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Nordin, A. & Areskoug Josefsson, K. (2019). Behavioural and operational outcomes of a Master’s programme on improvement knowledge and leadership: A survey study. Leadership in Health Services
Open this publication in new window or tab >>Behavioural and operational outcomes of a Master’s programme on improvement knowledge and leadership: A survey study
2019 (English)In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose: The purpose of this paper is to evaluate behavioural changes and operational outcomes resulting from a Master’s programme on improvement knowledge and leadership in the Swedish welfare sector. The welfare sector is the collective term for tax-funded services the state, county councils and municipalities are responsible to provide.

Design/methodology/approach: A survey combined open-ended and closed questions using a five-point Likert scale. The questions were based on the learning objectives of the Master’s programme. The survey was sent to 139 graduates and achieved a response rate of 41 per cent (57 respondents). Responses were entered into a survey programme to enable the descriptive presentation of data; open-ended responses were analysed using conventional content analysis.

Findings: Respondents reported their increased knowledge and changed behaviours had impacted operational outcomes, e.g. processes efficiency, compliance with guidelines and quality. They said the programme was of value to themselves and society but requested more leadership knowledge. All respondents recommended the programme to others.

Originality/value: By operationalizing the Kirkpatrick framework, the paper describes outcomes on levels three and four, and the use of numerous best practice techniques for adult learning. This is valuable knowledge for organisers of improvement knowledge educations.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2019
Keywords
Curricula, Improvement knowledge, Leadership, Operational outcomes, adult, article, behavior change, content analysis, education, female, human, human experiment, learning, Likert scale, major clinical study, male, outcome assessment, practice guideline, welfare
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-45443 (URN)10.1108/LHS-09-2018-0049 (DOI)2-s2.0-85069467419 (Scopus ID)
Available from: 2019-08-05 Created: 2019-08-05 Last updated: 2019-08-22
Algurén, B., Nordin, A., Andersson-Gäre, B. & Peterson, A. (2019). In-depth comparison of two quality improvement collaboratives from different healthcare areas based on registry data - Possible factors contributing to sustained improvement in outcomes beyond the project time. Implementation Science, 14(1), Article ID 74.
Open this publication in new window or tab >>In-depth comparison of two quality improvement collaboratives from different healthcare areas based on registry data - Possible factors contributing to sustained improvement in outcomes beyond the project time
2019 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 14, no 1, article id 74Article in journal (Refereed) Published
Abstract [en]

Background: Quality improvement collaboratives (QICs) are widely used to improve healthcare, but there are few studies of long-term sustained improved outcomes, and inconsistent evidence about what factors contribute to success. The aim of the study was to open the black box of QICs and compare characteristics and activities in detail of two differing QICs in relation to their changed outcomes from baseline and the following 3 years.

Methods: Final reports of two QICs - one on heart failure care with five teams, and one on osteoarthritis care with seven teams, including detailed descriptions of improvement projects from each QIC's team, were analysed and coded by 18 QIC characteristics and four team characteristics. Goal variables from each team routinely collected within the Swedish Heart Failure Registry (SwedeHF) and the Better Management of Patients with OsteoArthritis Registry (BOA) at year 2013 (baseline), 2014, 2015 and 2016 were analysed with univariate statistics.

Results: The two QICs differed greatly in design. The SwedeHF-QIC involved eight experts and ran for 12 months, whereas the BOA-QIC engaged three experts and ran for 6 months. There were about twice as many activities in the SwedeHF-QIC as in the BOA-QIC and they ranged from standardisation of team coordination to better information and structured follow-ups. The outcome results were heterogeneous within teams and across teams and QICs. Both QICs were highly appreciated by the participants and contributed to their learning, e.g. of improvement methods; however, several teams had already reached goal values when the QICs were launched in 2013.

Conclusions: Even though many QI activities were carried out, it was difficult to see sustained improvements on outcomes. Outcomes as specific measurable aspects of care in need of improvement should be chosen carefully. Activities focusing on adherence to standard care programmes and on increased follow-up of patients seemed to lead to more long-lasting improvements. Although earlier studies showed that data follow-up and measurement skills as well as well-functioning data warehouses contribute to sustained improvements, the present registries' functionality and QICs at this time did not support those aspects sufficiently. Further studies on QICs and their impact on improvement beyond the project time should investigate the effect of those elements in particular. 

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Collaboratives, Data warehouses, Learning, Measurement skills, Quality improvement, Teams
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-45508 (URN)10.1186/s13012-019-0926-y (DOI)000477011600001 ()31337394 (PubMedID)2-s2.0-85069773796 (Scopus ID)GOA HHJ 2019 (Local ID)GOA HHJ 2019 (Archive number)GOA HHJ 2019 (OAI)
Funder
Swedish Association of Local Authorities and Regions
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-08-12Bibliographically approved
Suutari, A.-M., Areskoug Josefsson, K., Kjellström, S., Nordin, A. & Thor, J. (2019). Promoting a sense of security in everyday life—A case study of patients and professionals moving towards co-production in an atrial fibrillation “learning café”. Health Expectations
Open this publication in new window or tab >>Promoting a sense of security in everyday life—A case study of patients and professionals moving towards co-production in an atrial fibrillation “learning café”
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2019 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background

An improvement initiative sought to improve care for atrial fibrillation (AF) patients; many felt insecure about how to cope with AF.

Objective

To reveal AF patients' and professionals' experiences of pilot-testing a Learning Café group education programme, aimed at increasing the patients' sense of security in everyday life.

Design

Using an organizational case study design, we combined quantitative data (patients' sense of security) and qualitative data (project documentation; focus group interviews with five patients and five professionals) analysed using inductive qualitative content analysis.

Setting

AF patients and a multiprofessional team at a cardiac care unit in a Swedish district hospital.

Improvement activities

Two registered nurses invited AF patients and partners to four 2.5-hour Learning Café sessions. In the first session, they solicited participants' questions about life with AF. A physician, a registered nurse and a physiotherapist were invited to address these questions in the remaining sessions.

Results

AF patients reported gaining a greater sense of security in everyday life and anticipating a future shift from emergency care to planned care. Professionals reported enhanced professional development, learning more about person-centredness and gaining greater control of their own work situation. The organization gained knowledge about patient and family involvement.

Conclusions

The Learning Café pilot test?exemplifying movement towards co-production through patient-professional collaboration?generated positive outcomes for patients (sense of security), professionals (work satisfaction; learning) and the organization (better care) in line with contemporary models for quality improvement and with Self-Determination Theory. This approach merits further testing and evaluation in other contexts.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
atrial fibrillation, coping behaviours, co-production, health-care quality improvement, patient education, Self-Determination Theory
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-45651 (URN)10.1111/hex.12955 (DOI)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, SwedenForte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2019-08-22 Created: 2019-08-22 Last updated: 2019-08-22
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
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2480-1641

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