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Kilander, H., Brynhildsen, J., Alehagen, S., Fagerkrantz, A. & Thor, J. (2019). Collaboratively seeking to improve contraceptive counselling at the time of an abortion: A case study of quality improvement efforts in Sweden. BMJ Sexual and Reproductive Health, 45(3), 190-199
Open this publication in new window or tab >>Collaboratively seeking to improve contraceptive counselling at the time of an abortion: A case study of quality improvement efforts in Sweden
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2019 (English)In: BMJ Sexual and Reproductive Health, ISSN 2515-1991, Vol. 45, no 3, p. 190-199Article in journal (Refereed) Published
Abstract [en]

Background Many women find it difficult to choose and initiate a contraceptive method at the time of an abortion. There is a gap between regular clinical practice and existing evidence on motivational and person-centred counselling, as well as on use of long-acting reversible contraception (LARC). This study aims to describe and evaluate a Quality Improvement Collaborative (QIC) designed to enhance contraceptive services, with regard to changes in healthcare professionals' (HCPs') counselling in clinical practice, and in women's subsequent choice of, and access to, contraception. Methods Three multiprofessional teams working in abortion services from three hospitals in Sweden, and two women contributing with user experience, participated in a QIC during the period March-November 2017. Using a case study design, we collected and analysed both quantitative and qualitative data. Results Teams agreed on QIC goals, including that ≥50% of women would start LARC within 30 days post-abortion, and tested multiple evidence-based changes, aided by the two women's feedback. During the QIC, participating HCPs reported that they gained new knowledge and developed skills in contraceptive counselling at the time of an abortion. The teams welcomed the development of a performance feedback system regarding women's post-abortion contraception. While the majority of women counselled during the QIC chose LARC, only 20%-40% received it within 30 days post-abortion. Conclusion The QIC, incorporating user feedback, helped HCPs to develop capability in providing contraceptive services at the time of an abortion. Timely access to LARC remains a challenge in the present setting.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
accessibility, long- acting reversible contraception, person-centred counselling, pregnancy termination, quality improvement collaboratives, user involvement
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-45494 (URN)10.1136/bmjsrh-2018-200299 (DOI)31289100 (PubMedID)2-s2.0-85068865866 (Scopus ID)
Funder
Medical Research Council of Southeast Sweden (FORSS)Futurum - Academy for Health and Care, Jönköping County Council, Sweden
Available from: 2019-08-08 Created: 2019-08-08 Last updated: 2019-08-08Bibliographically approved
Bergerum, C., Thor, J., Josefsson, K. & Wolmesjö, M. (2019). How might patient involvement in healthcare quality improvement efforts work—A realist literature review. Health Expectations
Open this publication in new window or tab >>How might patient involvement in healthcare quality improvement efforts work—A realist literature review
2019 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625Article, review/survey (Refereed) Epub ahead of print
Abstract [en]

Introduction

This realist literature review, regarding active patient involvement in healthcare quality improvement (QI), seeks to identify possible mechanisms that contribute to success or failure. Furthermore, the paper outlines key considerations for organizing and supporting patient involvement in healthcare QI efforts.

Methods

Two literature searches were performed. Altogether, 1204 articles from a healthcare context were screened, focusing on improvement efforts that involve patients, healthcare professionals and/or managers and leaders. Among these, 107 articles fulfilled the chosen study selection criteria and were further analysed. Eighteen articles underwent a full realist review. In the realist synthesis, context-mechanism-outcome configurations were articulated as middle-range theories and organized thematically to generate a program theory on how active patient involvement in QI efforts might work.

Results

The articles exhibited a diversity of patient involvement approaches at different levels of healthcare organizations. To be successful, organizations? support of QI efforts that actively involved patients tailored the QI efforts to their context to achieve the desired outcomes, and involved the relevant microsystem members. Furthermore, it promoted interaction and partnership within the microsystem, and supported the behavioural change that follows.

Conclusion

This realist synthesis generates a program theory for active patient involvement in QI efforts; active patient involvement can be a tool (resource), if tailored for interaction and partnership (reasoning), that leads to behaviour change (outcome) within healthcare QI efforts. The theory explains essential resource and reasoning mechanisms, and outcomes that together form guidance for healthcare organizations when managing active patient involvement in QI efforts.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
clinical microsystem, co-design, co-production, healthcare management, healthcare organization, patient involvement, quality improvement, realist review
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-43571 (URN)10.1111/hex.12900 (DOI)
Available from: 2019-05-03 Created: 2019-05-03 Last updated: 2019-05-03
Holmqvist, M., Thor, J., Ros, A. & Johansson, L. (2019). "I trust my physician but want to be involved"  - Older persons' Experiences of regarding evaluation of their medication treatment. In: : . Paper presented at International Association of Gerontology and Geriatrics European Region Congress 2019, 23rd – 25th May 2019, Gothenburg, Sweden.
Open this publication in new window or tab >>"I trust my physician but want to be involved"  - Older persons' Experiences of regarding evaluation of their medication treatment
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-43790 (URN)
Conference
International Association of Gerontology and Geriatrics European Region Congress 2019, 23rd – 25th May 2019, Gothenburg, Sweden
Available from: 2019-05-27 Created: 2019-05-27 Last updated: 2019-06-03Bibliographically approved
Thor, J. (2019). Kvalitet och förbättringsarbete i hemsjukvård (1 uppl.ed.). In: Mirjam Ekstedt & Maria Flink (Ed.), Hemsjukvård: olika perspektiv på trygg och säker vård (pp. 282-293). Stockholm: Liber
Open this publication in new window or tab >>Kvalitet och förbättringsarbete i hemsjukvård
2019 (Swedish)In: Hemsjukvård: olika perspektiv på trygg och säker vård / [ed] Mirjam Ekstedt & Maria Flink, Stockholm: Liber, 2019, 1 uppl., p. 282-293Chapter in book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Liber, 2019 Edition: 1 uppl.
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-43382 (URN)9789147112777 (ISBN)
Available from: 2019-03-25 Created: 2019-03-25 Last updated: 2019-03-25Bibliographically approved
Suutari, A.-M. & Thor, J. (2018). ‘Learning Café’ group education program with atrial fibrillation patients – a model for co-production. In: : . Paper presented at International Forum on Quality and Safety in Healthcare, 2-4 May 2018, Amsterdam, the Netherlands.
Open this publication in new window or tab >>‘Learning Café’ group education program with atrial fibrillation patients – a model for co-production
2018 (English)Conference paper, Oral presentation only (Other academic)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-39185 (URN)
Conference
International Forum on Quality and Safety in Healthcare, 2-4 May 2018, Amsterdam, the Netherlands
Available from: 2018-04-19 Created: 2018-04-19 Last updated: 2018-10-15Bibliographically approved
Algurén, B., Andersson Gäre, B., Thor, J. & Andersson, A.-C. (2018). Quality indicators and their regular use in clinical practice – results from a survey among users of two cardiovascular National Registries in Sweden. International Journal for Quality in Health Care, 30(10), 786-792
Open this publication in new window or tab >>Quality indicators and their regular use in clinical practice – results from a survey among users of two cardiovascular National Registries in Sweden
2018 (English)In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 30, no 10, p. 786-792Article in journal (Refereed) Published
Abstract [en]

Objective: To examine the regular use of quality indicators from Swedish cardiovascular National Quality Registries (NQRs) by clinical staff; particularly differences in use between the two NQRs and between nurses and physicians.

Design: Cross-sectional online survey study.

Setting: Two Swedish cardiovascular NQRs: a) Swedish Heart Failure Registry and b) Swedeheart.

Participants: Clinicians (n=185; 70% nurses, 26% physicians) via the NQRs’ email networks.

Main outcome measures: Frequency of NQR use for a) producing healthcare activity statistics; b) comparing results between similar departments; c) sharing results with colleagues; d) identifying areas for quality improvement (QI); e) surveilling the impact of QI efforts; f) monitoring effects of implementation of new treatment methods; g) doing research; h) educating and informing healthcare professionals and patients.

Results: Median use of NQRs was ten times a year (25th and 75th percentiles range: 3 – 23 times/year). Quality indicators from the NQRs were used mainly for producing healthcare activity statistics. Median use of Swedeheart was six times greater than SwedeHF (p<0.000). Physicians used the NQRs more than twice as often as nurses (18 vs. 7.5 times/year; p<0.000) and perceived NQR work more often as meaningful. Around twice as many Swedeheart users had the role to participate in data analysis and in QI efforts compared to SwedeHF users.

Conclusions: Most respondents used quality indicators from the two cardiovascular NQRs infrequently (< 3 times/year). The results indicate that linking registration of quality indicators to using them for QI activities increases their routine use and makes them meaningful tools for professionals.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
Quality indicators, Quality Registry, meaningful usage, quality improvement, eHealth
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-39220 (URN)10.1093/intqhc/mzy107 (DOI)000457587100007 ()29762660 (PubMedID)2-s2.0-85060401965 (Scopus ID)
Available from: 2018-04-25 Created: 2018-04-25 Last updated: 2019-03-01Bibliographically approved
Andersson, A.-C., Andersson Gäre, B., Thor, J. & Lenrick, R. (2018). Rapport om utvärdering av IVO:s lärande tillsyn. Jönköping: Jönköping Academy for Improvement of Health and Welfare
Open this publication in new window or tab >>Rapport om utvärdering av IVO:s lärande tillsyn
2018 (Swedish)Report (Other academic)
Abstract [sv]

Inspektionen för vård och omsorg (IVO) har i sin tillsynspolicy lagt fokus på att främja lärande för att stödja utvecklingen av god kvalitet och säkerhet i vård och omsorg. Under 2017 har IVO givit Jönköping Academy for Improvement of Health and Welfare vid Jönköping University i uppdrag att utvärdera tillämpning av lärande tillsyn. Syftet med denna studie var att belysa om, och om möjligt hur, IVO:s tillsyn kan stödja verksamhetsutveckling och förbättring i de tillsynade verksamheter. Det finns många teoribildningar kring lärande och kvalitetsutveckling. Denna rapport tar utgångspunkt i teorier om organisatoriskt lärande, samskapande och förbättringskunskap och belyser vad som kan bidra, och i så fall hur, till en ömsesidig tillit som leder till ett fördjupat lärande som grund för förbättring.

Studien omfattar två tillsyner, där deltagarna bestod av personal från de berörda verksamheterna, samt IVO-inspektörer från de regionala IVO avdelningar. Det empiriska materialet samlades in genom intervjuer och en observation. En dokumentgenomgång av relevanta IVO dokument skapade underlag för utvecklandet av studiens intervjuguider. Intervjuerna bandades, transkriberades och analyserades med en metod inspirerad av tematisk analys, som utmynnade i fem teman: (I) Förberedelse inför tillsyn; (II) Genomförande i verksamheten; (III) Resultat i verksamheten; (IV) Förutsättningar för lärande; och (V) Önskemål för ökat lärande. Samtliga teman innehåller både förhållanden som stödjer (främjar) och som försvårar (hindrar) lärande:

  • Förberedelsearbetet ansågs inte bidra till en ökad tillit som förutsättning för lärande. Det uttrycktes en önskan om mer samskapande i förberedelsearbetet redan innan tillsynstillfället
  • Det framkom önskemål om att lärandet, som ett av målen med tillsynen, skulle lyftas tydligare i dialogen vid tillsynstillfället.
  • Det uppfattades som svårt att peka på reella resultat i verksamheterna som direkt berodde på tillsynen, men det beskrevs ändå som viktigt att tillsynen fanns.
  • Det fanns olika uppfattningar om hur IVO:s roll som tillsynsmyndighet påverkade lärandet. Ett större fokus på gemensam uppföljning skulle vara ett sätt att optimera lärandet både i verksamheterna och hos IVO:s inspektörer.
  • Ett lärande skulle gynnas av en tydlig gemensam problembeskrivning, samt fortlöpande uppföljningar och delad kunskap, exempelvis genom goda exempel och dialogkonferenser.

Generellt fanns en stor samstämmighet mellan IVO:s inspektörer och de verksamhetsföreträdare som intervjuats, men vissa skillnader framkom också. Rapporten avslutas med några avslutande reflektioner.

Place, publisher, year, edition, pages
Jönköping: Jönköping Academy for Improvement of Health and Welfare, 2018. p. 17
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38964 (URN)
Available from: 2018-03-06 Created: 2018-03-06 Last updated: 2018-03-06Bibliographically approved
Odhagen, E., Sunnergren, O., Söderman, A.-C. H., Thor, J. & Stalfors, J. (2018). Reducing post-tonsillectomy haemorrhage rates through a quality improvement project using a Swedish National quality register: a case study. European Archives of Oto-Rhino-Laryngology, 275(6), 1631-1639
Open this publication in new window or tab >>Reducing post-tonsillectomy haemorrhage rates through a quality improvement project using a Swedish National quality register: a case study
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2018 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 275, no 6, p. 1631-1639Article in journal (Refereed) Published
Abstract [en]

Tonsillectomy (TE) is one of the most frequently performed ENT surgical procedures. Post-tonsillectomy haemorrhage (PTH) is a potentially life-threatening complication of TE. The National Tonsil Surgery Register in Sweden (NTSRS) has revealed wide variations in PTH rates among Swedish ENT centres. In 2013, the steering committee of the NTSRS, therefore, initiated a quality improvement project (QIP) to decrease the PTH incidence. The aim of the present study was to describe and evaluate the multicentre QIP initiated to decrease PTH rates.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Quality improvement project, Post-tonsillectomy haemorrhage, Tonsillectomy, Healthcare quality improvement
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-39068 (URN)10.1007/s00405-018-4942-3 (DOI)000432207000032 ()29574597 (PubMedID)2-s2.0-85044359728 (Scopus ID)
Available from: 2018-03-28 Created: 2018-03-28 Last updated: 2019-01-21Bibliographically approved
Schmidt, I., Thor, J., Davidson, T., Nilsson, F. & Carlsson, C. (2018). The national program on standardized cancer care pathways in Sweden: Observations and findings half way through. Health Policy, 122(9), 945-948
Open this publication in new window or tab >>The national program on standardized cancer care pathways in Sweden: Observations and findings half way through
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2018 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 122, no 9, p. 945-948Article in journal (Refereed) Published
Abstract [en]

In 2015, the Swedish government initiated a national cancer reform program to standardize cancer care pathways. Primary aims included shortened waiting times among patients with suspected cancer, increased patient satisfaction and reduced regional variation. The implementation phase of the program is now more than half way through and both achievements and challenges have been identified. The ongoing evaluation demonstrates that professional engagement and adjustments on the meso- and micro-level of the system are essential to achieving sustainable improvements. Waiting times have shortened for the pathways launched first, and patients are satisfied with a more transparent process. Physicians in primary care are satisfied to inform patients about the pathways but point out problems with comorbidity and complicated diagnostic procedures related to unspecific symptoms. Mechanisms and ethical considerations behind possible crowding-out effects need to be thoroughly highlighted and discussed with staff and management. The results so far appear promising but meso- and micro-levels of the system need to be more involved in the design processes.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Cancer care, Microsystem perspective, Primary health care, Standardized pathways
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:hj:diva-41906 (URN)10.1016/j.healthpol.2018.07.012 (DOI)000445311500003 ()30075866 (PubMedID)2-s2.0-85050683269 (Scopus ID)
Available from: 2018-10-26 Created: 2018-10-26 Last updated: 2018-11-02Bibliographically approved
Kilander, H., Berterö, C., Thor, J., Brynhildsen, J. & Alehagen, S. (2018). Women's experiences of contraceptive counselling in the context of an abortion – An interview study. Sexual & Reproductive HealthCare, 17, 103-107
Open this publication in new window or tab >>Women's experiences of contraceptive counselling in the context of an abortion – An interview study
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2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 17, p. 103-107Article in journal (Refereed) Published
Abstract [en]

Objective: To identify and understand women's lived experiences of contraceptive counselling given at the same time as abortion counselling.

Methods: We interviewed 13 women aged 20–39 who had experienced an abortion and the related counselling. The women were recruited from five hospitals in Sweden. Interviews were analysed using an interpretative phenomenological approach.

Results: We identified two themes: need for respectful counselling and needs for guidance and access to contraceptives. The essence “Being in a state of limbo and feeling sceptical” was coalesced from the themes. The women described a state of limbo, as being caught in an unwanted and emotionally charged situation. They reported that respectful counselling and meeting a skilled health professional helped to dispel their scepticism and influenced their plans for contraceptive use post abortion. Furthermore, women who wanted an intrauterine device described difficulties in access post abortion.

Conclusion: The women seem to have a limited receptivity to contraceptive counselling when they have an unwanted pregnancy and are sceptical about contraceptives. Women, who experience respect in the counselling, report being helped in contraceptive decision-making. To receive respectful counselling and to have good access to intrauterine devices emerged as central needs among women at the time of an abortion.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Accessibility, Contraception, Family planning, Intrauterine device, Pregnancy termination, Respect
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-41555 (URN)10.1016/j.srhc.2018.07.007 (DOI)000445980700018 ()30193713 (PubMedID)2-s2.0-85051253988 (Scopus ID)
Available from: 2018-09-24 Created: 2018-09-24 Last updated: 2018-12-19Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1814-4478

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