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  • 1.
    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)
  • 2.
    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.

  • 3.
    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 1502-7724, Vol. 36, no 4, p. 406-414Article 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.
  • 4.
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Att genom reflection organisera för en medveten och kunskapsrik praktik2016In: Pedagogisk forskning i Sverige, ISSN 1401-6788, E-ISSN 2001-3345, Vol. 21, no 3-4, p. 261-282Article in journal (Refereed)
    Abstract [sv]

    Ett i högre grad vetenskapsbaserat samhälle ställer ökade krav på att professionellt arbete ska grundas i evidens och att beslut ska vila på evidens- baserade kriterier. På ett generellt plan är idén bakom en evidensbaserad praktik att överbrygga gapet mellan teori och praktik, men hittills har den evidensbaserade agendan främst fokuserat på professionellas instrumentella kunskapsanvändning. Mindre intresse har visats för en mer indirekt användning av forskningsbaserad kunskap, en så kallad konceptuell kunskapsanvändning med avsikt att utmana och förändra etablerade tanke- och vanemönster. Ett grundläggande antagande bakom denna artikel är att lärande gynnas när praktikern använder olika kunskapskällor. Artikeln bidrar till att utvidga och fördjupa reflektionens betydelse i professionell praktik. 

  • 5.
    Avby, Gunilla
    Linköpings universitet, Pedagogik och sociologi.
    Evidence in practice: On knowledge use and learning in social work2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Against the backdrop of the transformations in the entire framing of professional work, social work has come under close scrutiny in many countries, including Sweden. Doubts have been raised about practitioners’ existing knowledge base, and the importance of practitioners engaging in learning and the renewal and extension of professional capacities has been emphasized.

    The present thesis concerns knowledge use and learning in the daily practices of child investigation work. The aim is to explore processes of knowledge use and learning in practice. The study is based on a mix of qualitative approaches, basically from ethnography, comprising methods such as participant observations, interviews, reflective dialogues and documentary analysis of case data.

    The main findings demonstrate that investigation work is characterized mainly by the use of practice-based knowledge. Research-based knowledge is predominantly used as a means of explaining a client’s situation or to underpin and legitimize one’s own beliefs and decisions made on other grounds. Professional learning is largely adaptive in character, as the social workers learn to handle tasks in a fairly routinized way on the basis of rules or procedures that draw on existing knowledge in the practice setting.

    Two conclusions are drawn: First, the use of knowledge in child investigation work bears little resemblance to principles of evidence-based practice. Second, the reproduction of professional knowledge is largely implicit and taken for granted. The study offers insight into the much-discussed topic of putting knowledge into practice, which is of importance to strategies for organizing profes sional learning and knowledgeable practice.

  • 6.
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Organizing for deliberate practice through workplace reflection2016In: Supporting learning across working life: Models, processes and practices / [ed] Billett, Stephen; Dymock, Darryl; Choy, Sarojni, Springer, 2016, p. 75-90Chapter in book (Refereed)
  • 7.
    Avby, Gunilla
    Linköpings universitet, Pedagogik och sociologi.
    Professional practice as processes of muddling through: a study of learning and sense making in social work2015In: Vocations and Learning, ISSN 1874-785X, E-ISSN 1874-7868, Vol. 8, no 1, p. 95-113Article in journal (Refereed)
    Abstract [en]

    Using an ethnographic approach, the aim of this study was to explore how social workers learn and make sense of experiences in their daily practices. Five events that took place during an ordinary day of child investigation work are described and serve as the basis for the analysis. The findings imply that investigation work is largely a social rationalization process and that the interaction between different actors in work is a strategy to enhance the level of knowledge and contribute to learning among the professionals. Thus, learning is embedded in daily activities, for example, consulting colleagues, framing problems and building relationships. Furthermore, the findings suggest the possibility of assuming a contextualized view of reasoning, a so-called contextual rationality, which maintains that practitioners need to make judgments in a way that is sensitive to and relevant for their own contextualized settings. Contextual rationality is a reasonable strategy to deal with complex problems in daily practices that cannot be completely analysed or solved. Contextual rationality is thus not about accuracy, rather it engages individuals to find meaning and order in the complexity of modern organizations where norms, values and expectations provide frameworks for explanations. Besides offering an explanation for the basis of practice, the study identifies a variety of learning opportunities in everyday practice that could potentially be used in efforts to organize a more reflective practice to facilitate improved workplace learning.

  • 8.
    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).
    LearnOvation: an intervention to foster exploration and exploitation behaviour in health care management in daily practice2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 319Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Innovation has been identified as an important engine for improving the quality, productivity and efficiency of health care. Little is known about how to stimulate innovation capacity in primary health care in general; even less is known about how specific interventions should be designed to support managements' work with practice-based innovations. Research has shown that if managers and teams are excellent at handling the challenges of production (exploitation) and development (exploration), they are better at innovation. The aim of the study is to develop a dynamic management support programme to increase innovation leadership skills in daily practice.

    METHODS: The study has an interactive approach that allows the need for empirical and theoretical knowledge to emerge and merge, and a quasi-experimental cross-over design. Eight primary health care centres will participate in the study. In the first phase, the management teams at four health care centres will participate in the intervention, and the other four centres will serve as a control group. Thereafter, the units will switch places and the control group will experience the intervention. All staff at the 8 units will answer questionnaires at four points in time (before, during, after, 6 months later) to evaluate the effects of the intervention.

    DISCUSSION: The study will contribute to knowledge on how to organize processes of innovation and support exploitation and exploration behaviours by co-producing and testing a tailor-made management support programme for innovation work in primary health care. An expected long-term effect is that the support system will be disseminated to other centres both within and beyond the participating organizations.

  • 9.
    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.

  • 10.
    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
    Department of Social Work, University of Gothenburg, Göteborg, Sweden.
    Tending to innovate in Swedish primary health care: a qualitative study2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, no 1, article id 42Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Policymakers in many countries are involved in system reforms that aim to strengthen the primary care sector. Sweden is no exception. 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 innovation. The study was performed in relation to the introduction of a national health care reform, and conducted in Jönköping County Council, as the region's handling of health care reforms has attracted significant national and international interest. This study employed success case method to explore what enables primary care innovations.

    METHODS: Five Primary Health Care Centres (PHCCs) were purposively selected to ensure inclusion of a variety of aspects, such as size, location, ownership and regional success criteria. 48 in-depth interviews with managers and staff at the recruited PHCCs were analysed using content analyses. The COREQ checklist for qualitative studies was used to assure quality standards.

    RESULTS: This study identified three types of innovations, which break with previous ways of organizing work at these PHCCs: (1) service innovation; (2) process innovation; and (3) organizational innovation. A learning-oriented culture and climate, comprising entrepreneurial leadership, cross-boundary collaboration, visible and understandable performance measurements and ability to adapt to external pressure were shown to be advantageous for innovativeness.

    CONCLUSIONS: This qualitative study highlights critical features in practice that support primary care innovation. Managers need to consistently transform and integrate a policy "push" with professionals' understanding and values to better support primary care innovation. Ultimately, the key to innovation is the professionals' engagement in the work, that is, their willingness, capability and opportunity to innovate.

  • 11.
    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)
  • 12.
    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.))
  • 13.
    Avby, Gunilla
    et al.
    Linköpings universitet, HELIX Vinn Excellence Centre.
    Nilsen, Per
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Abrandt Dahlgren, Madeleine
    Linköpings universitet, Pedagogik och vuxnas lärande.
    Ways of understanding evidence-based practice in social work: A qualitative study2014In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, Vol. 44, no 6, p. 1366-1383Article in journal (Refereed)
    Abstract [en]

    This qualitative, empirical study explores and describes the variation in how evidence-based practice (EBP) is understood in social work. A phenomenographic approach to design and analysis was applied. Fourteen semi-structured interviews were conducted with politicians, managers and executive staff in three social welfare offices in Sweden. The main findings suggest that there are qualitatively different ways in which EBP is understood, described in five categories: (i) fragmented; (ii) discursive; (iii) instrumental; (iv) multifaceted; and (v) critical. The outcome space is hierarchically structured with a logical relationship between the categories. However, the informants found it difficult to account for EBP, depending on what was expressed as deficient knowledge of EBP in the organisation, as well as ability to provide a seemly context for EBP. The results highlight the importance of acknowledging these differences in the organisation to compose a supportive atmosphere for EBP to thrive rather than merely assume the case of evidence-based social work. The categories can be utilised as stimuli for reflection in social work practice, and thereby provide the possibility to promote knowledge use and learning in the evolving evidence-based social work.

  • 14.
    Avby, Gunilla
    et al.
    Linköpings universitet, Pedagogik och sociologi.
    Nilsen, Per
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Ellström, Per-Erik
    Linköpings universitet, Pedagogik och sociologi.
    Exploring evidence-based practice in practice: the case of social work2015In: Sustainable development in organizations: studies on innovative practices / [ed] Mattias Elg, Per-Erik Ellström, Magnus Klofsten, Malin Tillmar, Cheltenham: Edward Elgar Publishing , 2015, p. 153-168Chapter in book (Refereed)
  • 15.
    Avby, Gunilla
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Linköpings universitet, Pedagogik och sociologi.
    Nilsen, Per
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Ellström, Per-Erik
    Linköpings universitet, Pedagogik och sociologi.
    Knowledge use and learning in everyday social work practice: A study in child investigation work2017In: Child & Family Social Work, ISSN 1356-7500, E-ISSN 1365-2206, Vol. 22, no Supplement S4, p. 51-61Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore knowledge use and learning among social workers in everyday child investigation work. Research was undertaken in two Swedish children’s services departments. The study applied an ethnographic approach. Methods for data collection included interviews, participant observations, reflective dialogues and a documentary analysis of case files. The social workers’ knowledge sources were classified into research-based, practice-based and ordinary knowledge. The findings show that the social workers preferred practice-based knowledge, which was primarily conveyed from colleagues and previous experience, and rarely consulted knowledge from sources found outside the practice setting. Furthermore, the findings suggest that the integration of knowledge was made possible through the social workers' engagement in both a verbal and a more cognitive (tacit) reasoning activity, processes that fostered learning at work. The social workers’ learning was predominantly adaptive as they learned to handle tasks in a fairly routinized way on the basis of rules or procedures. The findings lend support to the notion that the use of different knowledge forms could potentially trigger learning in everyday social work.

  • 16. Bergendorff, .
    et al.
    Grankvist, M.
    Nordström, Gunilla
    Inlärning kräver trygghet1994In: Att lära efter plugget: kvalitativa undersökningar av vuxnas studiesituation / [ed] Agnieszka Bron-Wojciechowska; Lena Porsander, Stockholm: Stockholms universitet, Pedagogiska institutionen , 1994Chapter in book (Other academic)
  • 17.
    Karlsson, Henrik
    et al.
    Research and Development Northwest (FoU Nordväst), Sollentuna, Sweden.
    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).
    Svendsen, Tore
    Department of Social Work, Stockholm University, Stockholm, Sweden.
    QUAT—a Tool for Evaluating the Quality of Core Assessments in Child-Protection Investigations2018In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263XArticle in journal (Refereed)
    Abstract [en]

    This article presents a quantitative tool for evaluating the documentation quality of core assessments in child-protection investigations called the Quality Assessment of the Triangle (QUAT). QUAT measures compliance with a set of quality standards for working with the Swedish adaptation of the British Integrated Children’s System (ICS), and should be viewed as an attempt to further the UK-led efforts to improve child-protection investigations by promoting research-based documentation systems. This article describes how QUAT was developed and later applied to a random sample of case files provided by the social services in Stockholm City, Sweden, to demonstrate its usability in practice. The contribution of QUAT is two-fold: first, it offers a way for managers to stimulate workplace learning by providing continuous feedback on the documentation and, second, it may help researchers to evaluate the effectiveness of interventions aiming to improve professional performance in terms of documenting child-protection investigations.

  • 18.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson Bäck, Monica
    Gothenburg University.
    Financial incentives and motivation: "What we do is the same but how we do it is different"2016Conference paper (Other academic)
    Abstract [en]

    There is an ongoing debate in the scientific community whether financial incentives have unintended consequences, for example less internal motivation and damaged professional autonomy. Little is however known about the views among health care professionals in primary care. Early findings show that financial incentives are no source of motivation, but can act as drivers for innovative quality improvements.

  • 19.
    Kjellström, Sofia
    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
    University of Gothenburg.
    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).
    Leadership as a driver for work motivation: a study of well-functioning primary healthcare centers in Sweden2017Conference paper (Refereed)
    Abstract [en]

    Introduction: Little is known about how, why, or under which circumstances work motivation is formed and linked to reforms and interventions.

    Aim: The aim of this study is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives.

    Material & method: Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. Forty-three interviews were completed with different medical professions and qualitative deductive content analysis was conducted.

    Results: Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers’ positive management was due to a unique combination of factors, such as clear direction of goals, a culture of nonhierarchical collaboration, and systematic quality improvement work. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. The units expressed a collective capacity to produce direction, alignment and commitment.

    Conclusions: The design of the reforms and leadership are essential preconditions for work motivation. Leaders need to consistently translate and integrate reforms with the professionals’ drives and values. This is done by encouraging participation through teamwork, time for structured reflection and quality improvement work. The values of the study consist of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms, and how professionals collectively produce leadership.

  • 20.
    Kjellström, Sofia
    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).
    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 Bäck, Monica
    University of Gothenburg.
    Research on successful and well-functioning organizations: The role of qualitative studies for theoretical and practical use. Workshop.2017Conference paper (Refereed)
    Abstract [en]

    Introduction: Organizations strive to handle external and internal demands, and a lot is being written about the struggles and shortages. However, there are organizations that thrive, combining quality of performance and beneficial working conditions. What can we learn from these cases and how are the best studied? Also, how do we move beyond a list of good looking features that we already know are essential, such as leadership and continuous quality improvement work, in order to produce knowledge which is of practical use.

    Goal: This workshop takes point of departure in a study on well function primary care centers. The aim is to share our primary insights from this project and learn from it weaknesses and strengths to inspire to innovative, theoretical and practical meaningful research.

    Method: Six primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private/non-profit and small/large units. In total 56 interviews were completed with various professions (managers, physicians, nurses, physical- and occupational therapists, care administrators, and nurse assistants). At this time, four different qualitative analysis approaches have been used.

    Results/Conclusion: Each center reveals inspiring as well as challenging features. In the workshop, we will discuss how we can learn from studying good practice and design to further our understanding on sustainable healthcare and the use of qualitative methods in this context.

  • 21.
    Kjellström, Sofia
    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).
    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).
    Andersson Bäck, Monica
    Department of Social Work, University of Gothenburg, Gothenburg, Sweden.
    De komplexa drivkrafterna inom vård och omsorg - en fallstudie av finansiella incitament och dess konsekvenser ur ett arbetsmiljöperspektiv: Slutrapport2017Report (Other academic)
    Abstract [sv]

    Olika ekonomiska drivkrafter och ersättningssystem används för att öka effektiviteten inom vård och omsorg. Forskningen visar dock att de ofta hamnar i konflikt med personalens motivation och normer. Studien har undersökt hur så kallade finansiella instrument påverkar patienters och anställdas upplevelse av arbetsmiljö och vårdkvalitet.

  • 22.
    Kjellström, Sofia
    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).
    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).
    Andersson Bäck, Monica
    Department of Social Work, University of Gothenburg, Gothenburg, Sweden.
    Work motivation among healthcare professionals: A study of well-functioning primary healthcare centers in Sweden2017In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 31, no 4, p. 487-502Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of this paper is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives.

    Design/methodology/approach

    Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. In total, 43 interviews were completed with different medical professions and qualitative deductive content analysis was conducted.

    Findings

    Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers? positive management was due to a unique combination of factors, such as clear direction of goals, a culture of non-hierarchical collaboration, and systematic quality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created.

    Practical implications

    Leaders need to consistently translate and integrate reforms with the professionals? drives and values. This is done by encouraging participation through teamwork, time for structured reflection, and quality improvement work.

    Social implications

    The design of the reforms and leadership are essential preconditions for work motivation.

    Originality/value

    The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.

  • 23.
    Nilsen, Per
    et al.
    Linköpings universitet, HELIX Vinn Excellence Centre.
    Nordström (Avby), Gunilla
    Linköpings universitet, HELIX Vinn Excellence Centre.
    Ellström, Per-Erik
    Linköpings universitet, HELIX Vinn Excellence Centre.
    Integrating research-based and practice-based knowledge through workplace reflection2012In: Journal of Workplace Learning, ISSN 1366-5626, E-ISSN 1758-7859, Vol. 24, no 6, p. 403-415Article in journal (Refereed)
    Abstract [en]

    Purpose – This paper seeks to present a theoretical framework with the aim of contributing to improved understanding of how reflection can provide a mechanism to integrate research-based knowledge with the pre-existing practice-based knowledge.

    Design/methodology/approach – The paper begins with an explanation of important concepts: research-based and practice-based knowledge, four levels of action and two modes of learning. Two mini cases concerning managers in the public sector in Sweden then provide an illustration of how research-based knowledge can be utilized to challenge practice-based knowledge. The concluding discussion addresses some of the challenges involved in achieving reflection in the workplace that utilizes research-based knowledge.

    Findings – The reflection programmes had several characteristics that facilitated their implementation: they achieved a balance between the workplace demands on the participating managers and time required for the reflection; the participants were specifically recruited, had full management support and were highly motivated to be part of the reflection groups; the facilitators played key roles in structuring the managers' discussions and linking their experiences to relevant research-based knowledge.

    Research limitations/implications – Methodological limitations of the cases constrain the conclusions to be drawn from these studies. However, it should be emphasized that the case studies were intended primarily as illustrations of how workplace reflection can be used to integrate research-based and practice-based knowledge. Obviously, there is a risk of social desirability bias because the interviewer was also involved in developing and implementing the reflection programmes. She also participated as a supervisor in mini case 2.

    Originality/value – The literature on reflection has largely focused on reflection in the context of education, training and preparing for work or a profession. The role of workplace reflection and learning for practitioners and managers in work has received far less attention. The emergence of the evidence-based practice (EBP) agenda has further highlighted the importance of workplace learning and reflection, as practitioners are increasingly expected to critically appraise research studies and integrate new findings into their practice. A more EBP requires reflecting practitioners who are able to synthesize research-based knowledge with their own practice-based knowledge acquired through experience. However, the process of integrating research-based and practice-based knowledge has not been the focus of much study.

  • 24.
    Nordström (Avby), Gunilla
    Jönköping University, School of Health and Welfare.
    Gränsöverskridande kunskapsbildning - praktik och teori i interaktion2009In: Vägval och dilemman i interaktiv forskning: kurspaper från Bridging the Gaps doktorandurs Interaktiv forskning 2008 / [ed] Mattias Elg, Boel Andersson Gäre, Jönköping: Landstinget i Jönköpings län , 2009, p. 27-45Chapter in book (Other academic)
    Abstract [sv]

    I detta paper kommer jag att föra ett resonemang kring möjligheten att kombinera ett praktiskt utvecklingsprojekt med ett interaktivt forskningsperspektiv. Jag inleder med att beskriva den praktik jag verkar i och mitt forskningsintresse, inkluderande ett antal aktuella begrepp. Därefter reflekterar jag över den interaktiva forskningen. Utifrån praktikens kontext och det problemområde som skisserats fram resonerar jag kring hur forskningen i samverkan med praktiken (interaktivt) skulle kunna struktureras för att bidra till att kritiskt skildra problemområdet och fördjupa kunskaperna i pågående utvecklingsprojekt. Avslutningsvis kommer jag att beröra forskarens roll med betoning på dikotomin med att både vara forskare och del av den studerade verksamheten. Mitt resonemang tar sin utgångspunkt ett par huvudfrågor:

    • Hur kan en interaktiv forskningsansats vara till fördel för att fångade faktorer som stödjer professionaliseringen av chefsrollen i dess kontextuella miljö, socialtjänsten i Jönköpings kommun samt vara till nytta för både praktiken och teorin?
    • Hur är det möjligt att hålla behövlig distans för att öka förståelsen för forskningsområdet och samtidigt bibehålla närheten som krävs för ett lyckat utvecklingsarbete?
  • 25.
    Nordström (Avby), Gunilla
    Linköpings universitet, HELIX Vinn Excellence Centre.
    Professionalism encounters Evidence-based Practice (EBP): What effects can EBP have on knowledge use and learning in professional practice?2011Conference paper (Other academic)
    Abstract [en]

    Today it is common to talk about “lean organizations”, where focus lays on cost efficiency and resource allocation. In professional work, e.g. in healthcare and social services the trend is referred to as New Public Management (NPM), involving considerable structural changes and an inevitable shift towards a more quantitatively oriented mode of decision making. Especially the social care is under the loop for changes; striving to create a practice, measurable, knowledgeable and with the ability to demonstrate the efficiency of its methods and efforts; referred to as EBP. With an exclusive focus on task performance the value of workers´ ability to conceptualize problems and solutions and engage creatively with families in their historical and social context is undermined. The rules constituting the arguments in practical reasoning are becoming more and more structured. Related to theories of how professionals develop abstractions to create powerful knowledge systems the introduction of EBP could in fact have a negative effect on knowledge use and learning. More stringent methods may lessen the room for discretion, in turn circumscribing the professional knowledge and with this making professional expertize needless in executing the work. 

    The aim with this paper is to explore possible consequences of introducing EBP in professional practice (social work). The paper is divided into two parts. While the first part touches key concepts and theories of relevance, the following will analyze EBP’s possible effects on knowledge use and learning from aspects of significance; involving different research traditions, implementation strategies and situational aspects for discretion and learning. The paper concludes in a discussion of consequences following with the growing transparency and rationalization-movement.

  • 26.
    Nordström (Avby), Gunilla
    Linköpings universitet, HELIX Vinn Excellence Centre.
    Understandings of Evidence-based Practice among politicians, managers and executive staff in social welfare agencies2012Conference paper (Other academic)
    Abstract [en]

    This paper aims to explore and describe understandings of EBP among various actors in social welfare agencies in Sweden.

    Method: Fourteen semi-structured interviews were conducted with politicians, managers and executive staff in social welfare agencies in Sweden.

    Result: The main findings suggest that there are four understandings concerning the concept of EBP. These are labeled: i) popular discourse; ii) procedural application; iii) transparent view; and iv) philosophical approach.

    Conclusion: Although the analysis is ongoing, the results point to certain inconsistencies concerning how EBP is understood in social welfare practice. This variation in understandings is explained in terms of attitudes and beliefs regarding the view of practice, quality and knowledge. However, EBP was difficult to account for depending on what was expressed as deficient knowledge of EBP in the organization, as well as its’ ability to provide an applicable atmosphere.

  • 27.
    Nordström, Gunilla
    Jönköping University, School of Education and Communication, HLK, Lifelong learning/Encell.
    Vuxnas lärande otydligt inslag i lärarutbildningar2004In: KOM: kommunikation mellan kommunala vuxenutbildare, ISSN 0347-4445, Vol. 30, no 2, p. 40-41Article in journal (Other (popular science, discussion, etc.))
  • 28.
    Nordström, Gunilla
    et al.
    Jönköping University, School of Education and Communication, HLK, Lifelong learning/Encell. Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work.
    Bengtsson-Sandberg, Karin
    Kunskapslyftet: Ett lyft för hela själen2004Report (Other academic)
  • 29.
    Per, Nilsen
    et al.
    Linköpings universitet, Socialmedicin och folkhälsovetenskap.
    Nordström (Avby), Gunilla
    Linköpings universitet, HELIX Vinn Excellence Centre.
    Ellström, Per-Erik
    Linköpings universitet, HELIX Vinn Excellence Centre.
    Integrating research-based and practice-based knowledge through workplace reflection2011Conference paper (Refereed)
1 - 29 of 29
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