiers
urn:nbn:se:hj:diva-38455 (URN)
Conference
NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden
Note

Nordiska ministerrådets nätverk

Available from: 2018-01-11 Created: 2018-01-11 Last updated: 2018-10-02Bibliographically approved
Andersson Bäck, M., Kjellström, S. & Avby, G. (2017). Medical manager hybrids for handling institutional complexity and change in primary care. In: : . Paper presented at NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden.
Open this publication in new window or tab >>Medical manager hybrids for handling institutional complexity and change in primary care
2017 (English)Conference paper, Oral presentation only (Refereed)
Abstract [en]

Introduction: This article deals with hybrid persons combining medical professionalism and management for handling institutional complexity and change in primary care. Primary care and identity are in transition in many western countries, in Sweden emphasized by the 2007 reform for patient choice and competition. Research has shown that embedded hybrid actors, familiar and socialized in a field and to its logics, tend to be influential for handling complexity and change. Yet hydrids and their enactment in primary care is an underexplored area.

Aim: The aim is to contribute to our understanding of hybrid persons and how they are combining medical professionalism and management in primary care, while managing complexity and change.

Material and methods: In a case study of six successful primary healthcare centers, public and private, covering 56 interviews and observations with various professions, two medical managers ‘hybrids’ showed to be particularly interesting. These were analyzed in-depth, including analysis of staff’s and colleagues’ experiences and contrasted by other managers and hybrids. For the analysis we draw on institutional logic perspective (Thornton, Occasion & Lounsbury 2012) in order to capture preconditions as well as enactment of such change agents.

Results/conclusions: The hydrids contributed to innovation, creativity and learning in their primary care centres. At their workplace, coherence and a good ambience coexisted with feelings of high work pace and lacking role clarity among the multidisciplinary staff. Categorized in line with McGivern and colleagues(2015) term as ‘willing hybrids’, the persons studied revealed high ambitions to challenge existing institutional order giving professionalism new forms, while seeking to innovate practices and division of work among healthcare staff in primary care. By doing so the hybrids integrated professionalism and managerialism and were influential in reframing problems and solutions, which aligned several logics at play. However several obstacles related to professional as well as bureaucratic issues appeared along the way.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38439 (URN)
Conference
NOVO 11th Symposium, “Measures to meet Nordic challenges for sustainable health care organizations”, 9-10 November 2017, Gothenburg, Sweden
Note

Nordiska ministerrådets nätverk

Available from: 2018-01-10 Created: 2018-01-10 Last updated: 2018-01-15Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6784-0133

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