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Andersson-Gäre, BoelORCID iD iconorcid.org/0000-0003-1176-8173
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Publications (10 of 38) Show all publications
Nyström, M. E., Karltun, J., Keller, C. & Andersson Gäre, B. (2018). Collaborative and partnership research for improvement of health and social services: researcher’s experiences from 20 projects. Health Research Policy and Systems, 16, Article ID 46.
Open this publication in new window or tab >>Collaborative and partnership research for improvement of health and social services: researcher’s experiences from 20 projects
2018 (English)In: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 16, article id 46Article in journal (Refereed) Published
Abstract [en]

Background

Getting research into policy and practice in healthcare is a recognised, world-wide concern. As an attempt to bridge the gap between research and practice, research funders are requesting more interdisciplinary and collaborative research, while actual experiences of such processes have been less studied. Accordingly, the purpose of this study was to gain more knowledge on the interdisciplinary, collaborative and partnership research process by investigating researchers’ experiences of and approaches to the process, based on their participation in an inventive national research programme. The programme aimed to boost collaborative and partnership research and build learning structures, while improving ways to lead, manage and develop practices in Swedish health and social services.

Methods

Interviews conducted with project leaders and/or lead researchers and documentation from 20 projects were analysed using directed and conventional content analysis.

Results

Collaborative approaches were achieved by design, e.g. action research, or by involving practitioners from several levels of the healthcare system in various parts of the research process. The use of dual roles as researcher/clinician or practitioner/PhD student or the use of education designed especially for practitioners or ‘student researchers’ were other approaches. The collaborative process constituted the area for the main lessons learned as well as the main problems. Difficulties concerned handling complexity and conflicts between different expectations and demands in the practitioner’s and researcher’s contexts, and dealing with human resource issues and group interactions when forming collaborative and interdisciplinary research teams. The handling of such challenges required time, resources, knowledge, interactive learning and skilled project management.

Conclusions

Collaborative approaches are important in the study of complex phenomena. Results from this study show that allocated time, arenas for interactions and skills in project management and communication are needed during research collaboration to ensure support and build trust and understanding with involved practitioners at several levels in the healthcare system. For researchers, dealing with this complexity takes time and energy from the scientific process. For practitioners, this puts demands on understanding a research process and how it fits with on-going organisational agendas and activities and allocating time. Some of the identified factors may be overlooked by funders and involved stakeholders when designing, performing and evaluating interdisciplinary, collaborative and partnership research.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Collaborative research, co-production, integrated knowledge translation, partnership research, quality improvement, healthcare, social services
National Category
Information Systems, Social aspects
Identifiers
urn:nbn:se:hj:diva-39675 (URN)10.1186/s12961-018-0322-0 (DOI)000433968800001 ()29843735 (PubMedID)2-s2.0-85047814253 (Scopus ID)
Available from: 2018-06-01 Created: 2018-06-01 Last updated: 2019-02-14Bibliographically approved
Andersson, A.-C., Melke, A., Andersson Gäre, B. & Golsäter, M. (2018). Identification of children as relatives with a systematic approach; a prerequisite in order to offer advice and support. Quality Management in Health Care, 27(3), 172-177
Open this publication in new window or tab >>Identification of children as relatives with a systematic approach; a prerequisite in order to offer advice and support
2018 (English)In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 27, no 3, p. 172-177Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to elucidate conditions at all system levels in a specific health care service to develop practices for identification of children as relatives. An interactive research approach with the intention to create mutual learning between practice and research was used. The participating health care service cared for both clinic in- and outpatients with psychiatric disorders. Health care professionals from different system levels (micro, meso, macro) participated, representing different professions. At the first project meeting, it was obvious that there was no systematic approach to identify children as relatives. At the micro level, activities such as a pilot survey and an open house activity were carried out. At the meso level, it was discussed how to better support collaboration between units. At the management (macro) level, it was decided that all units should appoint at least one child agent, with the aim to increase collaboration throughout the whole health care service. To change focus, in this case from only parents to inclusion of children, is an important challenge faced by health care services when forced to incorporate new policies and regulations. The new regulations contribute to increased complexity in already complex organizations. This study highlights that such challenges are underestimated.

Place, publisher, year, edition, pages
Wolters Kluwer, 2018
Keywords
health care system, identification of children as relatives, incorporation of new regulations, interactive research, micro-level perspectives
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-41184 (URN)10.1097/QMH.0000000000000181 (DOI)000436873500010 ()29944630 (PubMedID)2-s2.0-85049356843 (Scopus ID)
Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2018-08-20Bibliographically approved
Nordin, A., Andersson-Gäre, B. & Andersson, A.-C. (2018). Prospective sensemaking of a national quality register in health care and elderly care. Leadership in Health Services, 31(4), 398-408
Open this publication in new window or tab >>Prospective sensemaking of a national quality register in health care and elderly care
2018 (English)In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 31, no 4, p. 398-408Article in journal (Refereed) Published
Abstract [en]

Purpose

The purpose of this paper is to examine how external change agents (ECAs) engaged to disseminate a national quality register (NQR) called Senior alert nationwide in the Swedish health care and elderly care sectors interpret their work. To study this, sensemaking theories are used.

Design/methodology/approach

This is a qualitative inductive interview study including eight ECAs. To analyze the data, a thematic analysis is carried out.

Findings

Well-disseminated NQRs support health care organizations’ possibility to work with quality improvement and to improve care for patient groups. NQRs function as artifacts that can influence how health care professionals make sense of their work. In this paper, a typology depicting how the ECAs make sense of their dissemination work has been developed. The ECAs are engaged in prospective sensemaking. They describe their work as being about creating future good results, both for patients and affiliated organizations, and they can balance different quality aspects.

Originality/value

The number of NQRs increased markedly in Sweden and elsewhere, but there are few reports on how health care professionals working with the registers interpret their work. The use of ECAs to disseminate NQRs is a novel approach. This paper describes how the ECAs are engaged in prospective sensemaking – an under-researched perspective of the sensemaking theory.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2018
Keywords
External change agents, Quality registers, Sensegivers, Sensemaking theory
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-37299 (URN)10.1108/LHS-03-2017-0012 (DOI)000445062000004 ()30234450 (PubMedID)2-s2.0-85040221428 (Scopus ID)
Available from: 2017-09-13 Created: 2017-09-13 Last updated: 2019-03-05Bibliographically 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
Nordin, A., Andersson-Gäre, B. & Andersson, A.-C. (2018). Sensemaking and cognitive shifts – learning from dissemination of a National Quality Register in health care and elderly care. Leadership in Health Services, 31(4), 371-383
Open this publication in new window or tab >>Sensemaking and cognitive shifts – learning from dissemination of a National Quality Register in health care and elderly care
2018 (English)In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 31, no 4, p. 371-383Article in journal (Refereed) Published
Abstract [en]

Purpose

The purpose of this study is to examine and establish how sensemaking develops among a group of external change agents (ECAs) engaged to disseminate a national quality register nationwide in Swedish health care and elderly care. To study the emergent sensemaking, the theoretical concept of cognitive shift has been used.

Design/methodology/approach

The data collection method included individual semi-structured interviews, and two sets of interviews (initial sensemaking and renewed sensemaking) have been conducted. Based on a typology describing how ECAs interpret their work, structural analyses and comparisons of initial and renewed sensemaking are made and illuminated in spider diagrams. The data are then analyzed to search for cognitive shifts.

Findings

The ECAs’ sensemaking develops. Three cognitive shifts are identified, and a new kind of issue-related cognitive shift, the outcome-related cognitive shift, is suggested. For the ECAs to customize their work, they need to be aware of how they interpret their own work and how these interpretations develop over time.

Originality/value

The study takes a novel view of the interrelated concepts of sensemaking and sensegivers and points out the cognitive shifts as a helpful theoretical concept to study how sensemaking develops.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2018
Keywords
External change agents, Quality registers, Cognitive shifts
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-37300 (URN)10.1108/LHS-03-2017-0013 (DOI)000445062000002 ()30234448 (PubMedID)2-s2.0-85040218718 (Scopus ID)
Available from: 2017-09-13 Created: 2017-09-13 Last updated: 2019-03-05Bibliographically approved
Knutsson, S., Enskär, K., Andersson-Gäre, B. & Golsäter, M. (2017). Children as relatives to a sick parent: Healthcare professionals’ approaches. Nordic journal of nursing research, 37(2), 61-69
Open this publication in new window or tab >>Children as relatives to a sick parent: Healthcare professionals’ approaches
2017 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 37, no 2, p. 61-69Article in journal (Refereed) Published
Abstract [en]

An illness or injury sustained by a family member affects all family members. It is consequently important that a child’s need to be involved in a family member’s care is clearly recognized by healthcare professionals. The aim of this study was to describe healthcare professionals’ approaches to children as relatives of a parent being cared for in a clinical setting. A web-based study-specific questionnaire was sent and responded to by 1052 healthcare professionals in Sweden. Data were analysed using descriptive statistics and qualitative analysis. The results show that guidelines and routines are often lacking regarding involving children in the care of a parent. Compared to other areas, psychiatric units seem to have enacted routines and guidelines to a greater extent than other units. The results indicate that structured approaches based on an awareness of the children’s needs as well as a child-friendly environment are vital in family-focused care. These aspects need to be prioritized by managers in order to support children’s needs and promote health and wellbeing for the whole family.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
child; children as relatives; healthcare professionals; ill parent; web questionnaire
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-34082 (URN)10.1177/2057158516662538 (DOI)
Available from: 2016-11-23 Created: 2016-11-23 Last updated: 2017-09-06Bibliographically 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
Nordin, A., Andersson-Gäre, B. & Andersson, A.-C. (2017). Emergent programme theories of a national quality register - a longitudinal study in Swedish elderly care. Journal of Evaluation In Clinical Practice, 23(6), 1329-1335
Open this publication in new window or tab >>Emergent programme theories of a national quality register - a longitudinal study in Swedish elderly care
2017 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, no 6, p. 1329-1335Article in journal (Refereed) Published
Abstract [en]

Rationale, aim, and objective: This study aimed to explore programme theories of a national quality register. A programme theory is a bundle of assumptions underpinning how and why an improvement initiative functions. The purpose was to examine and establish programme theories of a national quality register widely used in Sweden: Senior alert. The paper reports on how programme theories among change recipients emerge in relation to the established programme theory of the initiator.

Methods: A qualitative approach and a longitudinal research design were used. To develop programme theories among change recipients, individual semistructured interviews were conducted. Three sets of interviews were conducted in the period of 2011 to 2013, totalling 22 interviews. In addition, 4 participant observations were made. To develop the initiator's programme theory, an iterative multistage collaboration process between the researchers and the initiator was used. A directed content analysis was used to analyse data.

Findings: The initiator and change recipients described similar programme logics, but differing programme theories. With time, change recipients' programme theories emerged. Their programme theories converged and became more like the programme theory of the initiator.

Conclusions: This study has demonstrated the importance of making both the initiator's and change recipients' programme theories explicit. To learn about conditions for improvement initiatives, comparisons between their programme theories are valuable. Differences in programme theories provide information on how initiators can customize support for their improvement initiatives. Similar programme logics can be underpinned by different programme theories, which can be deceptive. Programme theories emerge over time and need to be understood as dynamic phenomena. 

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Clinical guidelines, Healthcare, National quality registers, Programme theory
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-37224 (URN)10.1111/jep.12782 (DOI)000418713100026 ()28748651 (PubMedID)2-s2.0-85026366236 (Scopus ID)
Available from: 2017-09-08 Created: 2017-09-08 Last updated: 2018-01-11Bibliographically 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
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1176-8173

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