Healthcare is in constant change with fast development in knowledge, new technology and varying needs and expectations from patients, citizens, management, and politicians. There is a challenge in balancing the involved actors´ focus, needs, preferences, and resources for healthcare improvement. Improvement of healthcare is an ongoing activity, sometimes managed and controlled, often not. A key ingredient for success is competence where the need for competence varies with perspectives of the improving actors. Actors in healthcare improvement are professionals, patients, politicians, management, citizens, researchers, research foundations and others. In this report a review of frameworks in healthcare improvement are presented together with management myths and questions around needs for healthcare improvement competence and capabilities currently on the agenda.

Most improvement initiatives of some size have substantial parts of IT and have had so for a considerable time. This rather long experience of more and less successful IT implementation and use is transparent and useful in all kinds of healthcare improvement. One important issue in this report is what has real impact is the actual understanding and use of innovations and artefacts by healthcare actors in a broad sense for healthcare improvement (e.g., new clinical evidence, clinical guidelines, process changes, information systems and more). The aim in this report is to review frameworks which can be useful in healthcare improvement as well as in the study of healthcare improvement.

Conclusions concern what is found to be important to study and understand healthcare improvement, considering the presented frameworks. Improvement of healthcare is present in all the frameworks but in different ways and what is emphasized concerning scope and focus. Improving healthcare take place in the interaction of at least two parts, one of which is healthcare professionals, and another is the patient/next-of-kin. Professionals and patient populations interact in processes of social networks and structures. Actors and context are useful concepts for understanding action (use) and its social contexts. The actual use of innovations is best understood in terms of integration into clinical activities and processes – actors’ interaction, coordination and communication activities and processes.

Theoretical implications are that there is a need for more research concerning meso and macro perspectives on methods for healthcare improvement, and the interplay of perspectives regarding the understanding of improvement in healthcare. Of course, a challenge is that the objects of improvement are complex adaptive systems of healthcare is not easily to catch in simple rules. They are genuinely difficult both to change and evaluate changes. Practical implications of the report support design and contents of education programs in improvement of healthcare, in better understanding usefulness, practice, use, and experience base. To help the understanding of the need and usefulness of integrating different perspectives for successful healthcare improvement, e.g., micro, meso, and macro perspectives, use of mixed methods and more. 

A recent trend in health care is patient-centred health, but are health care organizations ready to cope with that change? Changes at the patient level are one aspect but there is a need for reshaping the organization of health care. There is a need to focus much more on prevention care, helping patients to cope and become better self-managers, focusing on the patient process, working together and empowering patients. The aim of this paper is to gain a better understanding of the lack of sustainability over time in two patient-centred care (PCC) projects by using actor network theory (ANT) as an analytical framework. We use case studies from heart fibrillation and heart failure care organizations in a Swedish county council. The cases concern initiatives to achieve better interactions for these patients and organize care to become more patient-centred. Both initiatives have now been partly abandoned in the organization, although research and guidelines recommend such care organizations. The analysis of the different actors dominating the translation process towards a PCC network and of the way they get together in networks reveals that this is a time-consuming process, taking place long after the initial training and PCC implementation activities. We discuss the temporality of stability, the reversible process with chimerical enrolments, and how a complex and changing environment demands constant re-problematization of PCC.  We also include how the understanding of the translation and negotiation process can influence decisions on allocating sufficient time and resources to the process. We shed light on the importance of understanding and managing the organizational change in a PCC project and thus also of when to implement patient-centred e-health solutions.

This paper investigates the conditions for the assimilation of information systems (IS) and information technology (IT) in organizations and the influence of various actors in the organization and eBusiness context. To do so it draws on the literature on assimilation gap, sociomateriality and infrastructure together with a study of implementation and use of information and communication technology in and among organizations in a Swedish region. There were substantial investments in web infrastructure made on a regional level and the focus of this study is how the investments were transformed and assimilated in practices, relations and communication. Based on the empirical data from the case study, the paper extends the assimilation process into interplay among actors in organizations contexts. It describes organizations’ strategies for coping with their needs for information and the actors in these processes. Two categories of actors are identified, sensemaking and sensegiving actors, as most important in assimilation of IS/IT in organizations. A sociomaterial perspective gives guidance and a better understanding of the assimilation process in terms of knowledge and interpretative frames, and how assimilation involves identity construction and negotiations among sensemaking and sensegiving actors. The contribution of this paper is a better understanding of the context of assimilation and adaptation of IT in organizations’ business processes, and steps to be taken to improve readiness.

Within dominant branches of contemporary research and public debate, applications like Facebook and Twitter are perceived as social media for user participation. Technical possibilities and socio cultural restrictions for user involvement are identified and discussed. Common to both perspectives is that users’ willingness to participate tends to be taken for granted. By studying a case where the users’ response indicates weak willingness to participate, despite the website producers’ efforts to offer social media for participation, this article wish to contribute to a better understanding of the conditions for online participation on the so-called social Web.

UMO is a very popular Swedish health promoting website intended for offering adolescents knowledge and advisory service on sexual, reproductive and psychical health. In 2010 UMO extended the use of social media by opening a Facebook fan page. One of the reasons was to attract new segments of the target audience, another was to make adolescents become fans. More than a year after the start, none of this have developed in accordance with the intentions and expectations. Analyses of data, gained from a content analysis of UMO’s Facebook fan page besides completing interviews with the administrator of the fan page and adolescent users of UMO, indicates a whole set of possible explanations for UMO’s shortcomings.

The study shows on yet another problem with uncritically asserting that the new Web 2.0 and social media benefit participation. What has been overlooked is that obstacles to participation might as well be sought from the participants themselves, and be an active choice by the audience. The bottom line is that mediatization does not describe a fait accompli, and that socio-cultural change in its wake in no way is universal, but rather is characterized by a set of particularities.

UMO ist eine populäre schwedische Website zu gesundheitsbezogenen Themen, auf der Jugendliche Wissen und Beratung zu den Themen sexuelle Gesundheit, Fortpflanzung und psychische Gesundheit finden können. Nachdem UMO sich 2010 dazu entschlossen hatte, eine Facebook Fan Page zu gründen, um unter anderem neue Segmente der Zielgruppe anzusprechen und Jugendliche als Fans zu gewinnen, haben sich diese Erwartungen nach über einem Jahr nicht erfüllt. Die Analyse der Daten, die aus einer Inhaltsanalyse der UMO Facebook Fan Page sowie ergänzenden Interviews mit dem Administrator der Fan Page und jugendlichen Nutzerinnen und Nutzern von UMO gewonnen wurden, weisen auf mögliche Ursachen hin.

Purpose – ICT has considerable importance for increasing productivity and growth. Using ICT requires resources to create value. As resources are more limited in smaller enterprises, and the contexts and conditions for using ICT in SMEs are not well known, the purpose is to investigate conditions in the context of sensemaking for ICT adoption and use among SMEs.

Design/methodology/approach – This study uses a qualitative and explorative methodological point of departure and approach. More than 60 interviews are performed within a geographical region. Empirical data were analyzed for similarities and patterns into themes and topics.

Findings – The article was able to highlight the conditions for using ICT in SMEs by applying a qualitative research approach. The important findings from this research as a formative ICT infrastructure can be viewed as constituted by needs identified among SMEs, in sensemaking, sensegiving, and service infrastructures. In SMEs there are less infrastructure and fewer overhead and support services than in larger enterprises. The adoption processes in SMEs differ from the ones in larger enterprises in that they rely more on external relations in a public infrastructure for sensemaking in ICT adoption and use.

Research limitations/implications – Formative ICT infrastructure in SMEs is not a well-known concept. The need for formative infrastructure in ICT adoption and use in SMEs relies on external partners and other actors in the sensemaking and sensegiving processes. Further research is needed for understanding actors and roles better, as well as arenas for sensemaking ICT in SMEs.

Practical implications – Designing the infrastructure for ICT use and development, particularly in SMEs, but also in other enterprises and organizations, requires better understanding of the conditions. The emphasis on infrastructure for ICT adoption processes will help SMEs to receive more relevant investments.

Originality/value – The study integrates micro- and macro-perspectives and combines theories from different fields to extend the knowledge of formative infrastructure for SME's adoption and use of ICT in terms of firm size and dependency on public infrastructure.

The paper presents findings from a research study of an information systems master program in Sweden, targeting healthcare professionals. The aim of the study was to explore if and how mechanisms of empowerment and reflective practice can be evoked in healthcare professionals by participating in a master program in information systems. A mixed research methodology was applied, including participant observation, document analysis and a learning style inventory. The findings of the study showed signs of the students achieving a higher degree of empowerment in their professional roles, as well as beginning to actively use reflective practice as a means of professional development. The findings are summarised in a tentative framework of reflective empowerment. The findings call for further research on how IT-centred master programs targeting healthcare professional could enhance professional development.

Innovations in health care are often characterized by complexity and fuzzy boundaries, involving both the elements of the innovation and the organizational structure required for a full implementation. Evaluation in health care is traditionally based on the collection and dissemination of evidence-based knowledge stating the randomized controlled trial, and the quasi-experimental study design as the most rigorous and ideal approaches. These evaluation approaches capture neither the complexity of innovations in health care, nor the characteristics of the organizational structure of the innovation. As a result, the reasons for innovations in health care not being disseminated are not fully explained. The aim of the paper is to present a design-evaluation framework for complex innovations in health care in order to understand what works for whom under what circumstances combining design theory and realist evaluation. The framework is based on research findings of a case study of a complex innovation, a health care quality register, in order to understand underlying assumptions behind the design of the innovation, as well as the characteristics of the implementation process. The design-evaluation cycle is hypothesized to improve the design and implementation of complex innovation by using program/kernel theories to develop design principles, which are evaluated by realistic evaluation, resulting in further refinement of program/kernel theories. The goal of the design-evaluation cycle is to provide support to implementers and practitioners designing and implementing complex innovations in health care, for improving dissemination of complex innovations.