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Sensemaking and cognitive shifts – learning from dissemination of a National Quality Register in health care and elderly care
Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).ORCID-id: 0000-0003-1176-8173
Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.ORCID-id: 0000-0003-0409-1985
2018 (engelsk)Inngår i: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 31, nr 4, s. 371-383Artikkel i tidsskrift (Fagfellevurdert) 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.

sted, utgiver, år, opplag, sider
Emerald Group Publishing Limited, 2018. Vol. 31, nr 4, s. 371-383
Emneord [en]
External change agents, Quality registers, Cognitive shifts
HSV kategori
Identifikatorer
URN: urn:nbn:se:hj:diva-37300DOI: 10.1108/LHS-03-2017-0013ISI: 000445062000002PubMedID: 30234448Scopus ID: 2-s2.0-85040218718OAI: oai:DiVA.org:hj-37300DiVA, id: diva2:1140896
Tilgjengelig fra: 2017-09-13 Laget: 2017-09-13 Sist oppdatert: 2019-03-05bibliografisk kontrollert
Inngår i avhandling
1. Expressions of shared interpretations - Intangible outcomes of continuous quality improvement efforts in health- and elderly care
Åpne denne publikasjonen i ny fane eller vindu >>Expressions of shared interpretations - Intangible outcomes of continuous quality improvement efforts in health- and elderly care
2017 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
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.

sted, utgiver, år, opplag, sider
Jönköping: Jönköping University, School of Health and Welfare, 2017. s. 100
Serie
Dissertation Series. School of Health and Welfare, ISSN 1654-3602 ; 084
Emneord
Continuous quality improvement, Improvement science, Outcomes
HSV kategori
Identifikatorer
urn:nbn:se:hj:diva-37302 (URN)978-91-85835-83-6 (ISBN)
Disputas
2017-10-06, Qulturum, Region Jönköping County, Jönköping, 13:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2017-09-13 Laget: 2017-09-13 Sist oppdatert: 2017-12-14bibliografisk kontrollert

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