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What is best for Esther? A simple question that moves mindsets and improves care
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership. Region Jönköping County, Jönköping, Sweden.ORCID iD: 0000-0002-9104-920X
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership.ORCID iD: 0000-0003-0409-1985
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Region Jönköping County, Jönköping, Sweden.ORCID iD: 0000-0002-2202-4818
Jönköping University, School of Engineering, JTH, Supply Chain and Operations Management.ORCID iD: 0000-0003-4853-3140
2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, p. 1-16, article id 873Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Persons in need of services from different care providers in the health and welfare system often struggle when navigating between them. Connecting and coordinating different health and welfare providers is a common challenge for all involved. This study presents a long-term regional empirical example from Sweden-ESTHER, which has lasted for more than two decades-to show how some of those challenges could be met. The purpose of the study was to increase the understanding of how several care providers together could succeed in improving care by transforming a concept into daily practice, thus contributing with practical implications for other health and welfare contexts.

METHODS: The study is a retrospective longitudinal case study with a qualitative mixed-methods approach. Individual interviews and focus groups were performed with staff members and persons in need of care, and document analyses were conducted. The data covers experiences from 1995 to 2020, analyzed using an open inductive thematic analysis.

RESULTS: This study shows how co-production and person-centeredness could improve care for persons with multiple care needs involving more than one care provider through a well-established Quality Improvement strategy. Perseverance from a project to a mindset was shaped by promoting systems thinking in daily work and embracing the psychology of change during multidisciplinary, boundary-spanning improvement dialogues. Important areas were Incentives, Work in practice, and Integration, expressed through trust in frontline staff, simple rules, and continuous support from senior managers. A continuous learning approach including the development of local improvement coaches and co-production of care consolidated the integration in daily work.

CONCLUSIONS: The development was facilitated by a simple question: "What is best for Esther?" This question unified people, flattened the hierarchy, and reminded all care providers why they needed to improve together. Continuously focusing on and co-producing with the person in need of care strengthened the concept. Important was engaging the people who know the most-frontline staff and persons in need of care-in combination with permissive leadership and embracing quality improvement dimensions. Those insights can be useful in other health and welfare settings wanting to improve care involving several care providers.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023. Vol. 23, no 1, p. 1-16, article id 873
Keywords [en]
Co-production, Collaboration, Complex care, Mindset, Perseverance, Person centeredness, Quality improvement, System-thinking
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:hj:diva-62253DOI: 10.1186/s12913-023-09870-1ISI: 001050063400002PubMedID: 37592279Scopus ID: 2-s2.0-85168289821Local ID: GOA;;898130OAI: oai:DiVA.org:hj-62253DiVA, id: diva2:1790478
Funder
Region Jönköping CountyEuropean Social Fund (ESF)Available from: 2023-08-23 Created: 2023-08-23 Last updated: 2023-08-29Bibliographically approved

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Vackerberg, NicolineAndersson, Ann-ChristinePeterson, AnetteKarltun, Anette

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BMC Health Services Research
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