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  • 1.
    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 1464-3677, Vol. 30, no 10, p. 786-792Article 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.

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  • 2.
    Algurén, Beatrix
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Food and Nutrition, and Sport Science, UNIVERSITY OF GOTHENBURG.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Framtid och framgång för kvalitetsregisters möjligheter2015Conference paper (Refereed)
  • 3.
    Algurén, Beatrix
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Food and Nutrition, and Sport Science, UNIVERSITY OF GOTHENBURG.
    Gäre, Klas
    Jönköping University, Jönköping International Business School, JIBS Entrepreneurship Centre.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Från Kvalitetsregister till bättre vård och omsorg – komplexitetens utmaning2013In: Nationella kvalitetsregisterkonferensen 2013, 9-10 oktober, Quality Hotel Friends Arena, Stockholm.: Forum för medicinsk kvalitet & ständigt förbättringsarbete. Kan kvalitetsregister styra vården?, 2013Conference paper (Refereed)
  • 4.
    Algurén, Beatrix
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Food and Nutrition and Sport Science, University of Gothenburg, Faculty of Education, Gothenburg, Sweden.
    Nordin, Annika
    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). Futurum, Region Jönköping County, Jönköping, Sweden.
    Peterson, Anette
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum, Region Jönköping County, Jönköping, Sweden.
    In-depth comparison of two quality improvement collaboratives from different healthcare areas based on registry data - Possible factors contributing to sustained improvement in outcomes beyond the project time2019In: Implementation Science, E-ISSN 1748-5908, Vol. 14, no 1, article id 74Article in journal (Refereed)
    Abstract [en]

    Background: Quality improvement collaboratives (QICs) are widely used to improve healthcare, but there are few studies of long-term sustained improved outcomes, and inconsistent evidence about what factors contribute to success. The aim of the study was to open the black box of QICs and compare characteristics and activities in detail of two differing QICs in relation to their changed outcomes from baseline and the following 3 years.

    Methods: Final reports of two QICs - one on heart failure care with five teams, and one on osteoarthritis care with seven teams, including detailed descriptions of improvement projects from each QIC's team, were analysed and coded by 18 QIC characteristics and four team characteristics. Goal variables from each team routinely collected within the Swedish Heart Failure Registry (SwedeHF) and the Better Management of Patients with OsteoArthritis Registry (BOA) at year 2013 (baseline), 2014, 2015 and 2016 were analysed with univariate statistics.

    Results: The two QICs differed greatly in design. The SwedeHF-QIC involved eight experts and ran for 12 months, whereas the BOA-QIC engaged three experts and ran for 6 months. There were about twice as many activities in the SwedeHF-QIC as in the BOA-QIC and they ranged from standardisation of team coordination to better information and structured follow-ups. The outcome results were heterogeneous within teams and across teams and QICs. Both QICs were highly appreciated by the participants and contributed to their learning, e.g. of improvement methods; however, several teams had already reached goal values when the QICs were launched in 2013.

    Conclusions: Even though many QI activities were carried out, it was difficult to see sustained improvements on outcomes. Outcomes as specific measurable aspects of care in need of improvement should be chosen carefully. Activities focusing on adherence to standard care programmes and on increased follow-up of patients seemed to lead to more long-lasting improvements. Although earlier studies showed that data follow-up and measurement skills as well as well-functioning data warehouses contribute to sustained improvements, the present registries' functionality and QICs at this time did not support those aspects sufficiently. Further studies on QICs and their impact on improvement beyond the project time should investigate the effect of those elements in particular. 

  • 5.
    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.

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  • 6.
    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.

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  • 7.
    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 context2020In: International Journal of Healthcare Management, ISSN 2047-9700, E-ISSN 2047-9719, Vol. 13, no 3, p. 236-244Article 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.

  • 8.
    Andersson, Ann-Christine
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Johansson, Rose-Marie
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Ryhov County Hospital, Jönköping, Sweden.
    Elg, Mattias
    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).
    Christensson, Lennart
    Ryhov County Hospital, Jönköping, Sweden.
    Using quality improvement methods to implement guidelines to decrease the proportion of urinary retention in orthopaedic care2017In: International Archives of Nursing and Health Care, ISSN 2469-5823, Vol. 3, no 1, article id IANHC-3-065Article in journal (Refereed)
    Abstract [en]

    In patients treated with indwelling urethral catheter (IUC), complications such as catheter associated urinary tract infections are common, while underuse of IUC may cause harmful urinary retention (UR). A quality improvement (QI) program called ‘Indwelling urethral catheter (IUC) - only when needed’ was developed in Jönköping County Council, Sweden, aiming at creating a new approach: hospital staff should be able to identify and manage patients with risk of UR, prevent UR or treat UR without delay, and only use urinary IUCs on appropriate indications. The aim of this study was to describe the process of application of the quality improvement program. The Model for Improvement was used, and process coaches were appointed in the participating units. Their training was based on clinical issues and facts about UR, IUCs, guidelines, QI methods and measurements. Data were collected through prospective and retrospective patient record reviews, and differences were analyzed by inferential statistics.

    Before the intervention, only two patients out of 296 were cared for following the guidelines perfectly. During the intervention, adherence to guidelines showed a rising trend, and reached a new stable level, with an average of 67% adherence to guidelines. A systematic improvement program supported by coaches and improvement tools can increase the adherence to new guidelines and incorporate them into local practice. This study also shows that adherence to guidelines can improve patient safety, in this case a decreased risk for and incidence of UR in an orthopaedic patient population.

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  • 9.
    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, Dept. 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.

  • 10.
    Andersson Hagiwara, Magnus
    et al.
    School of Health Sciences, University of Borås, 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).
    Elg, Mattias
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Division of Quality Technology and Management, Linköping University, Sweden.
    Interrupted time series versus statistical process control in quality improvement projects2016In: Journal of Nursing Care Quality, ISSN 1057-3631, E-ISSN 1550-5065, Vol. 31, no 1, p. E1-E8Article in journal (Refereed)
    Abstract [en]

    To measure the effect of quality improvement interventions, it is appropriate to use analysis methods that measure data over time. Examples of such methods include statistical process control analysis and interrupted time series with segmented regression analysis. This article compares the use of statistical process control analysis and interrupted time series with segmented regression analysis for evaluating the longitudinal effects of quality improvement interventions, using an example study on an evaluation of a computerized decision support system.

  • 11.
    Andersson-Gäre, Boel
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, HHJ. Studies on Integrated Health and Welfare (SIHW). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum Region Jönköpings län.
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Från kunskap till handling – för barnens bästa2023Report (Other academic)
  • 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.
    Day, Annika L.
    et al.
    Department of Physiotherapy, Ryhov County Hospital, Jönköping, Sweden.
    Währborg, Peter
    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. Futurum Akademi for Health and Care Region Jönköping County.
    Rydå, Ulla
    Jansson, Marian
    An evaluation of daily relaxation training and psychosomatic symptoms in young children2016In: Health Behavior and Policy Review, ISSN 2326-4403, Vol. 3, no 3, p. 198-208Article in journal (Refereed)
    Abstract [en]

    Objectives: We evaluated the efficacy of daily relaxation training on psychosomatic symptoms during one school year among 8-year-old children. Methods: Cortisol in saliva, abdominal circumference including body mass index (BMI), heart rate, rate pressure product (RPP), and stress in children (SIC) were measured. Teachers in the intervention classes were interviewed. The intervention consisted of a daily relaxation therapy (RT). Results: The intervention group showed reduced heart rate. Individuals of the intervention group showed an improvement regarding headaches and the ability to fall asleep. The qualitative results showed that the RT had a calming effect on both the children and the teachers. Conclusions: RT among children may be of use to cope with stress as interpreted by some improved parameters in the intervention group.

  • 14. 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, 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.

  • 15.
    Fröding, Elin
    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). Region Jönköpings län, Jönköping, 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). Futurum, Region Jönköpings län, Jönköping, Sweden.
    Westrin, Åsa
    Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Ros, Axel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Region Jönköpings län, Jönköping, Sweden.
    Suicide as an incident of severe patient harm: A retrospective cohort study of investigations after suicide in Swedish healthcare in a 13-year perspective2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 3, article id e044068Article in journal (Refereed)
    Abstract [en]

    Objectives

    To explore how mandatory reporting to the supervisory authority of suicides among recipients of healthcare services has influenced associated investigations conducted by the healthcare services, the lessons obtained and whether any suicide-prevention-related improvements in terms of patient safety had followed.

    Design and settings

    Retrospective study of reports from Swedish primary and secondary healthcare to the supervisory authority after suicide.

    Participants

    Cohort 1: the cases reported to the supervisory authority in 2006, from the time the reporting of suicides became mandatory, to 2007 (n=279). Cohort 2: the cases reported in 2015, a period of well-established reporting (n=436). Cohort 3: the cases reported from September 2017, which was the time the law regarding reporting was removed, to November 2019 (n=316).

    Primary and secondary outcome measures

    Demographic data and received treatment in the months preceding suicide were registered. Reported deficiencies in healthcare and actions were categorised by using a coding scheme, analysed per individual and aggregated per cohort. Separate notes were made when a deficiency or action was related to a healthcare-service routine.

    Results

    The investigations largely adopted a microsystem perspective, focusing on final patient contact, throughout the overall study period. Updating existing or developing new routines as well as educational actions were increasingly proposed over time, while sharing conclusions across departments rarely was recommended.

    Conclusions

    The mandatory reporting of suicides as potential cases of patient harm was shown to be restricted to information transfer between healthcare providers and the supervisory authority, rather than fostering participative improvement of patient safety for suicidal patients.

    The similarity in outcomes across the cohorts, regardless of changes in legislation, suggests that the investigations were adapted to suit the structure of the authority’s reports rather than the specific incident type, and that no new service improvements or lessons are being identified.

  • 16.
    Fröding, Elin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Vincent, C
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Dept. for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Westrin, Åsa
    Ros, Axel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Requirements for effective investigation and learning after suicide: The views of persons with lived experience and professionalsManuscript (preprint) (Other academic)
  • 17.
    Fröding, Elin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Region Jönköping County, Jönköping, Sweden.
    Vincent, C
    Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum, Region Jönköping County, Sweden.
    Westrin, Åsa
    Department of Clinical Sciences Lund, Psychiatry, Lund University, and Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, Lund, Sweden.
    Ros, Axel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum, Region Jönköping County, Jönköping, Sweden.
    Six Major Steps to Make Investigations of Suicide Valuable for Learning and Prevention2022In: Archives of Suicide Research, ISSN 1381-1118, E-ISSN 1543-6136Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVE: The decline in suicide rates has leveled off in many countries during the last decade, suggesting that new interventions are needed in the work with suicide prevention. Learnings from investigations of suicide should contribute to the development of these new interventions. However, reviews of investigations have indicated that few new lessons have been learned. To be an effective tool, revisions of the current investigation methods are required. This review aimed to describe the problems with the current approaches to investigations of suicide as patient harm and to propose ways to move forward.

    METHODS: Narrative literature review.

    RESULTS: Several weaknesses in the current approaches to investigations were identified. These include failures in embracing patient and system perspectives, not addressing relevant factors, and insufficient competence of the investigation teams. Investigation methods need to encompass the progress of knowledge about suicidal behavior, suicide prevention, and patient safety.

    CONCLUSIONS: There is a need for a paradigm shift in the approaches to investigations of suicide as potential patient harm to enable learning and insights valuable for healthcare improvement. Actions to support this paradigm shift include involvement of patients and families, education for investigators, multidisciplinary analysis teams with competence in and access to relevant parts across organizations, and triage of cases for extensive analyses. A new model for the investigation of suicide that support these actions should facilitate this paradigm shift.

    HIGHLIGHTS

    • There are weaknesses in the current approaches to investigations of suicide.
    • A paradigm shift in investigations is needed to contribute to a better understanding of suicide.
    • New knowledge of suicidal behavior, prevention, and patient safety must be applied.
  • 18.
    Godfrey, Marjorie M.
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Nelson, Eugene C.
    Geisel School of Medicine at Dartmouth, Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
    Nilsson, Mats
    Futurum, Jönköping County Council, Jönköping, Sweden.
    Ahlström, Gerd
    The Swedish Institute for Health Sciences and Department of Health Sciences, Lund University, Lund, Sweden.
    Coaching interprofessional health care improvement teams: the coachee, the coach and the leader perspectives2014In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 22, no 4, p. 452-464Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate health care improvement team coaching activities from the perspectives of coachees, coaches and unit leaders in two national improvement collaboratives.

    BACKGROUND: Despite numerous methods to improve health care, inconsistencies in success have been attributed to factors that include unengaged staff, absence of supportive improvement resources and organisational inertia.

    METHODS: Mixed methods sequential exploratory study design, including quantitative and qualitative data from interprofessional improvement teams who received team coaching. The coachees (n = 382), coaches (n = 9) and leaders (n = 30) completed three different data collection tools identifying coaching actions perceived to support improvement activities.

    RESULTS: Coachees, coaches and unit leaders in both collaboratives reported generally positive perceptions about team coaching. Four categories of coaching actions were perceived to support improvement work: context, relationships, helping and technical support.

    CONCLUSIONS: All participants agreed that regardless of who the coach is, emphasis should include the four categories of team coaching actions.

    IMPLICATIONS FOR NURSING MANAGEMENT: Leaders should reflect on their efforts to support improvement teams and consider the four categories of team coaching actions. A structured team coaching model that offers needed encouragement to keep the team energized, seems to support health care improvement.

  • 19.
    Gremyr, Andreas
    et al.
    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).
    Greenhalgh, Trisha
    Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
    Malm, Ulf
    Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    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).
    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. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Using complexity assessment to inform the development and deployment of a digital dashboard for schizophrenia care: Case study2020In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 22, no 4, article id e15521Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Health care is becoming more complex. For an increasing number of individuals, interacting with health care means addressing more than just one illness or disorder, engaging in more than one treatment, and interacting with more than one care provider. Individuals with severe mental illnesses such as schizophrenia are disproportionately affected by this complexity. Characteristic symptoms can make it harder to establish and maintain relationships. Treatment failure is common even where there is access to effective treatments, increasing suicide risk. Knowledge of complex adaptive systems has been increasingly recognized as useful in understanding and developing health care. A complex adaptive system is a collection of interconnected agents with the freedom to act based on their own internalized rules, affecting each other. In a complex health care system, relevant feedback is crucial in enabling continuous learning and improvement on all levels. New technology has potential, but the failure rate of technology projects in health care is high, arguably due to complexity. The Nonadoption, Abandonment, and challenges to Scale-up, Spread, and Sustainability (NASSS) framework and complexity assessment tool (NASSS-CAT) have been developed specifically to help identify and manage complexity in technology-related development projects in health care.

    OBJECTIVE: This study aimed to use a pilot version of the NASSS-CAT instrument to inform the development and deployment of a point-of-care dashboard supporting schizophrenia care in west Sweden. Specifically, we report on the complexity profile of the project, stakeholders' experiences with using NASSS-CAT, and practical implications.

    METHODS: We used complexity assessment to structure data collection and feedback sessions with stakeholders, thereby informing an emergent approach to the development and deployment of the point-of-care dashboard. We also performed a thematic analysis, drawing on observations and documents related to stakeholders' use of the NASSS-CAT to describe their views on its usefulness.

    RESULTS: Application of the NASSS framework revealed different types of complexity across multiple domains, including the condition, technology, value proposition, organizational tasks and pathways, and wider system. Stakeholders perceived the NASSS-CAT tool as useful in gaining perspective and new insights, covering areas that might otherwise have been neglected. Practical implications derived from feedback sessions with managers and developers are described.

    CONCLUSIONS: This case study shows how stakeholders can identify and plan to address complexities during the introduction of a technological solution. Our findings suggest that NASSS-CAT can bring participants a greater understanding of complexities in digitalization projects in general.

  • 20.
    Gremyr, Andreas
    et al.
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Schizophrenia Spectrum Disorders, Sahlgrenska University Hospital, Sahlgrenska Universitetssjukhuset Psykiatri Psykos, Mölndal, 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).
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH, USA.
    Elwyn, Glyn
    Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH, USA.
    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). Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH, USA.
    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. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Care Science, Malmö University, Malmö, Sweden.
    The role of co-production in Learning Health Systems2021In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 33, no Supplement 2, p. ii26-ii32Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Co-production of health is defined as 'the interdependent work of users and professionals who are creating, designing, producing, delivering, assessing, and evaluating the relationships and actions that contribute to the health of individuals and populations'. It can assume many forms and include multiple stakeholders in pursuit of continuous improvement, as in Learning Health Systems (LHSs). There is increasing interest in how the LHS concept allows integration of different knowledge domains to support and achieve better health. Even if definitions of LHSs include engaging users and their family as active participants in aspects of enabling better health for individuals and populations, LHS descriptions emphasize technological solutions, such as the use of information systems. Fewer LHS texts address how interpersonal interactions contribute to the design and improvement of healthcare services.

    OBJECTIVE: We examined the literature on LHS to clarify the role and contributions of co-production in LHS conceptualizations and applications.

    METHOD: First, we undertook a scoping review of LHS conceptualizations. Second, we compared those conceptualizations to the characteristics of LHSs first described by the US Institute of Medicine. Third, we examined the LHS conceptualizations to assess how they bring four types of value co-creation in public services into play: co-production, co-design, co-construction and co-innovation. These were used to describe core ideas, as principles, to guide development.

    RESULT: Among 17 identified LHS conceptualizations, 3 qualified as most comprehensive regarding fidelity to LHS characteristics and their use in multiple settings: (i) the Cincinnati Collaborative LHS Model, (ii) the Dartmouth Coproduction LHS Model and (iii) the Michigan Learning Cycle Model. These conceptualizations exhibit all four types of value co-creation, provide examples of how LHSs can harness co-production and are used to identify principles that can enhance value co-creation: (i) use a shared aim, (ii) navigate towards improved outcomes, (iii) tailor feedback with and for users, (iv) distribute leadership, (v) facilitate interactions, (vi) co-design services and (vii) support self-organization.

    CONCLUSIONS: The LHS conceptualizations have common features and harness co-production to generate value for individual patients as well as for health systems. They facilitate learning and improvement by integrating supportive technologies into the sociotechnical systems that make up healthcare. Further research on LHS applications in real-world complex settings is needed to unpack how LHSs are grown through coproduction and other types of value co-creation.

  • 21.
    Gremyr, Andreas
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Psychotic Disorders, Sahlgrenska University Hospital, Mölndal, Sweden.
    Holmberg, Christopher
    Department of Psychotic Disorders, Sahlgrenska University Hospital, Mölndal, Sweden.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Malm, Ulf
    Sahlgrenska Academy at Gothenburg University, Institute of Neuroscience and Physiology, Göteborg, 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. ARN-J (Aging Research Network - Jönköping). Futurum Academy for Health and Care, Region Jönköping County, Jönköping, Sweden.
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    How a Point-of-Care Dashboard Facilitates Co-production of Health Care and Health for and with Individuals with Psychotic Disorders: A Mixed-methods Case Study2022In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, article id 1599Article in journal (Refereed)
    Abstract [en]

    Background

    Individuals with psychotic disorders experience widespread treatment failures and risk early death. Sweden’s largest department specializing in psychotic disorders sought to improve patients’ health by developing a point-of-care dashboard to support joint planning and co-production of care. The dashboard was tested for 18 months and included more than 400 patients at two outpatient clinics.

    Methods

    This study evaluates the dashboard by addressing two questions:

    1. Can differences in health-related outcome measures be attributed to the use of the dashboard?
    2. How did the case managers experience the accessibility, use, and usefulness of the dashboard for co-producing care with individuals with psychotic disorders? 

    This mixed-method case study used both Patient-Reported Outcome Measures (PROM) and data from a focus group interview with case managers. Data collection and analysis were framed by the Clinical Adoption Meta Model (CAMM) phases: i) accessibility, ii) system use, iii) behavior, and iv) clinical outcomes. The PROM used was the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0), which assesses functional impairment and disability. Patients at clinics using the dashboard were matched with patients at clinics not using the dashboard. PROM data were compared using non-parametric statistics due to skewness in distribution. The focus group included five case managers who had experience using the dashboard with patients.

    Results

    Compared to patients from clinics that did not use the dashboard, patients from clinics that did use the dashboard improved significantly overall (p = 0.045) and in the domain self-care (p = 0.041). Focus group participants reported that the dashboard supported data feedback-informed care and a proactive stance related to changes in patients’ health. The dashboard helped users identify critical changes and enabled joint planning and evaluation.

    Conclusion

    Dashboard use was related to better patient health (WHODAS scores) when compared with matched patients from clinics that did not use the dashboard. In addition, case managers had a positive experience using the dashboard. Dashboard use might have lowered the risk for missing critical changes in patients’ health while increasing the ability to proactively address needs. Future studies should investigate how to enhance patient co-production through use of supportive technologies.

  • 22.
    Gäre, Klas
    et al.
    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. Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Thor, Johan
    Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Evidence informed healthcare improvement: Design and evaluation2023Report (Other academic)
    Abstract [en]

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

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

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

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

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  • 23. Hagelberg, Stefan
    et al.
    Andersson Gäre, BoelJönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.Fasth, AndersMånsson, BengtEnman, Yvonne
    Barnreumatologi2008Collection (editor) (Other academic)
  • 24.
    Hagelberg, Stefan
    et al.
    Sektionen för barnreumatologi, Astrid Lindgrens barnsjukhus, Karolinska universitetssjukhuset, Stockholm.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Barnreumatologisk vård: teamarbete och nätverk2008In: Barnreumatologi / [ed] S. Hagelberg et al., Lund: Studentlitteratur , 2008, p. 157-160Chapter in book (Other academic)
  • 25.
    Hagiwara, Magnus
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Suserud, Björn-Ove
    University of Borås, School of Health Sciences, 501 90 Borås, Sweden.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Sjöqvist, Bengt-Arne
    Department of Signals and Systems, Chalmers University of Technology, Gothenburg, Sweden.
    Henricson, Maria
    Jönköping University, School of Health and Welfare.
    Jonsson, Anders
    University of Borås, School of Health Sciences, 501 90 Borås, Sweden.
    The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study2014In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 14, no 70, p. 1-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Errors in the decision-making process are probably the main threat to patient safety in the prehospital setting. The reason can be the change of focus in prehospital care from the traditional "scoop and run" practice to a more complex assessment and this new focus imposes real demands on clinical judgment. The use of Clinical Guidelines (CG) is a common strategy for cognitively supporting the prehospital providers. However, there are studies that suggest that the compliance with CG in some cases is low in the prehospital setting. One possible way to increase compliance with guidelines could be to introduce guidelines in a Computerized Decision Support System (CDSS). There is limited evidence relating to the effect of CDSS in a prehospital setting. The present study aimed to evaluate the effect of CDSS on compliance with the basic assessment process described in the prehospital CG and the effect of On Scene Time (OST).

    METHODS:

    In this time-series study, data from prehospital medical records were collected on a weekly basis during the study period. Medical records were rated with the guidance of a rating protocol and data on OST were collected. The difference between baseline and the intervention period was assessed by a segmented regression.

    RESULTS:

    In this study, 371 patients were included. Compliance with the assessment process described in the prehospital CG was stable during the baseline period. Following the introduction of the CDSS, compliance rose significantly. The post-intervention slope was stable. The CDSS had no significant effect on OST.

    CONCLUSIONS:

    The use of CDSS in prehospital care has the ability to increase compliance with the assessment process of patients with a medical emergency. This study was unable to demonstrate any effects of OST.

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  • 26.
    Hazelzet, Jan A.
    et al.
    Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
    Thor, Johan
    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).
    Kremer, Jan A. M.
    IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
    van Weert, Nico
    Society Personalized Healthcare, Nijmegen, The Netherlands.
    Savage, Carl
    Medical Management Centre, Department of Learning, Informatics, Management & Ethics, Karolinska Institute, Stockholm, Sweden.
    Elwyn, Glyn
    The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA.
    Value-based healthcare's blind spots: call for a dialogue2021In: F1000Research, Vol. 10, no 1314Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    The value-based healthcare (VBHC) concept was first proposed as a solution to many of the ills of healthcare. Since then, we have seen the term “value” defined, used, confused, and interpreted in multiple ways. While we may disagree that competition based on value will solve healthcare’s complex challenges, value is a concept integral to the future of healthcare. Before VBHC becomes consigned to the long list of quality improvement trends and management fads that have passed through healthcare, we call for a dialogue around the term value and the implications of its different interpretations. The intention is not just to critique, but to facilitate ongoing efforts to substantially improve healthcare in ways that are relevant and sustainable for society at large.

  • 27.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Wijk, Helle
    Institute of Health and Care Science, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Dept. for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum-the Academy for Health and Care, Region Jönköping County, Sweden.
    Petersson, Christina
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum-the Academy for Health and Care, Region Jönköping County, Sweden.
    Shared decision-making and person-centred care in Sweden: Exploring coproduction of health and social care services2022In: Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen, ISSN 1865-9217, E-ISSN 2212-0289, Vol. 171, p. 129-134Article in journal (Refereed)
    Abstract [en]

    In Sweden the health system is nationally regulated and locally provided by 21 regions and 290 municipalities. To meet the shifting paradigm, where the person is viewed as a co-producer of health and care, Sweden has laws, regulations and policies which support the patient as an active partner in the communication with professionals in the system. Coproduction, person-centred care and shared decision making contribute jointly to the paradigm shift. Principles of human dignity and equity must be supported nationally and enacted in the decentralized, regional provision of care. Infrastructures exist or are under development which can support and strengthen care that is co-produced and based in a person-centred philosophy and approach, where shared decision making becomes a reality in practice. A Knowledge management system together with National Quality registries have the potential to form a co-produced, person-centred learning health system, where patients, and next of kin and professionals are included as partners. The joint integration of Shared decision making, Person-centre care and Coproduction into the Swedish healthcare system now looks like a possible way to realize the emerging paradigm.

  • 28.
    Johansson, Linda
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Finkel, Deborah
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Psychology, Indiana University Southeast, New Albany, IN, USA.
    Lannering, Christina
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Region Jönköping County, Futurum, Ryhov, Jönköping, Sweden.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 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, Ryhov, Jönköping, Sweden.
    Hallgren, Jenny
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). School of Health Sciences, University of Skövde, Skövde, Sweden.
    Lindmark, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Ernsth-Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Using aggregated data from Swedish national quality registries as tools to describe health conditions of older adults with complex needs2021In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 33, p. 1297-1306Article in journal (Refereed)
    Abstract [en]

    Background: Combining National Quality Registries (NQRs) with existing National Health Registries (NHRs) might make it possible to get a wider picture of older adults health situation. The aim was to examine the feasibility of aggregating data across different NQRs and existing NHRs to explore the possibility to investigate trajectories and patterns of disease and care, specifically for the most ill older adults.

    Method: A Swedish twin population (N = 44,816) was linked to nine NQRs and four NHRs. A descriptive mixed-method study was performed. A manifest content analysis identified which health parameters were collected from each NQR. Factor analysis identified patterns in representation across NQRs. Two case studies illustrated individual trajectories of care by using NQRs and NHRs.

    Results: About 36% of the population was registered in one or more NQRs. NQRs included 1849 variables that were sorted into 13 categories with extensive overlap across the NQRs. Health and function variables were identified, but few social or cognitive variables. Even though most individuals demonstrated unique patterns of multi-morbidities, factor analysis identified three clusters of representation in the NQRs with sufficient sample sizes for future investigations. The two cases illustrated the possibility of following patterns of disease and trajectories of care.

    Conclusions: NQRs seem to be a significant source for collecting data about a population that may be underrepresented in most research on aging because of their age and poor health. However, NQRs are primarily disease related, and further development of the registries to maximize coverage and utility is needed. 

  • 29.
    Johnson, Julie K.
    et al.
    Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University Feinberg School of Medicine, 633 N. Saint Clair St, 20th floor, Chicago, 60611, IL, 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). Geisel School of Medicine at Dartmouth, Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, United States.
    Foster, Tina
    Obstetrics and Gynecology and Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
    Arvidsson, Charlotte
    Bra Liv Hälsan 1 Primary Care Centre, Region Jönköping County, Jönköping, Sweden.
    Batalden, Maren
    Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States.
    Forcino, Rachel
    Geisel School of Medicine at Dartmouth, Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, United States.
    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). Futurum—The Academy for Health and Care, Region Jönköping County, Länssjukhuset Ryhov, Jönköping, Sweden.
    A starter's guide to learning and teaching how to coproduce healthcare services2021In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 33, no Supplement 2, p. II55-II62Article in journal (Refereed)
    Abstract [en]

    Background: There has been insufficient attention paid to the role of learning in co-production-both how service users and professional service providers learn to co-produce effectively and how the lessons of co-production are captured at a service level.

    Objective: We aimed to develop and test a curriculum to support healthcare professionals' interest in learning how to co-produce health and healthcare services with patients.

    Methods: We developed a co-production curriculum that was tested iteratively in multiple in-person and virtual teaching sessions and short courses. We conducted a formative evaluation of the co-production curriculum and teaching tools to tailor the curriculum.

    Results: Several theories underpin our approach to learning and teaching how to co-produce healthcare services. The co-production curriculum is grounded in systems theory and shares elements of educational theories, namely, the postmodern curriculum matrix, the actor network theory and situated learning in communities of practice. Learning participants valued the sense of community, the experiential learning environment, and the practical methods to support their exploration of co-production.

    Conclusion: This paper summarizes the educational theories that underpin our efforts to develop and implement the curriculum, reports on a formative assessment conducted with learners, and makes recommendations for creating an environment for learning how health professionals can co-produce health and healthcare with patients.

  • 30.
    Karltun, Anette
    et al.
    Jönköping University, School of Engineering, JTH, Supply Chain and Operations Management. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Sanne, Johan M.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. IVL Swedish Environmental research Institute, Sweden.
    Aase, Karina
    SHARE – Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Norway.
    Anderson, Janet E.
    Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London.
    Fernandes, Alexandra
    ISCTE, Lisbon University Institute, Portugal.
    Fulop, Naomi J.
    Department of Applied Health Research, University College London.
    Höglund, Per J.
    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). Futurum, Region Jönköping County, Jönköping, Sweden.
    Knowledge management infrastructure to support quality improvement: A qualitative study of maternity services in four European hospitals2020In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 124, no 2, p. 205-215Article in journal (Refereed)
    Abstract [en]

    The influence of multilevel healthcare system interactions on clinical quality improvement (QI) is still largely unexplored. Through the lens of knowledge management (KM) theory, this study explores how hospital managers can enhance the conditions for clinical QI given the specific multilevel and professional interactions in various healthcare systems.

    The research used an in-depth multilevel analysis in maternity departments in four purposively sampled European hospitals (Portugal, England, Norway and Sweden). The study combines analysis of macro-level policy documents and regulations with semi-structured interviews (96) and non-participant observations (193 hours) of hospital and clinical managers and clinical staff in maternity departments.

    There are four main conclusions: First, the unique multilevel configuration of national healthcare policy, hospital management and clinical professionals influence the development of clinical QI efforts. Second, these different configurations provide various and often insufficient support and guidance which affect professionals’ action strategies in QI efforts. Third, hospital managers’ opportunities and capabilities for developing a consistent KM infrastructure with reinforcing enabling conditions which merge national policies and guidelines with clinical reality is crucial for clinical QI. Fourth, understanding these interrelationships provides an opportunity for improvement of the KM infrastructure for hospital managers through tailored interventions.

  • 31.
    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).
    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, 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. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Ockander, Marlene
    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).
    Käll, Jacob
    Djursdala samhällsförening, Djursdala, Sweden, Sweden.
    McGrath, Jane
    We Coproduce, London, UK.
    Donetto, Sara
    Florence Nightingale Faculty of Nursing, 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, King's College London, London, United Kingdom.
    Exploring, measuring and enhancing the coproduction of health and well-being at the national, regional and local levels through comparative case studies in Sweden and England: the 'Samskapa' research programme protocol2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 7, article id e029723Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    Cocreation, coproduction and codesign are advocated as effective ways of involving citizens in the design, management, provision and evaluation of health and social care services. Although numerous case studies describe the nature and level of coproduction in individual projects, there remain three significant gaps in the evidence base: (1) measures of coproduction processes and their outcomes, (2) mechanisms that enable inclusivity and reciprocity and (3) management systems and styles. By focusing on these issues, we aim to explore, enhance and measure the value of coproduction for improving the health and well-being of citizens.

    METHODS AND ANALYSIS:

    Nine ongoing coproduction projects form the core of an interactive research programme ('Samskapa') during a 6-year period (2019-2024). Six of these will take place in Sweden and three will be undertaken in England to enable knowledge exchange and cross-cultural comparison. The programme has a longitudinal case study design using both qualitative and quantitative methods. Cross-case analysis and a sensemaking process will generate relevant lessons both for those participating in the projects and researchers. Based on the findings, we will develop explanatory models and other outputs to increase the sustained value (and values) of future coproduction initiatives in these sectors.

    ETHICS AND DISSEMINATION:

    All necessary ethical approvals will be obtained from the regional Ethical Board in Sweden and from relevant authorities in England. All data and personal data will be handled in accordance with General Data Protection Regulations. Given the interactive nature of the research programme, knowledge dissemination to participants and stakeholders in the nine projects will be ongoing throughout the 6 years. External workshops-facilitated in collaboration with participating case studies and citizens-both during and at the end of the programme will provide an additional dissemination mechanism and involve health and social care practitioners, policymakers and third-sector organisations. 

  • 32.
    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.

  • 33.
    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.

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  • 34.
    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 Organization & 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.

  • 35.
    Knutsson, Susanne
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Enskär, Karin
    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). Futurum-Academy for Health and Care, Region Jönköping County, Sweden.
    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, Sweden.
    Children as relatives to a sick parent: Healthcare professionals’ approaches2017In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 37, no 2, p. 61-69Article in journal (Refereed)
    Abstract [en]

    An illness or injury sustained by a family member affects all family members. It is consequently important that a child’s need to be involved in a family member’s care is clearly recognized by healthcare professionals. The aim of this study was to describe healthcare professionals’ approaches to children as relatives of a parent being cared for in a clinical setting. A web-based study-specific questionnaire was sent and responded to by 1052 healthcare professionals in Sweden. Data were analysed using descriptive statistics and qualitative analysis. The results show that guidelines and routines are often lacking regarding involving children in the care of a parent. Compared to other areas, psychiatric units seem to have enacted routines and guidelines to a greater extent than other units. The results indicate that structured approaches based on an awareness of the children’s needs as well as a child-friendly environment are vital in family-focused care. These aspects need to be prioritized by managers in order to support children’s needs and promote health and wellbeing for the whole family.

  • 36.
    Kvarnström, Susanne
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work.
    Cedersund, Elisabeth
    Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work.
    Andersson Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work. 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).
    Multiparty team talk: Constructions of user participation in an interprofessional team context2009In: Communication, Medicine & Ethics: COMET Conference 2009 / [ed] Srikant Sarangi, 2009Conference paper (Refereed)
    Abstract [en]

    Background. Today health and social care delivery are largely team based but the question remains whether the voice of the user is perceived as a team member or merely as the recipient of the care. There have however been few efforts to understand or change the smallest interprofessional frontline units who generate the actual service, i.e. the microsystems.

    Purpose. This paper presents preliminary findings regarding descriptions of constructions of user participation in a multiparty negotiation context.

    Materials and methods. The material consisted of ethnographic field notes and audiotapes from observations (n=8) of interprofessional team meetings in one clinical healthcare microsystem. The teams included the user and health professionals, e.g. medical social worker, physician and psychologist. The users who participated in the observed team meetings had all long-term mainly physical conditions.

    Findings and discussion. Preliminary inductive analyses of observations of interprofessional team situations involving users indicates identity constructions in multiparty talk where the user is beheld primarily as a loyal and active member of the team. Discussions will relate to how user participation is learned and constructed by users and health professionals in collaborative care at the microsystem level.

  • 37.
    Kvarnström, Susanne
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of 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. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Willumsen, Elisabeth
    Department of Social Studies, University of Stavanger, Norway.
    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, Quality Improvement and Leadership in Health and Welfare.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    How Service Users Perceive the Concept of Participation, Specifically in interprofessional practice2012In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, Vol. 42, no 1, p. 129-146Article in journal (Refereed)
    Abstract [en]

    This paper reports on empirical research exploring and describing the variations in service users' conceptions of service user participation (SUP), specifically in interprofessional practice. The social work practices in which front line workers were using interprofessional teamwork were explored at three Swedish welfare institutions. Service users included individuals with chronic pain disorders, obesity conditions or in need of short-term placement in elder care facilities. The qualitative study design was informed by a phenomenographical approach and conducted as semi-structured individual interviews with twenty-two service users. The main findings suggest five qualitative variations of service user's conceptions of SUP: (i) information transmission; (ii) choices and decisions among resources; (iii) comfortable relationship and communication; (iv) interaction for increased understanding; and (v) conditions for service user participation. The findings highlight the importance for the interprofessional team of social workers and other professionals to recognise the various ways of experiencing SUP by service users. The findings thereby support the possibilities to understand and to take into consideration the individual service user's conceptions of SUP in interprofessional practice.

  • 38.
    Lim, E. L. P.
    et al.
    Jönköping University, School of Health and Welfare.
    Khee, G. Y.
    Department of Pharmacy, Singapore General Hospital, Singapore.
    Thor, Johan
    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, HHJ, Dept. for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Thumboo, J.
    SingHealth Office of Regional Health, Singapore Health Services, Singapore.
    Allgurin, Monika
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Social Work. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    How the Esther Network model for coproduction of person-centred health and social care was adopted and adapted in Singapore: a realist evaluation2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 12, article id e059794Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The Esther Network (EN) model, a person-centred care innovation in Sweden, was adopted in Singapore to promote person-centredness and improve integration between health and social care practitioners. This realist evaluation aimed to explain its adoption and adaptation in Singapore. DESIGN: An organisational case study using a realist evaluation approach drawing on Greenhalgh et al (2004)'s Diffusion of Innovations in Service Organisations to guide data collection and analysis. Data collection included interviews with seven individuals and three focus groups (including stakeholders from the macrosystem, mesosystem and microsystem levels) about their experiences of EN in Singapore, and field notes from participant observations of EN activities. SETTING: SingHealth, a healthcare cluster serving a population of 1.37 million residents in Eastern Singapore. PARTICIPANTS: Policy makers (n=4), EN programme implementers (n=3), practitioners (n=6) and service users (n=7) participated in individual interviews or focus group discussions. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcome data from healthcare institutions (n=13) and community agencies (n=59) were included in document analysis. RESULTS: Singapore's ageing population and need to transition from a hospital-based model to a more sustainable community-based model provided an opportunity for change. The personalised nature and logic of the EN model resonated with leaders and led to collective adoption. Embedded cultural influences such as the need for order and hierarchical structures were both barriers to, and facilitators of, change. Coproduction between service users and practitioners in making care improvements deepened the relationships and commitments that held the network together. CONCLUSIONS: The enabling role of leaders (macrosystem level), the bridging role of practitioners (mesosystem level) and the unifying role of service users (microsystem level) all contributed to EN's success in Singapore. Understanding these roles helps us understand how staff at various levels can contribute to the adoption and adaptation of EN and similar complex innovations systemwide.

  • 39.
    Lim, Esther Li Ping
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Ong, R. H. S.
    Health Services Research, Changi General Hospital, Singapore.
    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, Department for Quality Improvement and Leadership.
    Wilińska, Monika
    Jönköping University, School of Health and Welfare, HHJ, Department of Social Work. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Department for Quality Improvement and Leadership. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Thumboo, J.
    SingHealth Office of Regional Health, Singapore Health Services, Singapore.
    An Evaluation of the Relationship between Training of Health Practitioners in a Person-Centred Care Model and their Person-Centred Attitudes2023In: International Journal of Integrated Care, E-ISSN 1568-4156, Vol. 23, no 4, article id 11Article in journal (Refereed)
    Abstract [en]

    Introduction: The Esther Network (EN) person-centred care (PCC) advocacy training aims to promote person-centred attitudes among health practitioners in Singapore. This study aimed to assess the relationship between the training and practitioners’ PCC attributes over a 3-month period, and to explore power sharing by examining the PCC dimensions of “caring about the service user as a whole person” and the “sharing of power, control and information”. Methods: A repeated-measure study design utilising the Patient-Practitioner Orientation Scale (PPOS), was administered to 437 training participants at three time points – before training (T1), immediately after (T2) and three months after training (T3). A five-statement questionnaire captured knowledge of person-centred care at T1 and T2. An Overall score, Caring and Sharing sub-scores were derived from the PPOS. Scores were ranked and divided into three groups (high, medium and low). Ordinal Generalised Estimating Equation (GEE) model analysed changes in PPOS scores over time. Results: A single, short-term training appeared to result in measurable improvements in person-centredness of health practitioners, with slight attenuation at T3. There was greater tendency to “care” than to “share power” with service users across all three time points, but the degree of improvement was larger for sharing after training. The change in overall person-centred scores varied by sex and profession (females score higher than males, allied health showed a smaller attenuation at T3). Conclusion: Training as a specific intervention, appeared to have potential to increase health practitioners’ person-centredness but the aspect of equalising power was harder to achieve within a hierarchical structure and clinician-centric culture. An ongoing network to build relationships, and a supportive system to facilitate individual and organisational reflexivity can reinforce learning.

  • 40.
    Lind, Jonas
    et al.
    Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden; Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Persson, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Public Health and Health Care, Region Jönköping County, Jönköping, Sweden.
    Vincent, Jonatan
    Department of Public Health and Health Care, Region Jönköping County, Jönköping, Sweden.
    Lindenfalk, Bertil
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Oliver, Brant J.
    Departments of Community and Family Medicine, Psychiatry, and the Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA.
    Smith, Andrew D.
    Multiple Sclerosis Center, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine Dartmouth College, Lebanon, New Hampshire, USA.
    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. ARN-J (Aging Research Network - Jönköping). Futurum, Region Jönköping County, Sweden.
    Contact patterns and costs of multiple sclerosis in the Swedish healthcare system: A population-based quantitative study2022In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 12, no 6, article id e2582Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The burden of disease for persons with multiple sclerosis (MS) and society is changing due to new treatments. Knowledge about the total need for care is necessary in relation to changing needs and new service models.

    OBJECTIVE: The aim of this study was to describe the contact patterns for MS patients, calculate costs in health care, and create meaningful subgroups to analyze contact patterns.

    METHODS: All patients diagnosed with MS at Ryhov Hospital were included. All contacts in the region from January 1, 2018, until September 30, 2019, were retrieved from the hospital administrative system. Data about age, sex, contacts, and diagnosis were registered. The cost was calculated using case costing, and costs for prescriptions were calculated from medical files.

    RESULTS: During the 21-month period, patients (n = 305) had 9628 contacts and 7471 physical visits, with a total cost of $7,766,109. Seventeen percent of the patients accounted for 48% of the visits. The median annual cost was $7386 in the group with 10 or fewer visits, compared to $22,491 in patients with more than 50 visits.

    CONCLUSION: There are considerable differences in the utilization of care and cost between patients with MS in an unselected population, meaning that the care needs to be better customized to each patient's demands.

  • 41.
    Neubeck, Truls
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Elg, Mattias
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Schneider, Thomas
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Famna - the Swedish Association for Non-Profit Health Care and Social Service.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Prospects and problems of transferring quality-improvement methods from health care to social services: two case studies2014In: The Permanente Journal, ISSN 1552-5767, E-ISSN 1552-5775, Vol. 18, no 2, p. 38-42Article in journal (Refereed)
    Abstract [en]

    Introduction: This study examines the use of quality-improvement(QI) methods in social services. Particularly the keyaspects—generalizable knowledge, interprofessional teamwork,and measurements—are studied in projects from the QI programForum for Values in Sweden.Methods: This is a mixed-method case study. Two projectsusing standard QI methods and tools as used in health carewere chosen as critical cases to highlight some problems andprospects with the use of QI in social services. The cases wereanalyzed through documented results and qualitative interviewswith participants one year after the QI projects ended.Results: The social service QI projects led to measurableimprovements when they used standard methods and tools forQI in health care. One year after the projects, the improvementswere either not continuously measured or not reported in anyinfrastructure for measurements. The study reveals that socialservices differ from health care regarding the availability and useof evidence, the role of professional expertise, and infrastructurefor measurements.Conclusions: We argue that QI methods as used in healthcare are applicable in social services and can lead to measurableimprovements. The study gives valuable insights for QI,not only in social services but also in health care, on howto assess and sustain improvements when infrastructures formeasurements are lacking. In addition, when one forms QIteams, the focus should be on functions instead of professions,and QI methods can be used to support implementation ofevidence-based practice.

  • 42.
    Nilsen, Per
    et al.
    Linköping University, Sweden.
    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).
    Bender, Miriam
    Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA.
    Leeman, Jennifer
    University of North Carolina, USA.
    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).
    Sevdalis, Nick
    King's College, London, UK.
    Improvement science2020In: Handbook on implementation science / [ed] P. Nilsen & S. A. Birken, Cheltenham: Edward Elgar Publishing, 2020, p. 389-408Chapter in book (Other academic)
  • 43.
    Nordal, Ellen Berit
    et al.
    Department of Pediatrics, University Hospital of North Norway, Tromsø, Norway.
    Rypdal, Veronika
    Department of Pediatrics, University Hospital of North Norway, Tromsø, Norway.
    Arnstad, Ellen Dalen
    Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.
    Aalto, Kristiina T.
    Children's Hospital, University of Helsinki, Helsinki, Finland.
    Berntson, Lillemor
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Ekelund, Maria
    Department of Pediatrics, Ryhov County Hospital, Jonkoping, Sweden.
    Fasth, Anders
    Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Glerup, Mia
    Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
    Herlin, Troels
    Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
    Nielsen, Susan M.
    Department of Pediatrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
    Peltoniemi, Suvi Marikki
    Helsingin Yliopisto, Helsinki, Finland.
    Zak, Marek Stanislaw
    Department of Pediatrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
    Songstad, Nils Thomas
    Department of Pediatrics, University Hospital of North Norway, Tromsø, Norway.
    Rygg, Marite
    Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.
    Marhaug, Gudmund O.
    St. Olavs Hospital, Trondheim, Norway.
    Pedersen, Freddy Karup
    Copenhagen.
    Lahdenne, Pekka
    Helsinki University Hospital, Helsinki, Finland.
    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).
    Participation in school and physical education in juvenile idiopathic arthritis in a Nordic long-term cohort study2019In: Pediatric Rheumatology, E-ISSN 1546-0096, Vol. 17, no 1, article id 44Article in journal (Refereed)
    Abstract [en]

    Background: The aim of the study was to describe school attendance and participation in physical education in school among children with juvenile idiopathic arthritis (JIA).

    Methods: Consecutive cases of JIA from defined geographical areas of Finland, Sweden and Norway with disease onset in 1997 to 2000 were followed for 8 years in a multi-center cohort study, aimed to be as close to population-based as possible. Clinical characteristics and information on school attendance and participation in physical education (PE) were registered.

    Results: Participation in school and in PE was lowest initially and increased during the disease course. Eight years after disease onset 228/274 (83.2%) of the children reported no school absence due to JIA, while 16.8% reported absence during the last 2 months due to JIA. Full participation in PE was reported by 194/242 (80.2%), partly by 16.9%, and none by 2.9%. Lowest participation in PE was found among children with ERA and the undifferentiated categories. Absence in school and PE was associated with higher disease activity measures at the 8-year visit. School absence > 1 day at baseline predicted use of disease-modifying anti-rheumatic drugs, including biologics (DMARDs) (OR 1.2 (1.1-1.5)), and non-remission off medication (OR 1.4 (1.1-1.7) 8 years after disease onset.

    Conclusion: School absence at baseline predicted adverse long-term outcome. In children and adolescents with JIA participation in school activities is mostly high after 8 years of disease. For the minority with low participation, special attention is warranted to promote their full potential of social interaction and improve long-term outcome.

  • 44.
    Nordin, Annika
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Region Jönköping County, Jönköping .
    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, 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.
    Emergent programme theories of a national quality register - a longitudinal study in Swedish elderly care2017In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, no 6, p. 1329-1335Article in journal (Refereed)
    Abstract [en]

    Rationale, aim, and objective: This study aimed to explore programme theories of a national quality register. A programme theory is a bundle of assumptions underpinning how and why an improvement initiative functions. The purpose was to examine and establish programme theories of a national quality register widely used in Sweden: Senior alert. The paper reports on how programme theories among change recipients emerge in relation to the established programme theory of the initiator.

    Methods: A qualitative approach and a longitudinal research design were used. To develop programme theories among change recipients, individual semistructured interviews were conducted. Three sets of interviews were conducted in the period of 2011 to 2013, totalling 22 interviews. In addition, 4 participant observations were made. To develop the initiator's programme theory, an iterative multistage collaboration process between the researchers and the initiator was used. A directed content analysis was used to analyse data.

    Findings: The initiator and change recipients described similar programme logics, but differing programme theories. With time, change recipients' programme theories emerged. Their programme theories converged and became more like the programme theory of the initiator.

    Conclusions: This study has demonstrated the importance of making both the initiator's and change recipients' programme theories explicit. To learn about conditions for improvement initiatives, comparisons between their programme theories are valuable. Differences in programme theories provide information on how initiators can customize support for their improvement initiatives. Similar programme logics can be underpinned by different programme theories, which can be deceptive. Programme theories emerge over time and need to be understood as dynamic phenomena. 

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  • 45.
    Nordin, Annika
    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).
    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, Ann-Christine
    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.
    Prospective sensemaking of a national quality register in health care and elderly care2018In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 31, no 4, p. 398-408Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of this paper is to examine how external change agents (ECAs) engaged to disseminate a national quality register (NQR) called Senior alert nationwide in the Swedish health care and elderly care sectors interpret their work. To study this, sensemaking theories are used.

    Design/methodology/approach

    This is a qualitative inductive interview study including eight ECAs. To analyze the data, a thematic analysis is carried out.

    Findings

    Well-disseminated NQRs support health care organizations’ possibility to work with quality improvement and to improve care for patient groups. NQRs function as artifacts that can influence how health care professionals make sense of their work. In this paper, a typology depicting how the ECAs make sense of their dissemination work has been developed. The ECAs are engaged in prospective sensemaking. They describe their work as being about creating future good results, both for patients and affiliated organizations, and they can balance different quality aspects.

    Originality/value

    The number of NQRs increased markedly in Sweden and elsewhere, but there are few reports on how health care professionals working with the registers interpret their work. The use of ECAs to disseminate NQRs is a novel approach. This paper describes how the ECAs are engaged in prospective sensemaking – an under-researched perspective of the sensemaking theory.

  • 46.
    Nordin, Annika
    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).
    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, 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.
    Sensemaking and cognitive shifts – learning from dissemination of a National Quality Register in health care and elderly care2018In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 31, no 4, p. 371-383Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of this study is to examine and establish how sensemaking develops among a group of external change agents (ECAs) engaged to disseminate a national quality register nationwide in Swedish health care and elderly care. To study the emergent sensemaking, the theoretical concept of cognitive shift has been used.

    Design/methodology/approach

    The data collection method included individual semi-structured interviews, and two sets of interviews (initial sensemaking and renewed sensemaking) have been conducted. Based on a typology describing how ECAs interpret their work, structural analyses and comparisons of initial and renewed sensemaking are made and illuminated in spider diagrams. The data are then analyzed to search for cognitive shifts.

    Findings

    The ECAs’ sensemaking develops. Three cognitive shifts are identified, and a new kind of issue-related cognitive shift, the outcome-related cognitive shift, is suggested. For the ECAs to customize their work, they need to be aware of how they interpret their own work and how these interpretations develop over time.

    Originality/value

    The study takes a novel view of the interrelated concepts of sensemaking and sensegivers and points out the cognitive shifts as a helpful theoretical concept to study how sensemaking develops.

  • 47.
    Norman, Ann-Charlott
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Elg, Mattias
    Department of Management and Engineering, HELIX Competence Centre, Linköping University, Linköping, Sweden.
    Nordin, Annika
    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). Futurum, Academy for Health and Care Region Jönköping County, Ryhov County Hospital, Jönköping, Sweden.
    Algurén, Beatrix
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Food and Nutrition, and Sport Science, Faculty of Education, University of Gothenburg, Gothenburg, Sweden.
    The role of professional logics in quality register use: a realist evaluation2020In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 20, p. 1-11, article id 107Article in journal (Refereed)
    Abstract [en]

    Background: Clinical practice improvements based on quality-register data are influenced by multiple factors. Although there is agreement that information from quality registers is valuable for quality improvement, practical ways of organising register use have been notoriously difficult to realise. The present study sought to investigate the mechanisms that lead various clinicians to use quality registers for improvement.

    Methods: This research involves studying individuals’ decisions in response to a Swedish programme focusing on increasing the use of quality registers. Through a case study, we focused on heart failure care and its corresponding register: the Swedish Heart Failure Register. The empirical data consisted of a purposive sample collected longitudinally by qualitative methods between 2013 and 2015. In total, 18 semi-structured interviews were carried out. We used realist evaluation to identify contexts, mechanisms, and outcomes.

    Results: We identified four contexts – registration, use of output data, governance, and improvement projects – that provide conditions for the initiation of specific mechanisms. Given a professional theoretical perspective, we further showed that mechanisms are based on the logics of either organisational improvement or clinical practice. The two logics offer insights into the ways in which clinicians choose to embrace or reject certain registers’ initiatives.

    Conclusions: We identified a strong path dependence, as registers have historically been tightly linked to the medical profession’s competence. Few new initiatives in the studied programme reach the clinical context. We explain this through the lack of an organisational improvement logic and its corresponding mechanisms in the context of the medical profession. Implementation programmes must understand the logic of clinical practice; that is, be integrated with the ways in which work is carried out in everyday practice. Programmes need to be better at helping core health professionals to reach the highest standards of patient care.

  • 48.
    Norman, Ann-Charlott
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Pedagogy, Linnaeus University, Växjö, Sweden.
    Fritzén, Lena
    Department of Pedagogy, Linnaeus University, Växjö, Sweden.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Pedagogical approaches in quality improvement coaching in healthcare: a Swedish case study of how improvement coaches approach learning in a contemporary healthcare system2015In: Nordic Journal of Studies in Educational Policy, ISSN 2002-0317, Vol. 1, no 3, article id 30178Article in journal (Refereed)
    Abstract [en]

    In this study we adopt a critical perspective and explore different coaching styles in quality improvement (QI) work in the provision of healthcare. Coaching has gained attention as an effective way to enhance QI in healthcare. This study investigates how coaching is realised in terms of learning: What kinds of learning ideals pervade QI coaching, and how is support for learning realised, given the prevailing conditions in a contemporary healthcare system? For the purpose of this case study, a group of coaches exchanged experiences about their pedagogic roles and the strategies that they employed, on four occasions, over a period of 4 months. The conversations were filmed and then analysed, using critical discourse analysis as an analytic framework. Three parallel styles of coaching were identified, which were symbolised by (1) a pointing, (2) a bypassing and (3) a guiding discourse. No persistent dominance of any one of the discourses was found, which suggests that there exists an ever-present tension between the pointing and guiding pedagogies of coaching activities. The findings indicate that QI coaching in healthcare is more complex than previous conceptualisations of coaching. Additionally, the findings present a new, ‘bypassing’ coaching style which the coaches themselves were not fully aware of.

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  • 49.
    Nyström, M. E.
    et al.
    Karolinska Institutet, Stockholm, Sweden and Umeå University, Umeå, Sweden.
    Karltun, Johan
    Jönköping University, School of Engineering, JTH, Supply Chain and Operations Management.
    Keller, Christina
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    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).
    Collaborative and partnership research for improvement of health and social services: researcher’s experiences from 20 projects2018In: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 16, article id 46Article in journal (Refereed)
    Abstract [en]

    Background

    Getting research into policy and practice in healthcare is a recognised, world-wide concern. As an attempt to bridge the gap between research and practice, research funders are requesting more interdisciplinary and collaborative research, while actual experiences of such processes have been less studied. Accordingly, the purpose of this study was to gain more knowledge on the interdisciplinary, collaborative and partnership research process by investigating researchers’ experiences of and approaches to the process, based on their participation in an inventive national research programme. The programme aimed to boost collaborative and partnership research and build learning structures, while improving ways to lead, manage and develop practices in Swedish health and social services.

    Methods

    Interviews conducted with project leaders and/or lead researchers and documentation from 20 projects were analysed using directed and conventional content analysis.

    Results

    Collaborative approaches were achieved by design, e.g. action research, or by involving practitioners from several levels of the healthcare system in various parts of the research process. The use of dual roles as researcher/clinician or practitioner/PhD student or the use of education designed especially for practitioners or ‘student researchers’ were other approaches. The collaborative process constituted the area for the main lessons learned as well as the main problems. Difficulties concerned handling complexity and conflicts between different expectations and demands in the practitioner’s and researcher’s contexts, and dealing with human resource issues and group interactions when forming collaborative and interdisciplinary research teams. The handling of such challenges required time, resources, knowledge, interactive learning and skilled project management.

    Conclusions

    Collaborative approaches are important in the study of complex phenomena. Results from this study show that allocated time, arenas for interactions and skills in project management and communication are needed during research collaboration to ensure support and build trust and understanding with involved practitioners at several levels in the healthcare system. For researchers, dealing with this complexity takes time and energy from the scientific process. For practitioners, this puts demands on understanding a research process and how it fits with on-going organisational agendas and activities and allocating time. Some of the identified factors may be overlooked by funders and involved stakeholders when designing, performing and evaluating interdisciplinary, collaborative and partnership research.

  • 50.
    Oliver, Brant J.
    et al.
    Geisel Sch Med Dartmouth, Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH 03755 USA..
    Batalden, Paul B.
    Geisel Sch Med Dartmouth, Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH 03755 USA..
    DiMilia, Peter Rocco
    Dartmouth Hitchcock Med Ctr, Community & Family Med, Lebanon, NH 03766 USA..
    Forcino, Rachel C.
    Geisel Sch Med Dartmouth, Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH 03755 USA..
    Foster, Tina C.
    Geisel Sch Med Dartmouth, Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH 03755 USA..
    Nelson, Eugene C.
    Geisel Sch Med Dartmouth, Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH 03755 USA..
    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). Jonkoping Acad Sch Hlth & Social Welf, Jonkoping, Sweden..
    COproduction VALUE creation in healthcare service (CO-VALUE): an international multicentre protocol to describe the application of a model of value creation for use in systems of coproduced healthcare services and to evaluate the initial feasibility, utility and acceptability of associated system-level value creation assessment approaches2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 10, article id e037578Article in journal (Refereed)
    Abstract [en]

    Introduction Coproduction introduces a fundamental shift in how healthcare service is conceptualised. The mechanistic idea of healthcare being a 'product' generated by the healthcare system and delivered to patients is replaced by that of a service co-created by the healthcare system and the users of healthcare services. Fjeldstadet aloffer an approach for conceptualising value creation in complex service contexts that we believe is applicable to coproduction of healthcare service. We have adapted Fjeldstad's value creation model based on a detailed case study of a renal haemodialysis service in Jonkoping, Sweden, which demonstrates coproduction characteristics and key elements of Fjeldstad's model. Methods and analysis We propose a five-part coproduction value creation model for healthcare service: (1) value chain, characterised by a standardised set of processes that serve a commonly occurring need; (2) value shop, which offers a customised response for unique cases; (3) afacilitated value network, which involves groups of individuals struggling with similar challenges; (4)interconnectionbetween shop, chain and network elements and (5)leadership. We will seek to articulate and assess the value creation model through the work of a community of practice comprised of a diverse international workgroup with representation from executive, financial and clinical leaders as well as other key stakeholders from multiple health systems. We then will conduct pilot studies of a qualitative self-assessment process in participating health systems, and ultimately develop and test quantitative measures for assessing coproduction value creation. Ethics and dissemination This study has been approved by the Dartmouth-Hitchcock Health Institutional Review Board (D-HH IRB) as a minimal risk research study. Findings and scholarship will be disseminated broadly through continuous engagement with health system stakeholders, national and international academic presentations and publications and an internet-based electronic platform for publicly accessible study information.

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