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Nordin, Annika
Publications (8 of 8) Show all publications
Nordin, A. & Ostrelius, M. (2018). How can contiuous quality improvement tools support systematic work environment management? Perspectives from practice and theory. In: : . Paper presented at 13th European Academy of Occupational Health Psychology Conference, 5-7 September 2018, Lisbon, Portugal.
Open this publication in new window or tab >>How can contiuous quality improvement tools support systematic work environment management? Perspectives from practice and theory
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-39524 (URN)
Conference
13th European Academy of Occupational Health Psychology Conference, 5-7 September 2018, Lisbon, Portugal
Available from: 2018-05-25 Created: 2018-05-25 Last updated: 2018-05-25Bibliographically approved
Nordin, A. & Gabrielsson-Järhult, F. (2018). Improvement knowledge in health and welfare. In: : . Paper presented at International Week in Health Care, Rehabilitation and Social Services, 12 to 16 of March 2018, Helsinki, Finland.
Open this publication in new window or tab >>Improvement knowledge in health and welfare
2018 (English)Conference paper, Oral presentation with published abstract (Other academic)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-38741 (URN)
Conference
International Week in Health Care, Rehabilitation and Social Services, 12 to 16 of March 2018, Helsinki, Finland
Available from: 2018-02-05 Created: 2018-02-05 Last updated: 2018-02-05Bibliographically approved
Nordin, A. (2018). Intangible outcomes of the work with a doctoral thesis. In: : . Paper presented at 13th European Academy of Occupational Health Psychology Conference, 5-7 September 2018, Lisbon, Portugal.
Open this publication in new window or tab >>Intangible outcomes of the work with a doctoral thesis
2018 (English)Conference paper, Oral presentation only (Refereed)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-39525 (URN)
Conference
13th European Academy of Occupational Health Psychology Conference, 5-7 September 2018, Lisbon, Portugal
Available from: 2018-05-25 Created: 2018-05-25 Last updated: 2018-05-25Bibliographically 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
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
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
Nordin, A. (2017). Expressions of shared interpretations - Intangible outcomes of continuous quality improvement efforts in health- and elderly care. (Doctoral dissertation). Jönköping: Jönköping University, School of Health and Welfare
Open this publication in new window or tab >>Expressions of shared interpretations - Intangible outcomes of continuous quality improvement efforts in health- and elderly care
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is anchored in improvement science, the research field of improvement. Improvement science describes and explores improvement in real-life contexts and “system of profound knowledge” (Deming, 2000) is a cornerstone. Performance measures, including their variation over time, are fundamental in the research and evaluation of outcomes of continuous quality improvement efforts (CQI efforts). However, the strong emphasis on operationalisations and measurements risks overshadowing other kinds of outcomes to which CQI efforts can lead.

Research has shown that it is advantageous that those performing change have some kind of “sharedness”, e.g. shared cognitions, understanding, knowledge, interpretations or frame of reference. Despite the diversity of concepts and scientific studies, “sharedness” is mainly described as a prerequisite for change.

This thesis addresses the call to broaden the scientific approach in improvement science and to take advantage of knowledge developed since Deming's time. It has a point of departure in the presumption that CQI efforts also lead to intangible outcomes; qualitative effects that are not easily captured with traditional performance measures. The concept “Expressions of shared interpretations” is used to study “sharedness” as intangible outcomes.

The overall aim with this thesis is to explore Expressions of shared interpretations as intangible outcomes of CQI efforts from the perspective of clinical microsystems and healthcare professionals. The specific aims are to examine and establish how Expressions of shared interpretations develop, influence CQI efforts and change over time.

Using a qualitative approach, this thesis comprises four papers, based on three studies. The empirical context is healthcare and welfare organizations providing care: hospital clinics in county councils/regions and nursing homes in municipalities. The studies include time periods from one to three and a half years, totalling six years. Expressions of shared interpretations inherently mean that the methods for data analysis need to be based on commonalities or patterns in the data. In this thesis three methods are used: qualitative content analysis, thematic analysis and directed content analysis. To examine time-related changes, year-to-year comparative analyses of themes and categories are done.

To explore Expressions of shared interpretations, different theoretical frameworks are used: team cognitions (Paper 1), sensemaking theory (Paper 2), cognitive shifts (Paper 3) and programme theories (Paper 4).

A directed content analysis is applied in a meta-analysis of the results presented in the four papers. The results indicate that Expressions of shared interpretations develop as intangible outcomes of CQI efforts and a general programme theory of CQI efforts in health- and elderly care is developed, illuminating how Expressions of shared interpretations change and influence CQI efforts. The general programme theory incorporates the PDSA cycle and describes the complex, interconnected and continuous development of Expressions of shared interpretations. It also illuminates how Expressions of shared interpretations provide change performers with momentum to engage in forthcoming PDSA cycles and how sensemaking is a central activity.

CQI efforts in health- and elderly care are characterised by a “just get on with it” attitude, while in this thesis, thoughtfulness is emphasized. Existing improvement tools support collaboration, creativity and analysis of critical aspects of the operations, yet none of the improvement tools help change performers gain understanding of the CQI effort as such. To address this, this thesis suggests that change performers complement the use of improvement tools with an inquiring mind, that they collaborate in thoughtful dialogues and that leaders function as inquirers. To support this posture, the widely used Model for improvement is complemented with a fourth question: What are our assumptions? The question pinpoints the need to be thoughtful in every step of the CQI effort, not just in the analysis of the problem at hand.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2017. p. 100
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 084
Keywords
Continuous quality improvement, Improvement science, Outcomes
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-37302 (URN)978-91-85835-83-6 (ISBN)
Public defence
2017-10-06, Qulturum, Region Jönköping County, Jönköping, 13:00 (English)
Opponent
Supervisors
Available from: 2017-09-13 Created: 2017-09-13 Last updated: 2017-12-14Bibliographically approved
Algurén, B. & Nordin, A. (2016). Så blir ditt register attraktiv för kliniknära förbättringsarbete: Noteringar från en pågående studie - angreppsätt för att förbättra ANVÄNDANDET av kvalitetsregister. In: : . Paper presented at Nationella kvalitetskonferensen, Göteborg, 12 april 2016.
Open this publication in new window or tab >>Så blir ditt register attraktiv för kliniknära förbättringsarbete: Noteringar från en pågående studie - angreppsätt för att förbättra ANVÄNDANDET av kvalitetsregister
2016 (Swedish)Conference paper, Oral presentation only (Other academic)
National Category
Health Sciences
Identifiers
urn:nbn:se:hj:diva-30906 (URN)
Conference
Nationella kvalitetskonferensen, Göteborg, 12 april 2016
Available from: 2016-06-28 Created: 2016-06-28 Last updated: 2016-06-28Bibliographically approved
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