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  • 1.
    Acheampong, Faustina
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, Jönköping International Business School, JIBS, Centre for Information Technology and Information Systems (CenITIS). Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Innovating healthcare through remote monitoring: Effects and business model2017In: Health Care Delivery and Clinical Science: Concepts, Methodologies, Tools, and Applications, IGI Global, 2017, p. 247-268Chapter in book (Other academic)
    Abstract [en]

    Information technology has been suggested to improve patient health outcomes and reduce healthcare cost. This study explored the business model and effects of collaborative innovation between caregivers and patients on healthcare delivery through remote patient monitoring by interviewing caregivers and surveying atrial fibrillation patients. Findings indicate that remote monitoring enhanced early detection of potential risks and quality of clinical decision-making with patients feeling more empowered and involved in their own care. The remote monitoring system which consisted of a home-based ECG and a web-based service and was offered free to patients, brought together caregivers, patients, service provider and the government as actors. The introduction of remote monitoring increased the workload of caregivers and facilitation of timely diagnostics and decision-making were not realized. IT is an enabler of innovation in healthcare, but it must be integrated into work processes with a viable business model to realize potential benefits and sustain it. 

  • 2.
    Adams, Mary
    et al.
    King’s College London, UK.
    Maben, Jill
    King’s College London, UK.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). King’s College London, UK.
    ‘It’s sometimes hard to tell what patients are playing at’: How healthcare professionals make sense of why patients and families complain about care2018In: Health, ISSN 1363-4593, E-ISSN 1461-7196, Vol. 22, no 6, p. 603-623Article in journal (Refereed)
    Abstract [en]

    This article draws from sociological and socio-legal studies of dispute between patients and doctors to examine how healthcare professionals made sense of patients’ complaints about healthcare. We analyse 41 discursive interviews with professional healthcare staff working in eight different English National Health Service settings to explore how they made sense of events of complaint and of patients’ (including families’) motives for complaining. We find that for our interviewees, events of patients’ complaining about care were perceived as a breach in fundamental relationships involving patients’ trust or patients’ recognition of their work efforts. We find that interviewees rationalised patients’ motives for complaining in ways that marginalised the content of their concerns. Complaints were most often discussed as coming from patients who were inexpert, distressed or advantage-seeking; accordingly, care professionals hearing their concerns about care positioned themselves as informed decision-makers, empathic listeners or service gate-keepers. We find differences in our interviewees’ rationalisation of patients’ complaining about care to be related to local service contingences rather than to fixed professional differences. We note that it was rare for interviewees to describe complaints raised by patients as grounds for improving the quality of care. Our findings indicate that recent health policy directives promoting a view of complaints as learning opportunities from critical patient/consumers must account for sociological factors that inform both how the agency of patients is envisaged and how professionalism exercised contemporary healthcare work.

  • 3.
    Ahlström, Gerd
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science.
    Integrating improvement learning into health professional educational curricula2008In: International Forum on Quality Improvement in Healthcare, France, April 24 2008: International Forum on QI , 2008, p. 1-Conference paper (Refereed)
    Abstract [en]

    We all need to start where we are and also wanting to go further all the time. This is the essence in quality improvement. The leader and the teachers must own this attitude themselves in order to have the ability to be trustworthy for the students. There is evidence in the literature about the impact of education on the professional attitude and role. This means that it is important to work with better professional development for better outcomes in the faculty.

    One starting point for us in the planning of our different programs are that improvement knowledge will be a streak through the whole education in order to establish a professional attitude of daily inspiration to produce the best practise. We have applied all curricula to Boologna declaration and in this system progression in learning is a key point. We have four levels in the basic education (3-years education which lead to Bachelor degree) where we start to introduce 1) Concepts and models in health improvement. Then let our students make a 2) Personal improvement in their everyday life. Later in the education we teach about 3) Evidence practise and systematic literature reviews. Finally the students are 4) Making health improvements in collaboration with the staff during one clinical education.

    All educational programmes on basic level since 2007 include aim descriptions about quality improvement. The aim of the learning is to have the competence to initiate and participate in work about health care improvements.

    Finally, besides the mentions aspects in improvement education there are some other factors that needs for better system performance.

  • 4.
    Aidemark, Jan
    et al.
    Linnaeus University.
    Askenäs, Linda
    Linnaeus University.
    Nygårdh, Annette
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Strömberg, Anna
    Linköping University.
    User involvement in the co-design of self-care support systems for heart failure patients2015In: Procedia Computer Science, ISSN 1877-0509, E-ISSN 1877-0509, Vol. 64, p. 118-124Article in journal (Refereed)
    Abstract [en]

    In this paper the nature of user involvement in a co-design process will be explored. The outlines of a research project aiming at developing support systems for self-care inpatients suffering from chronic heart failure will be presented. The project is planned to perform a co-design effort where users (patients and healthcare professionals) will be given the opportunity to influence the development of support systems. We will discuss a number of possibilities and challenges that lie in the design of this kind of project and also some findings from its early stages. This report presents the experiences of users’ input, which are discussed in the context of previous research on benefits of user contributions in systems development.

  • 5.
    Alexanderson, Kristina
    et al.
    Karolinska Institutet, Försäkringsmedicin.
    von Knorring, Mia
    Karolinska Institutet, Försäkringsmedicin.
    Keller, Christina
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Impact of a nationwide government program in Sweden on how healthcare managers, in their organisations, manage the work with sickness certification of patients2014In: The European journal of public health, Vol. 24, Supplement 2, 2014, p. 90-Conference paper (Refereed)
  • 6.
    Algurén, Beatrix
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. University of Gothenburg, Faculty of Education, Department of Food and Nutrition, and Sport Science, Sweden.
    Andersson Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Region Jönköping County, Futurum, Sweden.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Quality indicators and their regular use in clinical practice – results from a survey among users of two cardiovascular National Registries in Sweden2018In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the regular use of quality indicators from Swedish cardiovascular National Quality Registries (NQRs) by clinical staff; particularly differences in use between the two NQRs and between nurses and physicians.

    Design: Cross-sectional online survey study.

    Setting: Two Swedish cardiovascular NQRs: a) Swedish Heart Failure Registry and b) Swedeheart.

    Participants: Clinicians (n=185; 70% nurses, 26% physicians) via the NQRs’ email networks.

    Main outcome measures: Frequency of NQR use for a) producing healthcare activity statistics; b) comparing results between similar departments; c) sharing results with colleagues; d) identifying areas for quality improvement (QI); e) surveilling the impact of QI efforts; f) monitoring effects of implementation of new treatment methods; g) doing research; h) educating and informing healthcare professionals and patients.

    Results: Median use of NQRs was ten times a year (25th and 75th percentiles range: 3 – 23 times/year). Quality indicators from the NQRs were used mainly for producing healthcare activity statistics. Median use of Swedeheart was six times greater than SwedeHF (p<0.000). Physicians used the NQRs more than twice as often as nurses (18 vs. 7.5 times/year; p<0.000) and perceived NQR work more often as meaningful. Around twice as many Swedeheart users had the role to participate in data analysis and in QI efforts compared to SwedeHF users.

    Conclusions: Most respondents used quality indicators from the two cardiovascular NQRs infrequently (< 3 times/year). The results indicate that linking registration of quality indicators to using them for QI activities increases their routine use and makes them meaningful tools for professionals.

    The full text will be freely available from 2019-05-01 00:00
  • 7.
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    How to reach effective health service delivery?2017In: Journal of General Practice, ISSN 2329-9126, Vol. 5, no 4, article id 1000320Article in journal (Refereed)
  • 8.
    Andersson, Ann-Christine
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Ainalem, Ingrid
    Centre for Innovation and Improvement (CII), Region Skåne, Malmö, Sweden.
    Berg, Agneta
    School of Health and Society, Kristianstad University, Sweden.
    Janlov, Ann-Christin
    School of Health and Society, Kristianstad University, Sweden.
    Challenges to improve inter-professional care and service collaboration for people living with psychiatric disabilities in ordinary housing2016In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 25, no 1, p. 44-52Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe health care- and social service professionals' experiences of a quality-improvement program implemented in the south of Sweden. The focus of the program was to develop inter-professional collaboration to improve care and service to people with psychiatric disabilities in ordinary housing. Focus group interviews and a thematic analysis were used. The result was captured as themes along steps in process. (I) Entering the quality-improvement program: Lack of information about the program, The challenge of getting started, and Approaching the resources reluctantly. (II) Doing the practice-based improvement work: Facing unprepared workplaces, and Doing twice the work. (III) Looking backevaluation over 1 year: Balancing theoretical knowledge with practical training, and Considering profound knowledge as an integral part of work. The improvement process in clinical practice was found to be both time and energy consuming, yet worth the effort. The findings also indicate that collaboration across organizational boundaries was broadened, and the care and service delivery were improved.

  • 9.
    Andersson, Ann-Christine
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Lenrick, Raymond
    Rapport om utvärdering av IVO:s lärande tillsyn2018Report (Other academic)
    Abstract [sv]

    Inspektionen för vård och omsorg (IVO) har i sin tillsynspolicy lagt fokus på att främja lärande för att stödja utvecklingen av god kvalitet och säkerhet i vård och omsorg. Under 2017 har IVO givit Jönköping Academy for Improvement of Health and Welfare vid Jönköping University i uppdrag att utvärdera tillämpning av lärande tillsyn. Syftet med denna studie var att belysa om, och om möjligt hur, IVO:s tillsyn kan stödja verksamhetsutveckling och förbättring i de tillsynade verksamheter. Det finns många teoribildningar kring lärande och kvalitetsutveckling. Denna rapport tar utgångspunkt i teorier om organisatoriskt lärande, samskapande och förbättringskunskap och belyser vad som kan bidra, och i så fall hur, till en ömsesidig tillit som leder till ett fördjupat lärande som grund för förbättring.

    Studien omfattar två tillsyner, där deltagarna bestod av personal från de berörda verksamheterna, samt IVO-inspektörer från de regionala IVO avdelningar. Det empiriska materialet samlades in genom intervjuer och en observation. En dokumentgenomgång av relevanta IVO dokument skapade underlag för utvecklandet av studiens intervjuguider. Intervjuerna bandades, transkriberades och analyserades med en metod inspirerad av tematisk analys, som utmynnade i fem teman: (I) Förberedelse inför tillsyn; (II) Genomförande i verksamheten; (III) Resultat i verksamheten; (IV) Förutsättningar för lärande; och (V) Önskemål för ökat lärande. Samtliga teman innehåller både förhållanden som stödjer (främjar) och som försvårar (hindrar) lärande:

    • Förberedelsearbetet ansågs inte bidra till en ökad tillit som förutsättning för lärande. Det uttrycktes en önskan om mer samskapande i förberedelsearbetet redan innan tillsynstillfället
    • Det framkom önskemål om att lärandet, som ett av målen med tillsynen, skulle lyftas tydligare i dialogen vid tillsynstillfället.
    • Det uppfattades som svårt att peka på reella resultat i verksamheterna som direkt berodde på tillsynen, men det beskrevs ändå som viktigt att tillsynen fanns.
    • Det fanns olika uppfattningar om hur IVO:s roll som tillsynsmyndighet påverkade lärandet. Ett större fokus på gemensam uppföljning skulle vara ett sätt att optimera lärandet både i verksamheterna och hos IVO:s inspektörer.
    • Ett lärande skulle gynnas av en tydlig gemensam problembeskrivning, samt fortlöpande uppföljningar och delad kunskap, exempelvis genom goda exempel och dialogkonferenser.

    Generellt fanns en stor samstämmighet mellan IVO:s inspektörer och de verksamhetsföreträdare som intervjuats, men vissa skillnader framkom också. Rapporten avslutas med några avslutande reflektioner.

  • 10.
    Andersson, Ann-Christine
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Golsäter, Marie
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Melke, Anna
    Erfarenheter från lärandeseminarier: Barn som anhöriga: Reflektioner från följeforskning2016Report (Other academic)
    Abstract [sv]

    Under 2015 genomfördes nationella lärandeseminarier för att stärka implementeringen av den lag som ger barn rätt till information, råd och stöd när en förälder plötsligt avlider, är svårt sjuk eller skadad (HSL 2g §). Satsningen var ett förbättringsarbete som omfattade sex landsting som med hjälp av en projektledning träffades vid fyra tillfällen från januari till september. Två av träffarna skedde i Stockholm och två var digitala. Under våren 2015 knöts följeforskning till arbetet med frågeställningar om vilka resultat förbättringsarbetet gav och hur deltagarna upplevde arbetssättet. Syftet var att lyfta fram vad satsningen gav samt att lära inför framtida satsningar – är lärandeseminarier ett användbart arbetssätt för nationella implementeringssatsningar?

    Rapporten visar att lärandeseminarier tycks vara en användbar form. Teamen kan redovisa att de uppnått många av de mål som de föresatte sig under projekttiden. Det handlade om kartläggning av kunskapsläge och strukturer, kompetensutveckling samt utveckling av rutiner och material. Teamen uppskattade också att få delta i ett nationellt sammanhang som gav inspiration. Samtidigt framkom det önskemål om fortsatt och ännu mer handfast stöd i fortsatt implementering i klinisk verksamhet.

  • 11.
    Andersson, Ann-Christine
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Golsäter, Marie
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Melke, Anna
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. The Göteborg Region Association of Local Authorities, Gothenburg, Sweden.
    Learning through networking in healthcare and welfare: The use of a breakthrough collaborative in the Swedish context2017In: International Journal of Healthcare Management, ISSN 2047-9700, E-ISSN 2047-9719Article in journal (Refereed)
    Abstract [en]

    Breakthrough Collaborative (BC) aims at learning through networking, mainly at micro level, and is used as a tool to improve care and welfare organizations. The aim of this study was to explore and illuminate the challenges when applying BC model at meso and macro level. In 2010, the Swedish Health and Medical Services Act stated the responsibility of healthcare professionals to consider children’s needs as relatives. This study uses an interactive collaborative research model. To support healthcare organizations in the implementation of the regulation, county councils/regions in Sweden were invited to take part in a BC during 2015. Six teams from different county councils/regions participated. Team members were interviewed several times during the project time. Data were analyzed with an explorative and descriptive qualitative content analysis. The result illuminates the challenges faced when applying BC at meso and macro level. Most challenges concern preparation, support structures and system connections. There are similarities with the challenges met at micro level when BC is used at meso and macro level. But it seems even more important to consider how the team is constituted at meso and macro level to make use of the learnings and achieve long-term impact in the home organization.

  • 12.
    Andersson, Ann-Christine
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Futurum-Academy for Health and Care Region Jönköping County, Jönköping, Sweden.
    Melke, Anna
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Göteborg Region Association of Local Authorities, Gothenburg, Sweden.
    Andersson Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Golsäter, Marie
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD. Futurum-Academy for Health and Care Region Jönköping County, Jönköping, Sweden.
    Identification of children as relatives with a systematic approach; a prerequisite in order to offer advice and support2018In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 27, no 3, p. 172-177Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to elucidate conditions at all system levels in a specific health care service to develop practices for identification of children as relatives. An interactive research approach with the intention to create mutual learning between practice and research was used. The participating health care service cared for both clinic in- and outpatients with psychiatric disorders. Health care professionals from different system levels (micro, meso, macro) participated, representing different professions. At the first project meeting, it was obvious that there was no systematic approach to identify children as relatives. At the micro level, activities such as a pilot survey and an open house activity were carried out. At the meso level, it was discussed how to better support collaboration between units. At the management (macro) level, it was decided that all units should appoint at least one child agent, with the aim to increase collaboration throughout the whole health care service. To change focus, in this case from only parents to inclusion of children, is an important challenge faced by health care services when forced to incorporate new policies and regulations. The new regulations contribute to increased complexity in already complex organizations. This study highlights that such challenges are underestimated.

  • 13.
    Andersson Bäck, Monica
    et al.
    University of Gothenburg.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Identity work of successful primary care managers and competing institutional logics2017Conference paper (Refereed)
  • 14.
    Andersson Bäck, Monica
    et al.
    University of Gothenburg.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Medical manager hybrids for handling institutional complexity and change in primary care2017Conference paper (Refereed)
    Abstract [en]

    Introduction: This article deals with hybrid persons combining medical professionalism and management for handling institutional complexity and change in primary care. Primary care and identity are in transition in many western countries, in Sweden emphasized by the 2007 reform for patient choice and competition. Research has shown that embedded hybrid actors, familiar and socialized in a field and to its logics, tend to be influential for handling complexity and change. Yet hydrids and their enactment in primary care is an underexplored area.

    Aim: The aim is to contribute to our understanding of hybrid persons and how they are combining medical professionalism and management in primary care, while managing complexity and change.

    Material and methods: In a case study of six successful primary healthcare centers, public and private, covering 56 interviews and observations with various professions, two medical managers ‘hybrids’ showed to be particularly interesting. These were analyzed in-depth, including analysis of staff’s and colleagues’ experiences and contrasted by other managers and hybrids. For the analysis we draw on institutional logic perspective (Thornton, Occasion & Lounsbury 2012) in order to capture preconditions as well as enactment of such change agents.

    Results/conclusions: The hydrids contributed to innovation, creativity and learning in their primary care centres. At their workplace, coherence and a good ambience coexisted with feelings of high work pace and lacking role clarity among the multidisciplinary staff. Categorized in line with McGivern and colleagues(2015) term as ‘willing hybrids’, the persons studied revealed high ambitions to challenge existing institutional order giving professionalism new forms, while seeking to innovate practices and division of work among healthcare staff in primary care. By doing so the hybrids integrated professionalism and managerialism and were influential in reframing problems and solutions, which aligned several logics at play. However several obstacles related to professional as well as bureaucratic issues appeared along the way.

  • 15.
    Areskoug Josefsson, Kristina
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    Department of Social Work, University of Gothenburg, Gothenburg, Sweden.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Workers’ experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study2018In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed)
    Abstract [en]

    Objective: Staff experiences of healthy work environment (HWE) indicators at primary care units can assist in understanding why some primary care units function better than others. The aim of the study was to create increased understanding of how workers experienced HWE indicators at well-functioning primary care units.

    Design: Fifty in-depth interviews with staff at six primary care units in Sweden were analysed with deductive content analysis, revisiting a systematic review of HWE indicators.

    Results: The study presents additional perspectives on staff experiences of HWE indicators at well-functioning primary care units. The included primary care units (PCU) shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges. Staff at the included PCUs were encouraged to work to create and sustain a HWE, but each domain (indicator) also provided challenges that the staff and organisation needed to meet. The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work.

    Conclusions: Both managers and staff are encouraged to actively work not only to create and sustain an HWE but also to promote organisational virtuousness, employee commitment, joy at work and to increase the performance at work, which is of benefit to staff, patients and society.

    Key Points

    • Staff at well-functioning primary care units (PCUs) experienced healthy work environments
    • The included PCUs shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges.
    • Staff at the included PCUs were encouraged to work to create and sustain a healthy work environment, but each domain (indicator) also provided challenges that the staff and organisation needed to meet.
    • The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work.
  • 16.
    Aronsson, Frida
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Johansson, Sofia
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Organisatoriskt lärande för att öka vårdkvalitet: Lärdomar av att utveckla processledning vid en operations- och intensivvårdsklinik2018Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    Background: Complex organizations need to be patient centred, focus on processes, have holistic view and promote organizational learning to secure quality. Operation and intensive care unit, Ryhov, has potential to develop its Process Management (PM) and there is room for improved patient participation.

     

    Purpose: The purpose of the quality improvement project (QIP) was to identify and reduce quality gaps affecting patients, by develop PM and organizational learning. The purpose of the study was to describe co-workers’ understanding of the connection between PM and quality of care and describe their experiences from QIP.

     

    Methods: The QIP has developed organizational learning concerning two pilot processes by using Nolan’s model for improvement. The study of the QIP is qualitative, based on six focus group interviews. Qualitative content analysis was used to analyse the interviews.

     

    Results: PM demands access to improvement and professional knowledge. The organization need to create conditions for sustainability, make benefits obvious and ensure enough resources. Quality of care increases when the organization works structured and patient centred.

     

    Conclusions: PM creates conditions for continual improvements with focus on organizational learning and increased quality of care. The organization need to actively make PM an integral and living part.

  • 17.
    Avby, Gunilla
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Andersson Bäck, Monica
    University of Gothenburg.
    A reform as a lever for innovation and professionalism?2017Conference paper (Refereed)
    Abstract [en]

    Introduction: Consistently with international trends, managerial reforms and incentive systems in Sweden have been introduced to achieve quality improvement and increased efficiency in welfare services. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as service transformations or innovation.

    Aim: In this study we explore how organizational performance are changing within the context of a patient choice reform in primary healthcare.

    Material and Methods: This qualitative study is based on 48 semi-structured interviews with various professions (managers, physicians, nurses, physical- and occupational therapists, care administrators, and nurse assistants) at five PHCCs, conducted as part of a study designed to explore financial incentives and motivation in PHC in Sweden. The PHCCs were purposively selected to ensure the inclusion of both public and private facilities. All centers had a longstanding reputation for good leadership and high quality care. 

    Results: The findings show how professional fields and traits were dissolving and changing, triggering the emergence of innovative solutions in practice. Through ongoing negotiations of professional boundaries new practices unfolded and professionalism increasingly was achieved through contextual conditions. The expanding and changing of professional boundaries as shown in the study are implied to stimulate innovative processes. Thus, the main findings suggest that innovative practices developed as a relationship between contextual conditions and professionalism. E.g. nurses and physical therapists remitted patients directly to the hospital, multiprofessional teams for patient groups with joint needs handled patients that previous needed hospital care, and nurse assistants became responsible for summing patients with minor hypertension for blood pressure controls and consultations.

    Conclusions: The reform seemed to act as a lever for innovation and professionalism under certain conditions. How work is organized and managed is a contextual factor that not only affects work circumstances, but also provides conditions for innovation and professionalism. Impartial to governments’ ambitions to improve their responsiveness to the needs of citizens by altering market rules, new provider models may be of little assistance in achieving the desired effect on health sector reform outcomes if suitable contextual conditions are missing.

  • 18.
    Avby, Gunilla
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Andersson Bäck, Monica
    University of Gothenburg.
    Transforming primary healthcare: Exploring a new provider model as a lever for innovation and professionalism2017Conference paper (Refereed)
  • 19.
    Avby, Gunilla
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    Göteborgs universitet.
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Sparf, Anette
    Siljehult, Mats
    Samarbete bygger en stark primärvård2017In: Dagens Nyheter 2017-08-17, ISSN 1101-2447Article in journal (Other (popular science, discussion, etc.))
  • 20.
    Azong, Jecynta Amboh
    et al.
    University of Stirling, UK.
    Wilinska, Monika
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). University of Stirling, UK.
    Into a footnote: Unpaid care work and the Equality Budget in Scotland2017In: The European Journal of Women's Studies, ISSN 1350-5068, E-ISSN 1461-7420, Vol. 24, no 3, p. 218-232Article in journal (Refereed)
    Abstract [en]

    This article analyses the visibility of unpaid care work in Scotland by examining the (non-)development of discourse on unpaid care work in economic policy documents. Drawing on the problem approach to policy analysis, the article engages with the Equality Budget Statements (EBS) as policy documents that not only inform the government’s spending plans but are foremost statements of values and norms pursued by the government. This critical reading reveals that certain discourses give different meanings to women’s lives through the political significance of what remains unproblematized as part of the ensuing care discourse in Scotland. The developing discourse on economic policy and equality suggests that equality in Scotland is presupposed on labour market participation. This shrinks discourse on unpaid care work; the problem of unpaid care work is silenced, while the problem of women’s access to employment is redefined to mean a problem of difference and costly childcare only. The way certain issues have or have not appeared in governmental documents is explanatory of the importance and relevance of unpaid care work to the political discourse.

  • 21.
    Bartholdson, Pamela
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Så förhindrar vi fallolyckor - Observationsstudie av en multifaktoriell intervention2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 22.
    Batalden, Maren
    et al.
    Department of Medicine, Cambridge Health Alliance, Cambridge, MA, United States.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth, Lebanon, NH, United States.
    Margolis, Peter
    Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
    Seid, Michael
    Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
    Armstrong, Gail
    College of Nursing, University of Colorado, Aurora, CO, United States.
    Opipari-Arrigan, Lisa
    Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
    Hartung, Hans
    Department of Pulmonary Medicine, University Hospital Crosshouse, Kilmarnock, East Ayrshire, United Kingdom.
    Coproduction of healthcare service2016In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 25, no 7, p. 509-517Article in journal (Refereed)
    Abstract [en]

    Efforts to ensure effective participation of patients in healthcare are called by many names - patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services.

  • 23.
    Beckerman, Carina
    Handelshögskolan i Stockholm.
    Historien om en datajournal2005Report (Other academic)
    Abstract [sv]

    “Berätta för mig om datajournalprojektet? ”Med den uppmaningen i huvudet gick jag till mitt första möte med fyra anställda på en medicinsk avdelning på X-sjukhuset som ett år tidigare implementerat en datorbaserad patientjournal. Patientjournaler tillhör ju, liksom exempelvis flygledarjournaler, en viss sorts intellektuella artefakter som tills nyligen skrevs för hand med penna på papper. Den kunskap som ligger bakom produktionen av dessa föremål lärs ofta in på plats från en överordnad genom upprepad handling. När arbetsverktyg som dessa datorbaseras sker det inte smärtfritt. Både arbetsrutiner och arbetsrelationer förändras liksom även innehållet i dokumentet. Eftersom jag dessutom ville skaffa erfarenhet av narrativ metod så beslöt jag att låta fyra anställda och projektledaren på kliniken berätta så fritt som möjligt utan inblandning från min sida; därav ovanstående enkla uppmaning. Varför narrativ metod, undrar möjligen en del. Det är inte en vanlig metod inom forskning om informationssystem. Nej, men personligen tror jag och många andra med mig att historier spelar en ofta bortglömd roll i olika organisationers försök att utveckla, implementera och använda informationsteknologi. Detta, och den amerikanske sociologen Elliot Mishlers kritik om att ett alltför strukturerat sätt att intervjua förvandlar människor till artificiella objekt samtidigt som viktiga aspekter i exempelvis förändringsprocesser går förlorade, gjorde mig intresserad av att pröva narrativ metod. Dessutom är patientjournalen i sig en berättelse om en patients sjukdom. Många människor på olika arbetsplatser genomgår numera också dessa så flitigt förekommande IT-projekt, en del lyckade och andra mindre lyckade. En målgrupp för denna studie är därför personer som på olika sätt deltar i och arbetar med implementering av ny informationsteknologi inom sjukvården. En annan målgrupp är kollegor intresserade av narrativ metod.

  • 24.
    Beckerman, Carina
    Jönköping University, School of Health Science, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Implications of Transforming the Patient Record into a Knowledge Management System: Initiating a Movement of Coordination and Enhancement2008In: The ICFAI University Journal of Knowledge Management, ISSN 0972-9216, Vol. Nov, no 6Article in journal (Refereed)
    Abstract [en]

    Today there is often a need to re-innovate who you are and what you do and re-think the tools that are used and the business models that guide action. The purpose of this paper is to show how transforming a document, such as a patient record, might start a horizontal and vertical movement, a movement of coordination and enhancement in an organizational setting, such as a hospital clinic. The observations presented here and the conclusions drawn were obtained during a three year case study following implications of constructing and computerizing a patient record at three different hospitals. The results were then analyzed, interpreted and discussed within a framework combining theories about knowledge management and with cognitive theories about use of interpretative schemes and representations. This paper tries to look beyond the implications of reconstructing a patient record on a micro-level or explore if it is good or bad to computerize it. Instead this paper theorizes about how re-thinking the interpretative scheme for what a patient record is and how it may be used might restructure a health care setting. It proposes that what the employees want to achieve with the knowledge management system depends on what strategy they have for it.

  • 25.
    Beckerman, Carina
    Handelshögskolan i Stockholm.
    Sjukhus eller sjukvård - design av betong och infrastruktur2008In: Detta borde vårddebatten handla om / [ed] Claes-Fredrik Helgesson, Hans Winberg, Stockholm: IFL/EFI , 2008, p. 61-77Chapter in book (Other (popular science, discussion, etc.))
  • 26.
    Beckerman, Carina
    Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health Science, HHJ, Dep. of Behavioural Science and Social Work.
    Transforming and Computerizing Professional Artifacts: An Underestimated Opportunity for Learning2010In: International Journal of Healthcare Delivery Reform Initiative, ISSN 1938-0216, Vol. 2, no 3, p. -10Article in journal (Refereed)
    Abstract [en]

    Improving the artifacts a knowledge worker uses and how he or she exercises his or her knowledge is a desire that is part of being professional, especially since modern man are supposed to live in a knowledge society. In the knowledge society there is a continuous structuring and re-structuring, construction and re-construction and learning and re-learning going on due to implementing new information and communication technology. But many of these projects fail in spite of management spending huge amounts of money on them. This paper focuses on and wants to create an awareness of how an artefact such as a new knowledge management system becomes a driving force behind expanding the knowledge of an anesthesist and has implications for continuous learning among a group of employees at the anesthesia and intensive care unit. In addition to this, implementing new technology is an underestimated opportunity for learning. This paper suggests that a significant educational effort is taking place in society channelled through many these IT-projects, even when they fail.

  • 27.
    Bergerum, Carolina
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Quality Improvement in a Maternity Ward and Neonatal Intensive Care Unit. What are staff and patients' experiences of Experience-based Co-design?: Part 1: A qualitative study2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Recent focus on quality and patient safety has underlined the need to involve patients in improving healthcare. “Experience-based Co-design” (EBCD) is an approach to capture and understand patient and staff (i. e. users) experiences, identifying so called “touch points” and then working together equally in improvement efforts.

    Purpose:This article elucidates patient (defined as the mother-newborn couple with next of kin) and staff experiences following improvement work carried out according to EBCD in a maternity ward and neonatal intensive care unit (NICU) in a small, acute hospital in Sweden.

    Method: An experience questionnaire, derived from the EBCD approach tool set, was used for continuously evaluating each event of the EBCD improvement project. Furthermore, a focus group interview with staff and in-depth interviews with mother-father couples were held in order to collect and understand the experiences of working together according to EBCD. The analysis and interpretation of the interview data was carried through using qualitative, problem-driven content analysis. Themes, categories and sub-categories presented in this study constitute the manifest and latent content of the participants’ experiences of Experience-based Co-design.

    Results:The analysis of the experience questionnaires, prior to the interviews, revealed mostly positive experiences of the participation. Both staff and patient participants stated generally happy, involved, safe, good and comfortable experiences following each event of the improvement project so far.

    Two themes emerged during the analysis of the interviews. For staff participants the improvement project was a matter of learning within the microsystem through managing practical issues, moving beyond assumptions of improvement work and gaining a new way of thinking. For patients, taking part of the improvement project was expressed as the experience of involvement in healthcare through their participation and through a sense of improving for the future.

    Discussion: This study confirms that, despite practical obstacles for participants, the EBCD approach to improvement work provided an opportunity for maternity ward /NICU care being explored respectfully at the experience level, by assuring the sincere sharing of useful information within the microsystem continuously, and by encouraging and supporting the equal involvement of both staff and patients. Staff and patients wanted and were able to contribute to the EBCD process of gathering information about their experiences, analyzing and responding to collected data, and engaging themselves in improving the same. Furthermore, the EBCD approach provided staff and patients the opportunity of learning within the microsystem. Nevertheless, the responsibility of the improvement work remained the responsibility of the healthcare professionals.

  • 28.
    Biguet, Gabriele
    et al.
    Karolinska Institutet.
    Ekstrand Sporre, Åsa
    Jönköpings läns landsting.
    Thörne, Karin
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Att utvecklas genom att reflektera tillsammans i grupp2015In: Att lära och utvecklas i sin profession / [ed] Gabriele Biguet, Ingrid Lindquist, Cathrin Martin, Anna Pettersson, Lund: Studentlitteratur AB, 2015, p. 123-146Chapter in book (Other academic)
  • 29. Blackwell, R. W. N.
    et al.
    Lowton, K.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    Grudzen, C.
    Grocott, P.
    Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes2017In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 68, p. 83-94Article in journal (Refereed)
    Abstract [en]

    Background

    Increasing use of emergency departments among older patients with palliative needs has led to the development of several service-level interventions intended to improve care quality. There is little evidence of patient and family involvement in developmental processes, and little is known about the experiences of − and preferences for – palliative care delivery in this setting. Participatory action research seeking to enable collaborative working between patients and staff should enhance the impact of local quality improvement work but has not been widely implemented in such a complex setting.

    Objectives

    To critique the feasibility of this methodology as a quality improvement intervention in complex healthcare settings, laying a foundation for future work. Setting an Emergency Department in a large teaching hospital in the United Kingdom.

    Methods

    Experience-based Co-design incorporating: 150 h of nonparticipant observation; semi-structured interviews with 15 staff members about their experiences of palliative care delivery; 5 focus groups with 64 staff members to explore challenges in delivering palliative care; 10 filmed semi-structured interviews with palliative care patients or their family members; a co-design event involving staff, patients and family members.

    Findings

    The study successfully identified quality improvement priorities leading to changes in Emergency Department-palliative care processes. Further outputs were the creation of a patient-family-staff experience training DVD to encourage reflective discussion and the identification and application of generic design principles for improving palliative care in the Emergency Department. There were benefits and challenges associated with using Experience-based Co-design in this setting. Benefits included the flexibility of the approach, the high levels of engagement and responsiveness of patients, families and staff, and the impact of using filmed narrative interviews to enhance the ‘voice’ of seldom heard patients and families. Challenges included high levels of staff turnover during the 19 month project, significant time constraints in the Emergency Department and the ability of older patients and their families to fully participate in the co-design process.

    Conclusion

    Experience-based Co-design is a useful approach for encouraging collaborative working between vulnerable patients, family and staff in complex healthcare environments. The flexibility of the approach allows the specific needs of participants to be accounted for, enabling fuller engagement with those who typically may not be invited to contribute to quality improvement work. Recommendations for future studies in this and similar settings include testing the ‘accelerated' form of the approach and experimenting with alternative ways of increasing involvement of patients/families in the co-design phase. 

  • 30.
    Bonnivier, Anna
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Då; DiabetespatientNu; En människa med diabeteserfarenhet: Ett förbättringsarbete och en fallstudie om vård på ändrade villkor när en diabetesmottagning införde samskapad vård.2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background

    Enhancement for people with elevated HbA1c. Improvement area was described differently from the patient and the coworkers perspective and perceived the experience of participation and the need of standardized working methods.

     

    Purpose

    Improve patients diabetic related health and their experience of participation and decrease the average of HbA1c > 9%.

     

    Study if coproduction contributes to better diabetes care and outcomes by introducing a new working method based on PROM/PREM.

     

    Method

    Nolan's Improvement Model

    Qualitative case study with content analysis

     

    Results

    Total average of HbA1c fell by 15,2%.

    13 out of 14 patients lowered their HbA1c.

    PROM; two out of three quliaty parameters had a positive shift.

    PREM; one out of three had a positive shift.

    The study indicated that a new working method enhanced both the interaction and the relationship between patient and health care providers and simultaneously created a more valuable balance between shared knowledge and experience of the disease.

     

    Discussion

    The results of this thesis indicates that coproduction creates a better environment for quality and an opportunity for a mutual relationship. Patients' answers to PROM / PREM identified areas that enabled the healthcare provider to respond to patient needs, which strengthened the role of the patient in the meeting.

     

    Conclusion

    Coproduction provides opportunities for a qualitative relationship that creates an enhanced environment for knowledge exchange and development for patients and healthcare providers.

  • 31.
    Borén, Kristina
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Co-production design av ett beslutsstöd för patienter med rotatorkuffruptur2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Presently, there is a range of support programs aimed to help patients in the decision making process, in regards to their health and care. The purposes of these programs are to give the patient a reliable source of information, and allowing the patient to make their own decisions based on their personal values. However, there are no Swedish support programs for patients who suffer from rotator cuff tears. The purpose of this study was to develop the decision aid program from the United States, "Treatment Options for Rotator Cuff Tears: A Guide for Adults" from 2010, in order to function in a Swedish context. A further aim was to examine the similarities and differences between Swedish practice concerning rotator cuff tears in comparison to the version from 2010, and to describe how the decision support were perceived by patients. A co-production design with a deductive qualitative content analysis was used. The process included translation of the rotator cuff tear decisions aid program from 2010 to Swedish. Interviews with experienced physiotherapists, orthopedic surgeons and patients who have had experienced a rotator cuff tear were performed.

    The main similarities presented by the comparison of providers and patient perceptions were the patient’s active role in the treatment process, descriptions of relevant treatment options, and the patient understanding of the injury. Main differences were that the physician's role was more prominent compared to the physiotherapist in the decision aid program. Also, details in regard to the conservative and postoperative treatments were missing. Physiotherapists and orthopedic physicians described a lack of support systems for decision-making in current clinical practice. Patients found the decision aid to be simple and easy to understand with regard to the content and layout, as well as being a good start for the dialogue and interaction between the patient and the provider. Overall, patients were positively inclined to the decision aid program and felt that such could be an aid in the selection of treatment and decision making process. Physiotherapists and orthopedic physicians were also optimistic about decision aid, and it could act as a catalyst for the establishment of clinical consensus. The patients felt that the decision aid provided a feeling of safety and reassurance, as well as a platform for dialogue between themselves and physiotherapists and orthopedic physicians.

    Further research is needed in order to determine whether the patient experiences any benefits of decision aid in the actual decision making process. In order to improve the content of the program, it is also imperative to determine the level of detail, as well as the impact of overall cost and healthcare effectiveness regarding treatment of rotator cuff tears. 

  • 32.
    Burnett, Susan
    et al.
    Imperial College London, UK.
    Mendel, Peter
    Rand Corporation, Santa Monica, CA, USA.
    Nunes, Francisco
    Lisbon University Institute, Portugal.
    Wiig, Siri
    University of Stavanger, Norway.
    van den Bovenkamp, Hester
    Erasmus University Rotterdam, The Netherlands.
    Karltun, Anette
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Engineering, JTH, Industrial Engineering and Management. Jönköping University, School of Engineering, JTH. Research area Industrial Production.
    Robert, Glenn
    King’s College London, UK.
    Anderson, Janet
    King’s College London, UK.
    Vincent, Charles
    Oxford University, UK.
    Fulop, Naomi
    University College London, UK.
    Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries2016In: Journal of Health Services Research and Policy, ISSN 1355-8196, E-ISSN 1758-1060, Vol. 21, no 2, p. 109-117Article in journal (Refereed)
    Abstract [en]

    Objectives: Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands.

    Methods: An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals.

    Results: How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures.

    Conclusions: The development of hospital leaders’ skills in translating external requirements into implementation plans with internal support is a complex, but crucial, task, if quality is to remain a priority during times of austerity. Increasing quality improvement skills within a hospital, developing a culture where quality improvement becomes embedded and linking cost reduction measures to improving care are all required.

  • 33.
    Bäck, Monica Andersson
    et al.
    Department of Social Work, University of Gothenburg, Sweden.
    Calltorp, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    The Norrtaelje model: a unique model for integrated health and social care in Sweden2015In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 15, p. 1-11, article id e016Article in journal (Refereed)
    Abstract [en]

    Many countries organise and fund health and social care separately. The Norrtaelje model is a Swedish initiative that transformed the funding and organisation of health and social care in order to better integrate care for older people with complex needs. In Norrtaelje model, this transformation made it possible to bringing the team together, to transfer responsibility to different providers, to use care coordinators, and to develop integrated pathways and plans around transitions in and out of hospital and from nursing homes to hospital. The Norrtaelje model operates in the context of the Swedish commitment to universal coverage and public programmes based on tax-funded resources that are pooled and redistributed to citizens on the basis of need. The experience of Norrtaelje model suggests that one way to promote integration of health and social care is to start with a transformation that aligns these two sectors in terms of high level organisation and funding. This transformation then enables the changes in operations and management that can be translated into changes in care delivery. This "top-down" approach must be in-line with national priorities and policies but ultimately is successful only if the culture, resource allocation and management are changed throughout the local system.

  • 34.
    Börjesson, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    From shadow to person: Exploring roles in participant observations in an eldercare context2014In: Qualitative Social Work, ISSN 1473-3250, E-ISSN 1741-3117, Vol. 13, no 3, p. 406-420Article in journal (Refereed)
    Abstract [en]

    This article explores participant observation as a research method and more specifically addresses the intriguing situation of the researcher's role in interacting with participants in the setting. The materials used in the analysis are field notes from participant observations focused on staff at two eldercare units in a mid-sized city in Sweden. Because limitations when referring to Raymond Gold's roles of participant observations are known but sparsely described and discussed, this text attempts to provide that description and discussion. The specific question posed in the article is, (How) do roles for the researcher in participant observations change during the course of fieldwork? Randall Collins' theory on interaction ritual chains is used as an analytical tool to identify symbols in the two staff groups. The examples chosen from the field are symbols displayed at the units, which moreover illustrate that the researcher’s roles in participant observations not only change once or twice during the course of fieldwork but also change continuously. Consequently, fieldworkers shift roles in different situations when observing a variety of people and settings. Observations are developed in the interaction between the researcher and the participants; therefore, referring observations to a number of roles is restrictive and limiting.

  • 35.
    Börjesson, Ulrika
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Bengtsson, Staffan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Cedersund, Elisabet
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    “You have to have a certain feeling for this”: Exploring tacit knowledge in elder careManuscript (preprint) (Other academic)
  • 36.
    Börjesson, Ulrika
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Bengtsson, Staffan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Henning, Cecilia
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    A Free regulated work?: Organizational culture and shared knowledge in elder careManuscript (preprint) (Other academic)
  • 37.
    Börjesson, Ulrika
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Cedersund, Elisabet
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Bengtsson, Staffan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. Research Platform of Social Work.
    Reflection in Action: A multi-layered approach. “Cause I am good at that, you are supposed to say what you are good at these days!”Manuscript (preprint) (Other academic)
  • 38.
    Calltorp, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    How can our health systems be re-engineered to meet the future challenges?: The Swedish experience2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 74, no 5, p. 677-679Article in journal (Refereed)
  • 39.
    Castelpietra, Giulio
    et al.
    Primary Care Service Area, Friuli Venezia Giulia Region, Trieste, Italy.
    Salvador-Carulla, Luis
    Centre for Mental Health Research, Australian National University (ANU), Canberra, Australia.
    Almborg, Ann-Helene
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Nordic WHO-FIC Collaborating Centre, Oslo, Norway.
    Fernandez, Ana Isabel
    Community Health Service, Public Health Agency of Barcelona, Barcelona, Spain.
    Madden, Richard Cawley
    National Centre for Classification in Health, University of Sydney, Australia Received 8 August 2017; accepted 9 October 2017 Available online 7 November 2017 KEYWORDS Mental.
    Working draft: Classifications of interventions in mental health care. An expert review2017In: European Journal of Psychiatry, ISSN 0213-6163, E-ISSN 2340-4469, Vol. 31, no 4, p. 127-144Article in journal (Refereed)
    Abstract [en]

    Background and objectives: Specific classifications of mental health interventions have encountered many issues in their integration into a general classification of interventions. Nonetheless, there has not been any previous review on the content and structure of current classifications in relation to mental health care. This expert review aimed to compare the mental health interventions provided in a series of reference classification systems for the incorporation of mental health care into the International Classification of Health Interventions (ICHI).

    Methods: Twelve classifications are described with regards to the structure of the classification (unit of analysis, sections, multiaxiality, granularity) and context of utilization (purpose, descriptors, neutrality, interoperability and implementation).

    Results: Major problems identified include a granularity unbalance (i.e. differences in the number of codes and its specificity with other areas such as rehabilitation), unclear units of analysis (i.e. differences between procedures, interventions, packages of care and care programs), lack of clearly stated evidence-based interventions in a mental health context; and lack of a well-defined taxonomical tree. An ontology approach to the definition of the different entities involved in the throughput of mental care, including their hierarchical relationships and conceptual map, may have contributed to the failure of previous systems together with the development of systems to classify mental health interventions separate from generic health interventions.

    Conclusions: The present review provides additional ground for the development of the ICHI knowledge-base and highlights the importance of taxonomical disambiguation and international comparability in the development and implementation of classifications of mental care interventions. 

  • 40.
    Clarke, David
    et al.
    Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, Bradford, United Kingdom.
    Jones, Fiona
    Faculty of Health Social Care and Education, St George's University of London, London, United Kingdom.
    Harris, Ruth
    Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings?: A rapid evidence synthesis2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 7, article id e014650Article in journal (Refereed)
    Abstract [en]

    Background

    Co-production is defined as the voluntary or involuntary involvement of users in the design, management, delivery and/or evaluation of services. Interest in co-production as an intervention for improving healthcare quality is increasing. In the acute healthcare context, co-production is promoted as harnessing the knowledge of patients, carers and staff to make changes about which they care most. However, little is known regarding the impact of co-production on patient, staff or organisational outcomes in these settings.

    Aims

    To identify and appraise reported outcomes of co-production as an intervention to improve quality of services in acute healthcare settings.

    Design

    Rapid evidence synthesis.

    Data sources

    Medline, Cinahl, Web of Science, Embase, HMIC, Cochrane Database of Systematic Reviews, SCIE, Proquest Dissertation and Theses, EThOS, OpenGrey; CoDesign; The Design Journal; Design Issues.

    Study selection

    Studies reporting patient, staff or organisational outcomes associated with using co-production in an acute healthcare setting.

    Findings

    712 titles and abstracts were screened; 24 papers underwent full-text review, and 11 papers were included in the evidence synthesis. One study was a feasibility randomised controlled trial, three were process evaluations and seven used descriptive qualitative approaches. Reported outcomes related to (a) the value of patient and staff involvement in co-production processes; (b) the generation of ideas for changes to processes, practices and clinical environments; and (c) tangible service changes and impacts on patient experiences. Only one study included cost analysis; none reported an economic evaluation. No studies assessed the sustainability of any changes made.

    Conclusions

    Despite increasing interest in and advocacy for co-production, there is a lack of rigorous evaluation in acute healthcare settings. Future studies should evaluate clinical and service outcomes as well as the cost-effectiveness of co-production relative to other forms of quality improvement. Potentially broader impacts on the values and behaviours of participants should also be considered. 

  • 41. Dellve, Lotta
    et al.
    Wikström, Ewa
    Tengblad, Stefan
    Liff, Roy
    Andersson, Tomas
    Arman, Rebecka
    Tengelin, Ellinor
    Studiematerial: Hållbart chefskap i hälso- och sjukvården - med vinjetter om engagemang, stress, tidsanvändning, medarbetarskap och vårdpraktik [Elektronisk resurs]2012Report (Other academic)
  • 42. Desai, A.
    et al.
    Zoccatelli, G.
    Adams, M.
    Allen, D.
    Brearley, S.
    Rafferty, A. M.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, United Kingdom.
    Donetto, S.
    Taking data seriously: The value of actor-network theory in rethinking patient experience data2017In: Journal of Health Services Research and Policy, ISSN 1355-8196, E-ISSN 1758-1060, Vol. 22, no 2, p. 134-136Article in journal (Refereed)
    Abstract [en]

    Hospitals are awash with patient experience data, much of it collected with the ostensible purpose of improving the quality of patient care. However, there has been comparatively little consideration of the nature and capacities of data itself. Using insights from actor-network theory, we propose that paying attention to patient experience data as having agency in particular hospital interactions allows us to better trace how and in what circumstances data lead (or fail to lead) to quality improvement.

  • 43.
    Dobson, Roy Thomas
    et al.
    University of Saskatchewan.
    Stevenson, Katherine
    Health Quality Council, Saskatoon, Saskatchewan.
    Busch, Angela
    University of Saskatchewan.
    Scott, Darlene J.
    Saskatchewan Institute of Applied Science and Technology.
    Henry, Carol
    University of Saskatchewan.
    Wall, Patricia A.
    University of Saskatchewan.
    A quality improvement activity to promote interprofessional collaboration among health professions students2009In: American Journal of Pharmaceutical Education, ISSN 0002-9459, E-ISSN 1553-6467, Vol. 73, no 4, p. 1-7, article id 64Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To develop and evaluate a classroom-based curriculum designed to promote interprofessional competencies by having undergraduate students from various health professions work together on system-based problems using quality improvement (QI) methods and tools to improve patient-centered care.

    DESIGN: Students from 4 health care programs (nursing, nutrition, pharmacy, and physical therapy) participated in an interprofessional QI activity. In groups of 6 or 7, students completed pre-intervention and post-intervention reflection tools on attitudes relating to interprofessio nal teams, and a tool designed to evaluate group process.

    ASSESSMENT: One hundred thirty-four students (76.6%) completed both self-reflection instruments, and 132 (74.2%) completed the post-course group evaluation instrument. Although already high prior to the activity, students' mean post-intervention reflection scores increased for 12 of 16 items. Post-intervention group evaluation scores reflected a high level of satisfaction with the experience.

    CONCLUSION: Use of a quality-based case study and QI methodology were an effective approach to enhancing interprofessional experiences among students.

  • 44. Donetto, S.
    et al.
    Malone, M.
    Sayer, L.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing & Midwifery, King's College London, United Kingdom.
    New models to support the professional education of health visitors: A qualitative study of the role of space and place in creating ‘community of learning hubs’2017In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 54, p. 69-76Article in journal (Refereed)
    Abstract [en]

    Background

    In response to a policy-driven workforce expansion in England new models of preparing health visitors for practice have been implemented. ‘Community of Learning hubs’ (COLHs) are one such model, involving different possible approaches to student support in clinical practice placements (for example, ‘long arm mentoring’ or ‘action learning set’ sessions). Such models present opportunities for studying the possible effects of spatiality on the learning experiences of students and newly qualified health visitors, and on team relationships more broadly.

    Objectives

    To explore a ‘community of learning hub’ model in health visitor education and reflect on the role of space and place in the learning experience and professional identity development of student health visitors.

    Design

    Qualitative research conducted during first year of implementation.

    Settings

    Three ‘community of learning hub’ projects based in two NHS community Trusts in London during the period 2013–2015. Participants Managers and leads (n = 7), practice teachers and mentors (n = 6) and newly qualified and student health visitors (n = 16).

    Methods

    Semi-structured, audio-recorded interviews analysed thematically.

    Results

    Participants had differing views as to what constituted a ‘hub’ in their projects. Two themes emerged around the spaces that shape the learning experience of student and newly qualified health visitors. Firstly, a generalised need for a ‘quiet place’ which allows pause for reflection but also for sharing experiences and relieving common anxieties. Secondly, the role of physical arrangements in open-plan spaces to promote access to support from more experienced practitioners.

    Conclusions

    Attention to spatiality can shed light on important aspects of teaching and learning practices, and on the professional identities these practices shape and support. New configurations of time and space as part of educational initiatives can surface new insights into existing practices and learning models. 

  • 45. Donetto, S.
    et al.
    Penfold, C.
    Anderson, J.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    Maben, J.
    Nursing work and sensory experiences of hospital design: A before and after qualitative study following a move to all-single room inpatient accommodation2017In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 46, p. 121-129Article in journal (Refereed)
    Abstract [en]

    The embodied experience of nursing practice is rarely studied. Drawing on data from an internationally relevant larger study conducted in 2013–14, here we explore the sensory dimension of the embodied experiences of nursing staff working on two acute NHS hospital wards before and after a move to all-single room inpatient accommodation. We undertook a secondary analysis of 25 interviews with nursing staff (12 before and 13 after the move with half [13/25] using photographs taken by participants) from a mixed-method before-and-after study. This analysis focused on the sensory dimensions of nursing staff's experiences of their working practices and the effect of the built environment upon these. Drawing on Pallasmaa's theoretocal insights, we report how the all-single room ward design prioritises ‘focused vision’ and hinders peripheral perception, whilst the open ward environment is rich in contextual and preconscious information. We suggest all-single room accommodation may offer staff an impoverished experience of caring for patients and of working with each other. 

  • 46.
    Donlagic, Amira
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Lärdomar från SBAR-verktygets införande. En förbättring av samverkande sjukvård?2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 47.
    Edberg, Lina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Förbättrad informationsöverföring i äldreomsorg: - en fallstudie om implementering av ett modifierat SBAR-verktyg2018Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    Lack of communication is the single biggest reason for errors in healthcare. By standardizing the communication, the variation is reduced and logic and mutual agreement are created. The purpose of the improvement work was to increase patient safety by simplifying communication by introducing the SBAR communication tool. The subsequent study aimed to investigate how SBAR was experienced in the elderly care team, and to describe success factors and difficulties at the time of implementation.

     

    The author was inspired by action research. A content analysis has been applied on the data collected.

     

    There was an improvement in the information transfer, but the unit did not reach the set targets. SBAR was found useful by the professionals after practical training. The professionals felt greater security with a combination of oral and written report. The project created common learning through participatory observations and by clarifying the surrounding structures for the professionals. The project contributed to changed focus from an individual to a system level concerning the information process. The SBAR structure was slightly simplified to fit the multilingual context. New areas for improvement were identified and an activity board for the elderly was created. Keeping consistent education and training temporary staff was a challenge.

  • 48. Ekberg, J.
    et al.
    Timpka, T.
    Angbratt, M.
    Frank, L.
    Norén, A. -M
    Hedin, L.
    Andersen, E.
    Gursky, E. A.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum, Jönköping County Council, Jönköping, Sweden.
    Design of an online health-promoting community: Negotiating user community needs with public health goals and service capabilities2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 1, article id 258Article in journal (Refereed)
    Abstract [en]

    Background: An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities.

    Methods: Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified.

    Results: The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions.

    Conclusions: OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users' needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations.

  • 49.
    Engström, Karl
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Snabbare och säkrare övergång för patienter från primärvård till specialistpsykiatri: En empirisk fallstudie av antagandens betydelse för ett förbättringsarbete kring remisser och samverkan2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background

    In Sandviken, the adult psychiatric care is divided between Primary Health Centers and Psychiatry. The transferral of patients was unsafe and meant prolonged time before psychiatric treatment was started as 50 % of the referrals were declined.

    Purpose

    The improvement project aimed to reduce the proportion of declined referrals and to reduce time between referral and psychiatric treatment.

    The study aimed to find out beliefs existing among stakeholders and the effect of these on the improvement work.

    Methods

    The idea to test, a referral template, was chosen in advance of the project start. Several improvement tools were used and one primary focus was to base decisions upon facts.

    The study was an empirical case study with qualitative analysis made on documents and interviews.

    Results

    The improvement project didn’t achieve the set aims. The study showed that beliefs about what was needed and possible to do, contributed to the results of the improvement work.

    Conclusions

    The improvement project showed the importance of testing new ideas. The referral template wasn’t a working solution. Stakeholders beliefs about what was needed and possible to do, and how to do it, was shown to contribute to the results of the improvement work.

  • 50.
    Engvall, Charlotte
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Förbättrade förutsättningar för resiliens inom specialiserad barnsjukvård: tillämplighet av ”Resilience Assessment Grid”2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    This master´s thesis explores how an improvement work of developing and using the “Resilience Assessment Grid”, RAG, can support the potential for resilient performance on a paediatric ward, in light of the need for new safety strategies developed for complex adaptive systems. A qualitative case study of the improvement work was conducted. The improvement work was done according to the Model for Improvement.

    The work of developing and using RAG for measuring and managing resilient performance, supported the employees' potential for resilient performance by helping them in implementing strategic improvement interventions. The awareness and knowledge of patient safety and resilience increased, which led to increased understanding of the system and the needs of the system in terms of patient safety. We have not been able to show that the potential for resilient performance has improved by using RAG for measurement. We can neither demonstrate nor exclude that the potential will improve before further measurements have been made.

    Experience from the present study can be used in future interventions of improving the potential for resilient performance and patient safety in a complex adaptive system in the health care setting.

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