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  • 101.
    Kuziemsky, Craig E.
    et al.
    Telfer School of Management, University of Ottawa, ON, Canada.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Computer and Information Science/Human-Centered Systems, Linköping University, Sweden.
    Multi-sided markets for transforming healthcare service delivery2018In: Building Continents of Knowledge in Oceans of Data: The Future of Co-Created eHealth / [ed] Adrien Ugon, Daniel Karlsson, Gunnar O. Klein, Anne Moen, Amsterdam: IOS Press, 2018, Vol. 247, p. 626-630Conference paper (Refereed)
    Abstract [en]

    Changes in healthcare delivery needs have necessitated the design of new models for connecting providers and consumers of services. While healthcare delivery has traditionally been a push market, multi-sided markets offer the potential for transitioning to a pull market for service delivery. However, there is a need to better understand the business model for multi-sided markets as a first step to using them in healthcare. This paper addressed that need and describes a multi-sided market evaluation framework. Our framework identifies patient, governance and service delivery as three levels of brokerage consideration for evaluating multi-sided markets in healthcare. 

  • 102.
    Källvant, Jonas
    et al.
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Lundh, Theres
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Värdeskapande användning av radiologi: - Utbildning och mätning för förbättring2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction

    Medical science and medical facilities and clinical possibilities to help patients evolve con-stantly. Healthcare today can often make the diagnosis and provide effective treatment to cure the victim of ill health. Radiological surveys are an important tool but also provide risks in the form of radiation, and improper use of resources.

    Purpose

    The purpose of the improvement work was to create a better use of radiology and adherence to medical guidelines so that the patient gets the right for increase based on their needs and resources will be used more optimally. The goal was to increase the proportion of eligible studies.

    The purpose of the study of the improvement was to gain an understanding of

    • what factors affect physicians choice of radiological investigation and thereby provide entitlement degree
    • which activities in the improvement process affects eligibility degree and in what way

    Method

    Interventions in the form of education and measurements used to improve eligibility rate. As-sessment of the eligibility rate was made by a resident physician.

    A case study with a qualitative approach was implemented and focus-group interviews were used to study the improvement process.

    Results

    Results indicates that the eligibility rate increased slightly as a result of the selected interven-tions. Education in place, however, gave perceived benefits in terms of improved knowledge and learning for participants.

    The analysis showed that the uncertainty that physicians experience in their work with pa-tients can be attributed to the categories of knowledge and requirements.

    Discussion / Conclusion

    Education conducted by a radiology specialist has is shown to be a successful concept. Meas-urements as a method of learning and change were perceived as measurement for monitoring. Improved knowledge about the determinants of physician choice of survey has been achieved and areas for further improvement are identified.

  • 103.
    Lind, Susanne
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of nursing, Karolinska Institutet, Sweden.
    Sandberg, Jonas
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Brytting, T.
    Institute of Organisation and Worklife Ethics, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
    Fürst, C. J.
    Institute for Palliative Care, Lund University and Region Skåne, Sweden.
    Wallin, L.
    Department of Neurobiology, Care Sciences and Society, Division of nursing, Karolinska Institutet, Sweden.
    Implementation of the integrated palliative care outcome scale in acute care settings - a feasibility study2018In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 16, no 6, p. 698-705Article in journal (Refereed)
    Abstract [en]

    Objective: Although hospitals have been described as inadequate place for end-of-life care, many deaths still occur in hospital settings. Although patient-reported outcome measures have shown positive effects for patients in need of palliative care, little is known about how to implement them. We aimed to explore the feasibility of a pilot version of an implementation strategy for the Integrated Palliative care Outcome Scale (IPOS) in acute care settings.

    Method: A strategy, including information, training, and facilitation to support the use of IPOS, was developed and carried out at three acute care units. For an even broader understanding of the strategy, it was also tested at a palliative care unit. A process evaluation was conducted including collecting quantitative data and performing interviews with healthcare professionals.

    Result: Factors related to the design and performance of the strategy and the context contributed to the results. The prevalence of completed IPOS in the patient's records varied from 6% to 44% in the acute care settings. At the palliative care unit, the prevalence in the inpatient unit was 53% and the specialized home care team 35%. The qualitative results showed opposing perspectives concerning the training provided: Related to everyday work at the acute care units and Nothing in it for us at the palliative care unit. In the acute care settings, A need for an improved culture regarding palliative care was identified. A context characterized by A constantly increasing workload, a feeling of Constantly on-going changes, and a feeling of Change fatigue were found at all units. Furthermore, the internal facilitators and the nurse managers' involvement in the implementation differed between the units.

    Significance of the results: The feasibility of the strategy in our study is considered to be questionable and the components need to be further explored to enhance the impact of the strategy and thereby improve the use of IPOS.

  • 104.
    Lind, Susanne
    et al.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Flemingsberg, Sweden.
    Wallin, Lars
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Flemingsberg, Sweden.
    Brytting, Tomas
    The Institute of Organisation and Worklife Ethics, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
    Fürst, Carl Johan
    Institute for Palliative Care at Lund University and Region Skåne, Lund, Sweden.
    Sandberg, Jonas
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Implementation of national palliative care guidelines in Swedish acute care hospitals: A qualitative content analysis of stakeholders' perceptions2017In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 121, no 11, p. 1194-1201Article in journal (Refereed)
    Abstract [en]

    In high-income countries a large proportion of all deaths occur in hospitals. A common way to translate knowledge into clinical practice is developing guidelines for different levels of health care organisations. During 2012, national clinical guidelines for palliative care were published in Sweden. Later, guidance for palliative care was issued by the National Board of Health and Welfare. The aim of this study was two-fold: to investigate perceptions regarding these guidelines and identify obstacles and opportunities for implementation of them in acute care hospitals. Interviews were conducted with local politicians, chief medical officers and health professionals at acute care hospitals. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. The results showed little knowledge of the two documents at all levels of the health care organisation. Palliative care was primarily described as end of life care and only few of the participants talked about the opportunity to integrate palliative care early in a disease trajectory. The environment and culture at hospitals, characterised by quick decisions and actions, were perceived as obstacles to implementation. Health professionals' expressed need for palliative care training is an opportunity for implementation of clinical guidelines. There is a need for further implementation of palliative care in hospitals. One option for further research is to evaluate implementation strategies tailored to acute care. 

  • 105.
    Lindberg, Susanne
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare. Hälsohögskolan Jönköping.
    Ett kommunikationsverktyg utvecklat för och med nyblivna föräldrar: – en fallstudie inom postpartum vården2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 106. Lindgren, Åsa
    et al.
    Tengelin, Ellinor
    Dellve, Lotta
    Utformning av ett webbaserat verktyg för stresshantering2012Report (Other academic)
  • 107.
    Ljungberg, Maria
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Telemedicin inom barnsjukvård: Familjers och professionellas upplevelser och medverkan vid pilotinförandet av videokonsultationer2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Sjuka barn i norra delar av länet har inte samma tillgång till specifik barnkompetens på akutmottagningen vilket försvårar bedömningar. Konsekvenserna blir sämre vårdkvalitet samt långa resor till länssjukhuset. Familjer som vårdar svårt sjuka barn i hemmet är i behov av bättre stöd. Syftet med förbättringsarbetet var att skapa en ökad kvalitet i bedömningar av sjuka barn samt barnmedicinsk tillgänglighet för att bidra till ökad trygghet och vård på lika villkor genom att använda videokonsultation. Syftet med tillhörande studie var att beskriva och analysera föräldrars och professionellas upplevelser av att använda videokonsultationer mellan familj och barnsjukvård, samt att beskriva och analysera på vilket sätt de medverkade. Metod: PGSA-hjul användes för att planera, genomföra och studera införandet av videokonsultationer mellan länsdelssjukhus och länssjukhus samt mellan familj och barnsjukvården. Enskilda intervjuer, gruppintervjuer samt observationer genomfördes och materialet analyserades med en kavlitativ innehållsanalys. Resultat: Materialet var för litet gällande videokonsultationer mellan vårdinrättningarna för att säkerställa ett tillförlitligt resultat. Analysen i studien resulterade i temat; Underlättande av trygghet och delaktighet för familjer med svårt sjuka barn i hemmiljö. Diskussion: Spridningen av videokonsultationer tog tid och få respondenter i studien gör att resultatet blir svår att generalisera.Slutsats: Visuell information kompletterade den verbala vilket underlättade bedömningar men även barnets medverkan. 

  • 108.
    Locock, Louise
    et al.
    Health Services Research Unit, University of Aberdeen (Formerly University of Oxford), Health Sciences Building, Foresterhill, Aberdeen, Scotland.
    Kirkpatrick, Susan
    Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England.
    Brading, Lucy
    Institute of Psychology Health and Society/North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, England.
    Sturmey, Gordon
    Aberdeen, Scotland.
    Cornwell, Jocelyn
    Point of Care Foundation, London, England.
    Churchill, Neil
    Experience, Participation and Equalities, Leeds, England.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, England.
    Involving service users in the qualitative analysis of patient narratives to support healthcare quality improvement2019In: Research in Social Science and Disability, ISSN 1479-3547, E-ISSN 2056-7529, Vol. 5, no 1Article in journal (Refereed)
    Abstract [en]

    Patient or user involvement in health research is well-established but is often limited to advising on research questions and design, leaving researchers to collect and analyse ‘data’ (which in this paper means written copies of interviews with patients about their experiences). We were working with sets of interviews with 1) young people with depression and 2) people with experiences of stroke. We were looking for key themes that it would be useful for the NHS to know about, and we developed short films which healthcare staff can use to think about how to make care more patient-centred. We wanted to see what user involvement in this analysis would bring, and how best to achieve it practically.

  • 109.
    Lupaszkoi Hizden, Thomas
    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.
    Creating a community of practice to prevent readmissions: An improvement work on shared learning between an intensive care unit and a surgical ward2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background

    ICU readmissions within 72 hours after discharge from the intensive care unit (ICU) is a problem because this leads to higher mortality and longer hospital stays.

    This is a particular problem for the hospital studied for this thesis because there are only three fully equipped ICU beds available.

     

    Aim

    To prevent readmissions by introducing nursing rounds as a concept of “communities of practice” (CoP) and to identify supportive and prohibitive mechanisms in the improvement work and knowledge needed for further improvement work in similar settings.

     

    Methods

    Questionnaires, focus groups, Nelson’s improvement ramp, and qualitative content analysis.

     

    Results

    There were no readmissions from the participating ward after the nursing rounds started, but the reason for this is not clear. The staff experienced the nursing rounds as valuable and they reported greater feelings of confidence, increased exchange, and use of their own knowledge.

     

    Discussion

    The findings presented here support that hypothesis that CoP builds knowledge that can improve patient care. The information provided to the participants during the improvement project was identified as the most supportive mechanism for improvement work, and a lack of resources was seen as the most prohibitive mechanism.

  • 110.
    Lång, Elisabeth
    et al.
    FOI, Swedish Defence Research Agency, Stockholm, Sweden.
    Nystedt, Paul
    Jönköping University, Jönköping International Business School, JIBS, Economics. 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). Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Blowing up money? The earnings penalty of smoking in the 1970s and the 21st century2018In: Journal of Health Economics, ISSN 0167-6296, E-ISSN 1879-1646, Vol. 60, p. 39-52Article in journal (Refereed)
    Abstract [en]

    We analyze the earnings penalty of smoking among Swedish twins in two social contexts: the 1970s, when smoking was common and widely accepted and when there were relatively few tobacco laws aiming to reduce smoking; and the 2000s, when smoking had become more expensive, stigmatizing and less common, and when tobacco laws and regulations had intensified. The results show that the short-term earnings penalty of smoking was much higher in the 21st century than in the 1970s for men. For women, smokers had on average higher annual earnings compared to nonsmokers in the 1970s, but lower annual earnings in the 2000s. In the long run, there was an earnings gap for men between never-smokers and continuous smokers, whereas there was a pronounced earnings ‘bonus’ of smoking cessation for women. The results emphasize the importance of social context and the long-term horizon when evaluating the consequences of smoking for earnings.

  • 111.
    Löfgren, Oskar
    et al.
    Jönköping University, The Jönköping Academy for Improvement of Health and Welfare.
    Österström, Anna
    Jönköping University, The Jönköping Academy for Improvement of Health and Welfare.
    Lessons learnt from quality improvement in radiological service: Four key factors for sucess2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    BackgroundIn this study, we describe a Quality Improvement (QI) intervention in three radiology departments within the Swedish health care system, with a special focus on access and methodology.

    AimThe goals for the QI-intervention were to implement best practice for patients with suspected colon cancer, and reduce the Turn Around Time (TAT).The aim of the study was to identify relevant factors for successful QI in order to further develop the organisation to create a system of continuous QI (CQI) for the radiological service.

    MethodsInitially, a multiprofessional QI-team was formed. To identify waste and areas for improvement, process mapping and lead time analysis were conducted during a collaborative learning approach. A focus group interview was carried out with the participants in the QI-intervention and the local managers, and a qualitative content analysis of the focus group transcript was performed.

    ResultsBest practise was gradually introduced, and overall access was improved, but TAT was not changed. Four key factors for CQI were revealed; Communication, Engagement, Context, and Patient- and Customer focus. Moreover, the impact of providing useful and reliable measurements to the frontline staff was found to be high

    DiscussionThe lack of decreased TAT indicates that further redesign of the radiology process is needed. As the impact of measurements was considered high, an improved system for obtaining and providing useful information to all parts in the organization is essential. Moreover, the infrastructure for CQI needs to be developed further, e.g. by clarifying roles, educating in improvement knowledge, and developing multiprofessional meetings. Finally, motivating and engaging staff is crucial to improve healthcare. It is important with a deeper understanding what triggers this, patient centeredness could be one.

  • 112.
    Magnusson, Karin
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Kan förbättringsarbete ge ökad kunskap och bättre kvalitet?: Ett förbättringsprojekt om Non-Invasiv-Ventilation på en akutvårdsavdelning2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    This improvement project took place in an acute care setting. The aim was to improve the level of self-estimated knowledge in NIV-treatment among the staff, increase the level of adherence to existing guidelines and to describe the staff´s experiences of the improvement project. The project was designed according to Nolan’s model of improvement and was performed in four PDSA-cycles. Ten qualitative individual interviews were conducted and analysed with content analysis according to Graneheim-Lundman. The project improved the self-estimated level of knowledge among the staff, but showed no improvement on the use of guidelines at all. The PDSA-cycles proved to be a successful concept showing a gradually improvement of self-estimated level of knowledge after each cycle. The participants of the study described the necessity of repetitive education, discussions among the staff and the need of support from leaders and colleagues if improvement of knowledge should take place. The interviews revealed the importance for leaders to clarify witch level of knowledge they expected the staff to have and the need for a system for follow-up on development for each person of the staff. The study also revealed that guidelines must be useful, understood and have a clearly identified owner.

  • 113.
    Magnusson, Lina
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics. Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Fransson, Eleonor
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Ahlström, Gerd
    Lund University.
    Mobility and satisfaction with lower-limb prostheses and orthoses among users in Sierra Leone: A cross-sectional study2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 5, p. 438-446Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate patients' mobility and satisfaction with their lower-limb prosthetic or orthotic device and related service delivery in Sierra Leone; to compare groups of patients regarding type and level of assistive device, gender, area of residence, income; and to identify factors associated with satisfaction with the assistive device and service. Methods: A total of 139 patients answered questionnaires, including the Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire (QUEST 2.0). Results: Eighty-six percent of assistive devices were in use, but half needed repair. Thirty-three percent of patients reported pain when using their assistive device. Patients had difficulties or could not walk at all on: uneven ground (65%); hills (75%); and stairs (66%). Patients were quite satisfied with their assistive device and the service (mean 3.7 out of 5 in QUEST), but reported 886 problems. Approximately half of the patients could not access services. In relation to mobility and service delivery, women, orthotic patients and patients using above-knee assistive devices had the poorest results. The general condition of the assistive device and patients' ability to walk on uneven ground were associated with satisfaction with the assistive devices and service. Conclusion: Patients reported high levels of mobility while using their device although they experienced pain and difficulties walking on challenging surfaces. Limitations in the effectiveness of assistive devices and limited access to follow-up services and repairs were issues desired to be addressed.

  • 114.
    Malm, Dan
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Rolander, Bo
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Futurum Academy for Healthcare, Jönköping, Sweden.
    Ebefors, Eva-Marie
    Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Conlon, Lisa
    Futurum Academy for Healthcare, Jönköping, Sweden.
    Nygårdh, Annette
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Reducing the prevalence of catheter-related infections by quality improvement: Six-year follow-up study2016In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 6, no 2, p. 79-87Article in journal (Refereed)
    Abstract [en]

    Background: Peripheral venous catheter (PVC) insertion is a crucial nursing action during life support. Several factors that increase the risk of thrombophlebitis associated with PVCs have been reported. Objective: We wish to evaluate the impact of a quality improvement regarding PVC treatment for patients with coronary heart diseases.

    Method: A longitudinal, quantitative observational study was carried out in 2008 and 2013 in a hospital in southern Sweden with 360 consecutive patients suffering from acute chest pain. New routines for PVC treatment were included in the hospital with daily inspection according to a checklist. A structured observation protocol was used to survey the prevalence of thrombophlebitis between 2008 and 2013. Also, we examined the relationship between the location and luminal diameters of PVCs.

    Results: The student’s t-test showed significant differences between 2008 and 2013 with respect to luminal diameter of PVCs (p = 0.002), prevalence of thrombophlebitis (p = 0.003) and number of days with PVC left in situ (p < 0.001).

    Conclusion: These findings emphasize the value of using systematic daily inspections and checklists to achieve quality and safety in patients with acute chest pain having PVC-based treatment.

  • 115.
    Maslan, Alma
    Jönköping University, School of Health and Welfare.
    Personalens sjukfrånvaro som en kvalitetsaspekt i vård och omsorg: en kvalitativ studie av sjukfrånvaro och dess betydelse för hållbar kompetensförsörjning i hemtjänsten2017Independent thesis Advanced level (degree of Master (One Year)), 40 credits / 60 HE creditsStudent thesis
    Abstract [sv]

    Att värna och behålla en verksamhets mest värdefulla tillgång – dess mänskliga resurser – är av stor vikt för verksamhetens hållbarhet och framgång. Hälsa och ohälsa kopplat till arbetsmiljö- och kompetensförsörjningsfrågor har därför under en lång tid intresserat forskare. Den Svenska nationella statistiken över sjukskrivningar inom arbetslivet talar sitt tydliga språk: flest sjukfall har funnits och finns fortfarande bland vård- och omsorgsyrken. Med hänvisning till detta och med tanke på de utmaningar inom vård- och omsorg som avser svårigheter med kompetensförsörjning och rekrytering blir arbetsmiljöfrågor av ytterst vikt att fokusera på och undersöka vidare. Denna kvalitativa studie består av en intervjuundersökning med ett målstyrt urval. Syftet med studien är att belysa och fördjupa förståelsen för viktiga faktorer som medverkar till sjukskrivning av personal inom social omsorg. Resultaten bygger på svar från en semistrukturerad intervjuundersökning som genomfördes med 8 undersköterskor som arbetar i den kommunala hemtjänsten. Det empiriska materialet analyserades med hjälp av en tematisk innehållsanalys, vilket innebär att intervjumaterialet kategoriserades och analyserades utifrån ett index av centrala teman – de av intervjupersonerna beskrivna och identifierade huvudfaktorerna. Resultatet visar att fysiskt påfrestande arbetsuppgifter, väderaspekter, samt personalbrist är ergonomiska faktorer som leder till sjukfrånvaro i hemtjänsten. Psykosociala faktorer som beskrivs som medverkande till sjukfrånvaro anses utgöras av sammanhållningen i arbetslaget, ojämn arbetsbelastning som påverkas av brukaromsättning, mellanmänskliga relationer, strukturell organisering av arbetet, så som delade turer, när arbetsuppgifter utförs med minskad kvalitet, samt när personalen inte räcker. I uppsatsen redogörs först för den teoretiska bakgrunden och metod. Därefter belyses faktorer som bidrar till sjukfrånvaro och deras påverkan på personalens fysiska- och psykosociala arbetsmiljön. Uppsatsen avslutas med en diskussion om resultatet kopplat till kvalitetsförbättring.

  • 116. Mazzocato, Pamela
    et al.
    Holden, Richard
    Brommels, Mats
    Aronsson, Håkan
    Bäckman, Ulrika
    Elg, Mattias
    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, The Jönköping Academy for Improvement of Health and Welfare.
    How does lean work in emergency care?: A case study of a lean-inspired intervention at the Astrid Lindgren Children's Hospital, Stockholm, Sweden2012In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 12, no 1, p. 28-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:There is growing interest in applying lean thinking in healthcare, yet, there is still limited knowledge of how and why lean interventions succeed (or fail). To address this gap, this in-depth case study examines a lean-inspired intervention in a Swedish pediatric Accident and Emergency department.

    METHODS:We used a mixed methods explanatory single case study design. Hospital performance data were analyzed using analysis of variance (ANOVA) and statistical process control techniques to assess changes in performance one year before and two years after the intervention. We collected qualitative data through non-participant observations, semi-structured interviews, and internal documents to describe the process and content of the lean intervention. We then analyzed empirical findings using four theoretical lean principles (Spear and Bowen 1999) to understand how and why the intervention worked in its local context as well as to identify its strengths and weaknesses.

    RESULTS:Improvements in waiting and lead times (19-24%) were achieved and sustained in the two years following lean-inspired changes to employee roles, staffing and scheduling, communication and coordination, expertise, workspace layout, and problem solving. These changes resulted in improvement because they: (a) standardized work and reduced ambiguity, (b) connected people who were dependent on one another, (c) enhanced seamless, uninterrupted flow through the process, and (d) empowered staff to investigate problems and to develop countermeasures using a "scientific method". Contextual factors that may explain why not even greater improvement was achieved included: a mismatch between job tasks, licensing constraints, and competence; a perception of being monitored, and discomfort with inter-professional collaboration.

    CONCLUSIONS:Drawing on Spear and Bowen's theoretical propositions, this study explains how a package of lean-like changes translated into better care process management. It adds new knowledge regarding how lean principles can be beneficially applied in healthcare and identifies changes to professional roles as a potential challenge when introducing lean thinking there. This knowledge may enable health care organizations and managers in other settings to configure their own lean program and to better understand the reasons behind lean's success (or failure).

  • 117.
    Mazzocato, Pamela
    et al.
    Karolinska Institutet.
    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, Quality Improvement and Leadership in Health and Welfare. Karolinska Institutet.
    Bäckman, Ulrika
    Karolinska Institutet.
    Brommels, Mats
    Karolinska Institutet.
    Carlsson, Jan
    Karolinska Institutet.
    Jonsson, Fredrik
    Karolinska Institutet.
    Hagmar, Magnus
    Karolinska Institutet.
    Savage, Carl
    Karolinska Institutet.
    Complexity complicates lean: lessons from seven emergency services2014In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 28, no 2, p. 266-288Article in journal (Refereed)
    Abstract [en]

    Purpose – The purpose of this paper is to explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in hospital process performance data.

    Design/methodology/approach – A multiple case study based on a realistic evaluation approach to identify mechanisms for how lean impacts process performance and services’ capability to learn and continually improve. Four years of process performance data were collected from seven emergency services at a Swedish University Hospital: ear, nose and throat (ENT) (two), pediatrics (two), gynecology, internal medicine, and surgery. Performance patterns were linked with qualitative data collected through realist interviews.

    Findings – The complexity of the care process influenced how improvement in access to care was achieved. For less complex care processes (ENT and gynecology), large and sustained improvement was mainly the result of a better match between capacity and demand. For medicine, surgery, and pediatrics, which exhibit greater care process complexity, sustainable, or continual improvement were constrained because the changes implemented were insufficient in addressing the higher degree of complexity.

    Originality/value – The variation in process performance and sustainability of results indicate that lean efforts should be carefully adapted to the complexity of the care process and to the educational commitment of healthcare organizations. Ultimately, the ability to adapt lean to a particular context of application depends on the development of routines that effectively support learning from daily practices.

  • 118.
    Moberg, Anne-May
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Från lag till handling: En fallstudie av hur lagkravet om patientsäkerhetsberättelse nyttiggjordes i Stockholms läns landsting2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Caregivers shall according to the patient safety act 2010:659 annually write a patient safety declaration. Review of 76 patient safety declarations in Stockholm County Council (SCC), Sweden, showed a lack of knowledge about how to write and inadequate understanding of patient safety, particularly among smaller caregivers. Healthcare administrators could not answer caregivers’ questions on the patient safety declaration, why an improvement project was initiated to create support and to make the patient safety declaration useful.  

     

     

    Aim: To illustrate how a state steering initiative was handled in practice in the SCC and the experiences associated with the improvement project in health care administration, among caregivers and the interaction between them, and whether the efforts contributed to increased understanding of patient safety.

     

     

    Method: The study was a descriptive case study. The data collection was interviews of caregivers and healthcare administrators and document analysis. The analysies performed were qualitative and quantitative content analysis.

     

     

    Results: The patient safety declaration was made useful in the follow up process of caregivers with support of a template and a manual. The interaction between caregivers and healthcare administrators went from monitoring to dialogue. Learning increased and also understanding of patient safety to some degree.

     

    Conclusion: By being proactive and prepare support for caregivers to fulfill their commitment on patient safety declarations, several caregivers became aware of their responsibilities and obligations. The improvement project was accomplished with improvement knowledge and high level of participation, an approach that is recommended. Further research on the steering effects is suggested.

  • 119.
    Mugabe, Gabriel Nzarama
    et al.
    University of Rwanda, College of Business and Economics, Rwanda.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, Jönköping International Business School, JIBS, Centre for Information Technology and Information Systems (CenITIS). Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Wass, Sofie
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Implementation of ict based innovations as electronic medical record in sub-sahara Africa: Issues of relevance for future implementations2017In: Proceedings of the International Conference on E-Health, EH 2017 - Part of the Multi Conference on Computer Science and Information Systems 2017, IADIS Press, 2017, p. 95-101Conference paper (Refereed)
    Abstract [en]

    Electronic medical records (EMR) have been implemented in developed countries since 1972 when the first computer-stored medical record at Wishard Memorial Hospital was designed. However, less seem to be known about EMRs in an African context. The purpose of this paper is therefore to review studies on EMRs implemented in sub-Saharan Africa and to identify benefits and challenges met. Articles available in PubMed, PMC, Scopus, JAMIA and Google were searched through JIBS online library using the search string "EMR systems in Sub-Saharan Africa". In most the papers, EMRs have been implemented in HIV/AIDS settings allowing better monitoring of patients under antiretroviral therapy (ART). EMR systems have also succeeded to increase the number of patients under ART. Moreover, EMRs have improved work processes as they have reduced patients waiting time and enhanced monitoring of medical appointments. However, EMRs have suffered lack of electricity, poor Internet connectivity and computer illiteracy. Today, HIV/AIDS care providers have benefited on the implementation of EMRs and there is a possibility to extend the implementation to other healthcare departments.

  • 120.
    Mulvale, Gillian
    et al.
    McMaster University, Burlington, Ontario, Canada.
    Moll, Sandra
    McMaster University, Burlington, Ontario, Canada.
    Miatello, Ashleigh
    McMaster University, Burlington, Ontario, Canada.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). King's College London, London, UK.
    Larkin, Michael
    Aston University, Birmingham, UK.
    Palmer, Victoria J.
    The University of Melbourne, Parkville, Victoria, Australia.
    Powell, Alicia
    McMaster University, Burlington, Ontario, Canada.
    Gable, Chelsea
    McMaster University, Burlington, Ontario, Canada.
    Girling, Melissa
    Newcastle University, Newcastle upon Tyne, UK.
    Codesigning health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration.2019In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Codesign has the potential to transform health and other public services. To avoid unintentionally reinforcing existing inequities, better understanding is needed of how to facilitate involvement of vulnerable populations in acceptable, ethical and effective codesign.

    OBJECTIVE: To explore citizens' involvement in codesigning public services for vulnerable groups, identify challenges and suggest improvements.

    DESIGN: A modified case study approach. Pattern matching was used to compare reported challenges with a priori theoretical propositions.

    SETTING AND PARTICIPANTS: A two-day international symposium involved 28 practitioners, academics and service users from seven countries to reflect on challenges and to codesign improved processes for involving vulnerable populations.

    INTERVENTION STUDIED: Eight case studies working with vulnerable and disadvantaged populations in three countries.

    RESULTS: We identified five shared challenges to meaningful, sustained participation of vulnerable populations: engagement; power differentials; health concerns; funding; and other economic/social circumstances. In response, a focus on relationships and flexibility is essential. We encourage codesign projects to enact a set of principles or heuristics rather than following pre-specified steps. We identify a set of principles and tactics, relating to challenges outlined in our case studies, which may help in codesigning public services with vulnerable populations.

    DISCUSSION AND CONCLUSIONS: Codesign facilitators must consider how meaningful engagement will be achieved and how power differentials will be managed when working with services for vulnerable populations. The need for flexibility and responsiveness to service user needs may challenge expectations about timelines and outcomes. User-centred evaluations of codesigned public services are needed.

  • 121.
    Neher, M. S.
    et al.
    Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden.
    Johansson, P.
    Linkoping University, Department of Cardiology and Department of Social and Welfare studies, Linkoping, Sweden.
    Nilsen, P.
    Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Nygårdh, Annette
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Exploring implementation issues when introducing a novel internet-based intervention to treat cardiovascular disease-associated mental health issues- the Implement-IT project.2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S52-S53Article in journal (Refereed)
    Abstract [en]

    Background: Mental health (MH) problems such as depression and insomnia are prominent among patients with cardiovascular disease (CVD). They are associated with a negative impact on quality of life, higher health care costs and a poorer prognosis. Despite this most patients with CVD will not receive support or treatment for their MH problems. Studies in other patient groups have described internet based cognitive behavioral treatment (I-CBT) as a promising intervention, but I-CBT has not been tested in CVD patients. The I-CBT HEART research project aims specifically to develop and evaluate I-CBT programs for CVD patients with psychological distress. The programs, both of which are in early stages of clinical evaluation, respectively target patients with depressive symptoms and patients with insomnia. Two randomized controlled trials will be carried out, I-CBT for insomnia (HiT-IT) and I-CBT for depression (DOHART). Implementation research has shown overwhelming evidence of the difficulties that are often encountered in the diffusion and dissemination of novel treatments, such as I-CBT for CVD. To smooth the way for future use of a successful intervention in clinical practice, a better knowledge is needed of the factors that may hinder or support implementation in practice.

    Purpose: The overall aim of the IMPLEMENT-IT study, a part of the I-CBT HEART project, is to achieve a better understanding of potential future implementation issues by exploring barriers and facilitators from different stakeholder perspectives that may be of importance in future implementation.

    Methods: Both qualitative and quantitative data will be collected in conjunction with the RCT studies HiT-IT and DOHART. Interviews with stakeholders at different levels focusing on perceptions of the role of eHealth in traditional healthcare in general, and of the I-CBT HEART intervention in particular. Informants are recruited in groups of healthcare-tasked representatives of political parties at the regional level, local decision-makers in higher healthcare administration, clinical decision-makers, healthcare profe ssionals (providers), as well as patients. Our intention is to measure implementation leadership,empowerment and implementation climate in the clinical contexts, but also to develop valid and reliable instruments to be used in future studies.

    Conclusion: Studying factors that may potentially influence the implementation of a novel I-CBT program for treatment of MH problems in CVD patients through a mixed methods approach may assist the design of future implementation strategies in clinical cardiac care.

  • 122.
    Nelson, Eugene C.
    et al.
    Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.
    Dixon-Woods, Mary
    Institute of Public Health, University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom.
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.
    Homa, Karen
    Dartmouth-Hitchcock Health, Lebanon, NH, United States.
    Van Citters, Aricca D.
    Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.
    Morgan, Tamara S.
    Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.
    Eftimovska, Elena
    Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Fisher, Elliott S.
    Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.
    Ovretveit, John
    Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Harrison, Wade
    Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.
    Lind, Cristin
    Quality Register Center Stockholm, Karolinska Institutet, Stockholm County Council, Stockholm, Sweden.
    Lindblad, Staffan
    Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Patient focused registries can improve health, care, and science2016In: BMJ. British Medical Journal (International Ed.), ISSN 0959-8146, E-ISSN 0959-535X, Vol. 354, article id i3319Article in journal (Refereed)
  • 123.
    Neubeck, Truls
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Quality improvement within nonprofit social service providers2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    As a relatively new phenomenon in 2009, Swedish nonprofit social service providers proposed quality improvement as a way to reduce mistakes, use resources more effectively and meet the needs and expectations of clients in a better way. Although similar experiences have been studied in health care, the transfer of quality improvement to nonprofit social services gives a possibility for more knowledge on what enables, and constrains, systematic quality improvement in this specific context.

    This thesis is based on five years of supporting quality improvement in the Swedish nonprofit welfare sector. Specifically, it builds knowledge on which active mechanisms and enabling or constraining structures exist for nonprofit social service quality improvement. By studying quality improvement projects that have been conducted in the development program Forum for Values, critical cases and broad overviews are found valuable. These cases have resulted in four papers on quality improvement in nonprofit social services. The papers include: critical cases from a nursing home for elderly and a daycare for disabled children (Paper I); a critical case from a sheltered housing (Paper II); an overview of performance measurements in 127 quality improvement projects (Paper III); and an analytical model of how improvement policy and practice are bridged by intermediaries (Paper IV). In this thesis, enabled or constrained events and activities related to Deming's system of profound knowledge are identified from the papers and elaborated upon. As a basis for transforming practice into continuous improvement, profound knowledge includes the four knowledge domains: appreciation of a system, theory of knowledge, understanding of variation and psychology of change. From a realist perspective, the identified events are seen as enabled or constrained by mechanisms and underlying regularities, or structures, in the context of nonprofit social services.

    The emerging mechanisms found in this thesis are: describing and reflecting upon project relations; forming and testing a theory of action; collecting and displaying measurable results over time; and engaging and participating in a development program. The structures that enable these mechanisms are: connecting projects to shared values such as client needs; local ownership of what should be measured; and translating quality improvement into a single practice. Constraining structures identified are: a lack of generalizable scientific knowledge and inappropriate or missing infrastructure for measurements.

    Reflecting upon the emergent structures of nonprofit social services, the role of political macro structures, reflective practice, competence in statistical methods and areas of expertise becomes important. From this discussion and the findings some hypotheses for future work can be formulated. First, the identified mechanisms and structures form a framework that helps explain why intended actions of quality improvement occur or not. This frameworkcan be part of formulating a program theory of quality improvement in nonprofit social services. With this theory, quality improvement can be evaluated, reflected upon and further developed in future interventions. Second,new quality improvement interventions can be reproduced more regularly by active work with known enablers and constraints from this program theory. This means that long-lasting interventions can be performed and studied in a second generation of improvement efforts. Third, if organizations integrate quality improvement as a part of their everyday practice they also develop context-specific knowledge about their services. This context-specific knowledge can be adopted and further developed through dedicated management and understanding of variation.

    Thus, if enabling structures are invoked and constraining structures handled, systematic quality improvement could be one way to integrate generalizable scientific knowledge as part of an evidence-creating practice.

  • 124.
    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. Linköping University.
    Quality improvement in the case of sheltered housingIn: Article in journal (Other academic)
  • 125. Neubeck, Truls
    et al.
    Elg, Mattias
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Linköping University.
    Andersson, A.
    Process or result-oriented performance measures in improvement of Not for ProfitsManuscript (preprint) (Other academic)
  • 126.
    Nordenström, Jörgen
    et al.
    Karolinska institutet.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Karolinska institutet.
    Bästa praxis - en nyckel till bättre vårdkvalitet och mer effektiv vård2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, p. 34-37, article id DWYWArticle in journal (Other academic)
    Abstract [sv]

    Medicinska paradigm har en tendens att samlas under mer eller mindre lättfattliga begrepp. De senaste decennierna har paradigmen »evidens« och »kvalitet« dominerat [1]. Paradigmet skiftar nu mot »värde«.

  • 127.
    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).
    Expressions of shared interpretations - Intangible outcomes of continuous quality improvement efforts in health- and elderly care2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis is anchored in improvement science, the research field of improvement. Improvement science describes and explores improvement in real-life contexts and “system of profound knowledge” (Deming, 2000) is a cornerstone. Performance measures, including their variation over time, are fundamental in the research and evaluation of outcomes of continuous quality improvement efforts (CQI efforts). However, the strong emphasis on operationalisations and measurements risks overshadowing other kinds of outcomes to which CQI efforts can lead.

    Research has shown that it is advantageous that those performing change have some kind of “sharedness”, e.g. shared cognitions, understanding, knowledge, interpretations or frame of reference. Despite the diversity of concepts and scientific studies, “sharedness” is mainly described as a prerequisite for change.

    This thesis addresses the call to broaden the scientific approach in improvement science and to take advantage of knowledge developed since Deming's time. It has a point of departure in the presumption that CQI efforts also lead to intangible outcomes; qualitative effects that are not easily captured with traditional performance measures. The concept “Expressions of shared interpretations” is used to study “sharedness” as intangible outcomes.

    The overall aim with this thesis is to explore Expressions of shared interpretations as intangible outcomes of CQI efforts from the perspective of clinical microsystems and healthcare professionals. The specific aims are to examine and establish how Expressions of shared interpretations develop, influence CQI efforts and change over time.

    Using a qualitative approach, this thesis comprises four papers, based on three studies. The empirical context is healthcare and welfare organizations providing care: hospital clinics in county councils/regions and nursing homes in municipalities. The studies include time periods from one to three and a half years, totalling six years. Expressions of shared interpretations inherently mean that the methods for data analysis need to be based on commonalities or patterns in the data. In this thesis three methods are used: qualitative content analysis, thematic analysis and directed content analysis. To examine time-related changes, year-to-year comparative analyses of themes and categories are done.

    To explore Expressions of shared interpretations, different theoretical frameworks are used: team cognitions (Paper 1), sensemaking theory (Paper 2), cognitive shifts (Paper 3) and programme theories (Paper 4).

    A directed content analysis is applied in a meta-analysis of the results presented in the four papers. The results indicate that Expressions of shared interpretations develop as intangible outcomes of CQI efforts and a general programme theory of CQI efforts in health- and elderly care is developed, illuminating how Expressions of shared interpretations change and influence CQI efforts. The general programme theory incorporates the PDSA cycle and describes the complex, interconnected and continuous development of Expressions of shared interpretations. It also illuminates how Expressions of shared interpretations provide change performers with momentum to engage in forthcoming PDSA cycles and how sensemaking is a central activity.

    CQI efforts in health- and elderly care are characterised by a “just get on with it” attitude, while in this thesis, thoughtfulness is emphasized. Existing improvement tools support collaboration, creativity and analysis of critical aspects of the operations, yet none of the improvement tools help change performers gain understanding of the CQI effort as such. To address this, this thesis suggests that change performers complement the use of improvement tools with an inquiring mind, that they collaborate in thoughtful dialogues and that leaders function as inquirers. To support this posture, the widely used Model for improvement is complemented with a fourth question: What are our assumptions? The question pinpoints the need to be thoughtful in every step of the CQI effort, not just in the analysis of the problem at hand.

  • 128.
    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).
    Intangible outcomes of the work with a doctoral thesis2018Conference paper (Refereed)
  • 129.
    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. 

  • 130.
    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.

  • 131.
    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.

  • 132.
    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).
    Gabrielsson-Järhult, Felicia
    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).
    Improvement knowledge in health and welfare2018Conference paper (Other academic)
  • 133.
    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).
    Ostrelius, M.
    How can contiuous quality improvement tools support systematic work environment management? Perspectives from practice and theory2018Conference paper (Refereed)
  • 134.
    Nordström, Erik
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Samordnad individuell plan (SIP): Professionellas samt barn och föräldrars erfarenheter2016Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction. Many children and adolescents today have complex needs which require simultaneous action by the two principal’s health care and social services. There is also a legislated requirement since 2010 on interaction in the form of Coordinated Individual Plan (CIP). CIP allows children and parents to get an overview and make concerted efforts of health and social services through the meeting, planning and documented efforts.

    The aim of the thesis was to describe professionals’, children and parents’ experiences of coordinated individual plan (CIP). Paper 1 consists of a qualitative analysis of 12 filmed and transcribed focus group interviews with a total of 71 staff with different professions in health care, education and social services about their experiences of CIP. Paper 2 consists of a descriptive qualitative interview study with 13 participants (3 children, 10 parents).

    Result of paper 1 indicates that the participants act according to their core mission: nurturing, teaching and investigation.

    Result of paper 2 shows that children and parents experience of participation in the form of CIP increased over time and enabled a coordinated support from various health care providers, that children and/or the parents often had to coordinate themselves before CIP.

    Conclusions and practical implications. The analysis of paper 1 indicates that CIP was perceived as alternating between, on the one hand, a pro-active and service-focused tool, and on the other hand, a competing and compelling professional instrument. CIP seems to have the potential to contribute to an improved collaboration if the professional shows mutual peer respect and has a focus on children’s’ and parents' needs, in that they do not put too much emphasis on protecting their own business agenda instead of a partnership agenda. This is confirmed by paper 2 which shows that children and parents perceive that there are intentions to make the service user involved, but that this intention is hampered by disagreements, differences of intentions and lack of consensus between professionals, and children and parents may suffer confusion and fragmentation of efforts over a long period of time, which may put the child at risk. The service users need for coordination is limited by professionals’ exercise in power. The importance of good relations and personal support to accomplish functional coordination is outlined. If CIP will become the tool for comprehensive settlement and service user participation as it is meant to be, the relevant professions need to achieve a broader consensus on CIP to comply with the intent of a collaboration with expanded user participation.

  • 135.
    Nordström, Erik
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Josephson, Iréne
    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).
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Agenda för samverkan eller verksamhetens agenda? Om professionellas erfarenheter av samverkan enligt samordnad individuell plan (SIP)2016In: Socialvetenskaplig tidskrift, ISSN 1104-1420, no 1, p. 37-57Article in journal (Refereed)
    Abstract [en]

    Agenda for collaboration or an agency agenda? Professionals’ experiences of colla­boration according to a coordinated individual plan (CIP)

    An increasing number of children and adolescents develop complex needs that require simultaneous action by different professionals. Several reports state that efforts for these children and adolescents have become increasingly specialized and fragmented. Since 2010, there are statutory requirements for collaboration according to a coordinated individual plan (SIP) between health care and social services. Pre-school and school can after regional agreement be involved in the co-ordination as equal partner. Collaboration in line with CIP is expected to offset the fragmentation for benefit of the service users’ ability to monitor and comprehend interventions. The aim was to investigate professionals’ experiences of CIP. The study consists of qualitative analysis of 12 focus group interviews with a total of 71 staff with different professions in health care, education and social services about their experiences of CIP. The results indicate that the participants act according to their core mission: nurturing, teaching and investigation. Two main categories with four sub-categories each appeared in the analysis. The main category, hindering factors, contains the categories: different mandates and requirements, requirements for presence initiative, questioning and censure, and timelines and prioritization. The main category of facilitating factors contains the categories: similar interpretation of common agreement, mutual respect and shared learning, common terminology and documentation, and willingness to collaborate. The analysis indicate that CIP was perceived as alternating between, on the one hand, a pro-active and service-focused tool, and on the other hand, a competing and compelling professional instrument.

  • 136.
    Norman, Ann-Charlott
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Linnéuniversitetet, Institutionen för pedagogik (PED).
    “Money talks”: Conditions for learning in contemporary health care systems2013Conference paper (Other academic)
    Abstract [en]

    Context

    Observations were made at clinical ward meetings and process team meetings at an orthopedic- and rheumatology clinic in Sweden. Mostly nurses and assistant nurses participated along with their manager at the clinical ward meeting. The process team consists of staff from the patient’s process which in this case includes physicians, nurses, physiotherapists and occupational therapists from both primary and specialist care. The improvement work in both meetings is facilitated by a developmental leader.

     

    Problem 

    Various forms of money incentives, for example Pay for Performance programs, are used to increase the pace of improvements in contemporary health care systems. Given that learning sometimes is taken for granted in quality improvement work, this study set out to address what actually is said when professionals discuss improvements and how discursive patterns influence learning.

     Assessment of problem and analysis of its causes

     The study has an explorative qualitative design to investigate how discursive patterns occur in quality improvement conversations which means that quantified measuring was not appropriate.

     The study used a participatory research design with recurrent learning seminars between staff and researchers. The staff took part in addressing the research problem, planning the research process and validated tentative findings. Assessment of problem and analysis of causes was a mutual effort from both researchers and staff. Ideas for improvements came up during the learning seminars when the researchers highlighted findings.

     Intervention 

    The study had not an interventional purpose.

    Study design 

    A starting point in the methodology is that language is tightly connected to social learning. Five observations of quality improvement conversations were made and transcribed to texts. The conversations were analyzed through critical discourse analysis to identify discursive patterns and their interrelated discourse order (Fairclough). A framework of specific questions was constructed to guide the analytical process in Faircloughs’ three steps of description, interpretation and explanation.

    Strategy for change 

    As the study used a participatory research design, implementation, in its right term, was not needed because the staff saw what they needed to improve along with feedback and analysis from the researchers.

    Measurement of improvement 

    Methods, see questions 3 and 5 above.

    Results

    Four discursive patterns were found in the talk of improvements. We have named them the marketization pattern, the care-for-all pattern, the medical pattern and the value pattern. The marketization pattern dominates the dialogue while money is linked to quality control. The results also showed a balance between discourse patterns when money incentives were absent. In other words, professionals tend to integrate complex, and sometimes contradicting, quality aspects when they don’t compete about money. However, when improvement goals are linked to monetary incentives the professionals talk about what is the most profitable thing to do.  

    Effects of changes 

    See questions 3 and 4 above.

    Lessons learnt 

    The discourse order indicates that market principles impact on learning in terms of displacement effects. In a short term perspective, professionals learn that each patient represents an economical value which shades deeper understanding of what actually creates value for patients. Learning based on inter-professional shared understanding, in this case about how orthopedic care processes could improve, is set aside.

    The study implicates the importance of a balancing perspective on quality management if no quality aspect is to be left behind. Replicating studies in other contexts would be interesting to perform.

    Message for others: What is the main message based on the experience that you describe here that you would like to convey to others? Discuss what your findings mean for patients and/or systems of care.

    Money incentives promote learning about economical values and not what creates value for patients.

    Please declare any conflicts of interest below 

    The study is part of the research project Bridging the Gaps which is financed by Vinnvård. Otherwise no other conflict of interest is to be declared.

  • 137.
    Nygårdh, Anette
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Allemann, H.
    Linköping University, Department of Medical and Health Science, Linköping, Sweden.
    Strömberg, A.
    Linköping University, Department of Medical and Health Science, Linköping, Sweden.
    Aidemark, J.
    Linneaus University, Department of Informatics, Vaxjö, Sweden.
    Fruberg, C.
    Qulturum, Centre for Learning and Innovation in Health Care, Jönköping, Sweden.
    Karlsson, J.-E.
    Ryhov county Hospital, Deparment of Development (Qulturum), Jönköping, Sweden.
    Askenäs, L.
    Linneaus University, Department of Informatics, Växjö, Sweden.
    An experience-based co-design to accomplish person-centered self-care support for elderly persons with heart failure2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, p. 51-52, article id 139Article in journal (Refereed)
    Abstract [en]

    Introduction: Self-care refers to activities performed with the intention of improving or restoring health and well-being. A good understanding of the adaptations needed in daily life is a prerequisite to motivate individuals to implement such changes. Facilitating the person with heart-failure’s (HF) understanding of the diagnosis, how to handle symptoms, and when to seek healthcare, is one way of proactive self-care. Previous Information and communication technology (ICT) support has proved to be effective in younger patients, but the development has not been user-driven, i.e. involving references and experiences from the patient, their family members or healthcare professionals and have rarely been implemented in clinical practice. In addition, disregard of the user hands over control and responsibility to the healthcare professionals and misses the patient’s desires and requirements.

    Aim: To describe an experience-based co-design of ICT for self-care support in the context of heart failure care

    Methods: The steps in the process of developing ICT support programs for self-care were guided by an experienced based co-design methodology including: 1) Workshops regarding self-care needs. 2) Workshops regarding self-care support as a means to cope with the phases of the disease. 3) Workshops to assess the usability of the suggested ideas. 4) Workshops to test the different supports in action. The project involved older persons with HF, their family members, healthcare professionals, IT-developers, informatics, development leaders, and researchers. There was also a quality improvement process involved to improve working routines and communication between the person with HF and the healthcare professionals, which in turn, increases the value of the innovation. Data collection include tape- and video recorded workshops and diary notes supplied by the informants. All data are to be analyzed by content analysis to identify needs, opportunities and challenges of self-care.

    Results and conclusion: This design was found to be a useful method for finding and assess usability of person-centered self-care ICT support. To involve users in the development of self-care support has improved the opportunities to realize support needed. Sharing these perspectives increases professionally and organizationally learning in order to accomplish person-centered self-care. Preliminary findings show that ICT will be a part of solving some of the self-care needs described by patients, family member and health care providers and the next step in the project will be to test and adapt these tools.

  • 138.
    Nygårdh, Annette
    et al.
    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.
    Ahlström, Gerd
    Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    Wann-Hansson, Christine
    Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Handling a challenging context: experiences of facilitating evidence-based elderly care2016In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 24, no 2, p. 201-210Article in journal (Refereed)
    Abstract [en]

    Aim

    To explore improvement facilitators' experiences of handling their commission to implement evidence-based practice in elderly care for frail older persons.

    Background

    Improvement facilitators were put in place across Sweden in a time-limited project by the government, with one part of the project being to evaluate the model before establishing this facilitation of evidence-based practice in elderly care.

    Method

    Two focus groups were interviewed twice. Each group comprised three respondents. The interviews were analysed using qualitative content analysis.

    Findings

    A main theme, ‘Moving forward by adjusting to the circumstances’, described how the improvement facilitators handle their commitment. Five subthemes emerged: identifying barriers, keeping focus, maintaining motivation, building bridges and finding balance.

    Conclusion

    The improvement facilitators' commitment is ambiguous because of unclear leadership of, and responsibility for the national investment. They have to handle leaders' different approaches and justify the need for evidence-based practice. The improvement facilitators did not reflect on the impact of programme adaptations on evidence-based practice.

    Implications for nursing management

    The findings emphasise the need for collaboration between the improvement facilitator and the nurse manager. To fully implement evidence-based practice, negotiations with current practitioners for adaptation to local conditions are necessary. Furthermore, the value of improving organisational performance needs to be rigorously communicated throughout the organisation.

  • 139.
    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).
    Patient safety and abuse in health care2018Conference paper (Refereed)
  • 140.
    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).
    The co-production of patient safety2018Conference paper (Refereed)
  • 141.
    Odhagen, Erik
    et al.
    University of Gothenburg, Gothenburg, Sweden.
    Sunnergren, Ola
    Ryhov County Hospital Jönköping, Jönköping, Sweden.
    Söderman, Anne-Charlotte Hessén
    Karolinska Institutet, Stockholm, 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).
    Stalfors, Joacim
    University of Gothenburg, Gothenburg, Sweden.
    Reducing post-tonsillectomy haemorrhage rates through a quality improvement project using a Swedish National quality register: a case study2018In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 275, no 6, p. 1631-1639Article in journal (Refereed)
    Abstract [en]

    Tonsillectomy (TE) is one of the most frequently performed ENT surgical procedures. Post-tonsillectomy haemorrhage (PTH) is a potentially life-threatening complication of TE. The National Tonsil Surgery Register in Sweden (NTSRS) has revealed wide variations in PTH rates among Swedish ENT centres. In 2013, the steering committee of the NTSRS, therefore, initiated a quality improvement project (QIP) to decrease the PTH incidence. The aim of the present study was to describe and evaluate the multicentre QIP initiated to decrease PTH rates.

  • 142.
    Ogrinc, Greg
    et al.
    Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
    Davies, Louise
    Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
    Goodman, Daisy
    Geisel School of Medicine at Dartmouth, Hanover, NH, 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, Hanover, New Hampshire, USA.
    Davidoff, Frank
    Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, United States.
    Stevens, David
    Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, United States.
    SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process2016In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 25, no 12, p. 986-992Article in journal (Refereed)
    Abstract [en]

    Since the publication of Standards for QUality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasises the reporting of three key components of systematic efforts to improve the quality, value and safety of healthcare: the use of formal and informal theory in planning, implementing and evaluating improvement work; the context in which the work is done and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve healthcare, recognising that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (http://www.squire-statement.org). © Published by the BMJ Publishing Group Limited.

  • 143.
    Ogrinc, Greg
    et al.
    VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont.
    Davies, Louise
    VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont.
    Goodman, Daisy
    VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont.
    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, Hanover, New Hampshire.
    Davidoff, Frank
    The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire.
    Stevens, David
    The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire.
    Standards for QUality Improvement Reporting Excellence 2.0: revised publication guidelines from a detailed consensus process2016In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 200, no 2, p. 676-682Article in journal (Refereed)
    Abstract [en]

    Since the publication of Standards for QUality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this article, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts, and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of three key components of systematic efforts to improve the quality, value, and safety of health care: the use of formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve health care, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org).

  • 144.
    Oldaeus Almerén, Anna
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Kvalitetshöjande förbättringsinsatser inom cancervården: En fallstudie med fokus på behov2015Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Att skapa förutsättningar för en förbättrad cancervård, genom att fördjupa kunskapen och förståelsen om behov hos huvud- och halscancerpatienter under cancerprocessen. Därutö- ver önskas ett förbättrat omhändertagande genom att implementera och utvärdera kvalitetshö- jande förbättringsinsatser. Satsningen ska resultera i en trygg och smidig resa genom vården med ett minimum av avbrott mellan olika vårdhändelser.

    Metod: Patientens vårdkedja studerades med en fallstudie, utifrån en aktionsforskningsansats. Behoven identifierades med patientskuggning, reflektion från observationer och semistruktu- rerade fokusgruppsintervjuer med mikrosystemet, före (referensgrupp) och efter intervention (jämförelsegrupp). Analys genomfördes med kvalitativ innehållsanalys och Kano-modell.

    Resultat: En fast vårdkontakt var en viktig faktor i vårdkedjan. Den fasta vårdkontakten till- mötesgick behov såsom trygghet och tillgänglighet, vilket medförde en smidigare vårdkedja. Under hela vårdförloppet fanns ett stort behov av stöd, praktiskt liksom psykosocialt, från både profession och närstående. Oberoende av position i vårdkedjan önskades individanpas- sad information och ett gott bemötande. Interventionsgruppen rapporterade bättre tillgänglig- het och stöd i förhållande till jämförelsegruppen, som inte hade tillgång till kontaktsjukskö- terska. Involvering av hela mikrosystemet vid analys med Kano-modell medför att behov och förbättringsmöjligheter identifieras och valideras.

    Slutsatser: En kontaktsjuksköterska kan utgöra en fast vårdkontakt som tillmötesgår och sä- kerställer cancerpatienters behov. Närstående är en viktig del av mikrosystemet och måste beredas utrymme och resurser. En förbättringsinsats genom implementering av kontaktsjuk- sköterska, utformning av nutritions- och kvalitetsregisterrutiner baserat på patientens behov bidrar till god vård och minskar risken för resursslöseri. Studien har även bidragit med fördju- pad kunskap gällande applicering av Kano-modellen i Hälso- och sjukvårdsmiljö. 

  • 145.
    Palmer, Victoria J.
    et al.
    Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
    Weavell, Wayne
    Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
    Callander, Rosemary
    Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
    Piper, Donella
    Business School, University of New England, Armidale, NSW, Australia.
    Richard, Lauralie
    Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
    Maher, Lynne
    Ko Awatea Health System Innovation and Improvement, Counties Manukau Health, Auckland, New Zealand.
    Boyd, Hilary
    Strategy, Participation and Improvement Group, Auckland District Health Board, Auckland, New Zealand.
    Herrman, Helen
    Orygen, National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
    Furler, John
    Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
    Gunn, Jane
    Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
    Iedema, Rick
    Centre for Team Based Practice and Learning in Health Care, Health Schools, 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). Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    The Participatory Zeitgeist: An explanatory theoretical model of change in an era of coproduction and codesign in healthcare improvement2018In: Medical Humanities, ISSN 1468-215X, E-ISSN 1473-4265Article in journal (Refereed)
    Abstract [en]

    Healthcare systems redesign and service improvement approaches are adopting participatory tools, techniques and mindsets. Participatory methods increasingly used in healthcare improvement coalesce around the concept of coproduction, and related practices of cocreation, codesign and coinnovation. These participatory methods have become the new Zeitgeist - the spirit of our times in quality improvement. The rationale for this new spirit of participation relates to voice and engagement (those with lived experience should be engaged in processes of development, redesign and improvements), empowerment (engagement in codesign and coproduction has positive individual and societal benefits) and advancement (quality of life and other health outcomes and experiences of services for everyone involved should improve as a result). This paper introduces Mental Health Experience Co-design (MH ECO), a peer designed and led adapted form of Experience-based Co-design (EBCD) developed in Australia. MH ECO is said to facilitate empowerment, foster trust, develop autonomy, self-determination and choice for people living with mental illnesses and their carers, including staff at mental health services. Little information exists about the underlying mechanisms of change; the entities, processes and structures that underpin MH ECO and similar EBCD studies. To address this, we identified eight possible mechanisms from an assessment of the activities and outcomes of MH ECO and a review of existing published evaluations. The eight mechanisms, recognition, dialogue, cooperation, accountability, mobilisation, enactment, creativity and attainment, are discussed within an 'explanatory theoretical model of change' that details these and ideal relational transitions that might be observed or not with MH ECO or other EBCD studies. We critically appraise the sociocultural and political movement in coproduction and draw on interdisciplinary theories from the humanities - narrative theory, dialogical ethics, cooperative and empowerment theory. The model advances theoretical thinking in coproduction beyond motivations and towards identifying underlying processes and entities that might impact on process and outcome. Trial registration number: The Australian and New Zealand Clinical Trials Registry, ACTRN12614000457640 (results). 

  • 146.
    Peterson, Anette
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Learning and understanding for quality improvement under different conditions: An analysis of quality registry-based collaboratives in acute and chronic care2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The demands that are placed on healthcare systems continue to increase, but several studies show that patient care and healthcare system outcomes are not as good as they could be. To come to terms with these problems, many stakeholders turn to systematic quality improvement methods. However, research and practice also shows that change in organisations is difficult. Consequently many quality improvement projects fail. Quality Improvement Collaboratives (QICs), introduced through the use of the Breakthrough series model, represent a commonly used approach. Despite their widespread application, uncertainty remains regarding the effectiveness of QICs. In Sweden, a number of national quality registries document healthcare actions and outcomes for different patient-groups and problem-areas. While these registries have long been used for follow-up purposes and for clinical research, they have not been used extensively for systematic clinical improvement purposes. The overall aim of this thesis was to examine if, and how, QICs which are supported by national quality registries can contribute to quality improvement in the provision of healthcare. The aim was also to examine what learning and new understanding occurred in the application of QICs in different settings.

    The empirical material in this thesis comes from three QICs which included participating teams from different hospitals and health centres in Sweden. Each QIC included a national quality registry: the National Quality Registry for Acute Myocardial Infarction Care (RIKS-HIA); the National Diabetes Registry (NDR); and the Swedish Paediatric Diabetes Quality Registry (SWEDIABKIDS).

    The thesis draws on an interactive research approach. The data collection and analysis employed both qualitative and quantitative methods. Data fromthe National Quality Registries, final team reports, focus-group interviews, and team members’ experiences were analysed and triangulated.

    The studies shows that QICs which are supported by national quality registries helped teams to close a number of gaps between ordinary clinical practice and evidence-based guidelines, thereby contributing to the provision of better care and better clinical outcomes (Study I, Study II, and Study III). Important factors for success included stakeholders’ learning andunderstanding of the organisational context; structures that supported improvement efforts; and team members’ and managers’ commitment to improvement (Study IV). Furthermore, support by an internal team coach also promoted success (Study IV).

    This thesis shows how national quality registries can be used in combination with systematic improvement efforts to produce better clinical results. It concludes that different areas of QIC application pose different challenges; for example, addressing care for acute disease versus chronic disease and evaluating professionally influenced process measures versus patient dependent outcome measures. While different organizational contexts and care characteristics can pose challenges to QIC efforts, the formation of “Communities of Practice” during QICs enhanced the learning for improvement with and from others.

  • 147.
    Peterson, Anette
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Healthcare Department, Region of Jönköping, Jönköping, Sweden.
    Gudbjörnsdottir, Soffia
    Center of Registers in Region Västra Götaland, Gothenburg, Sweden.
    Löfgren, Ulla-Britt
    Center of Registers in Region Västra Götaland, Gothenburg, Sweden.
    Schiöler, Linus
    Sahlgrenska Academy, University of Gothenburg, Sweden.
    Bojestig, Mats
    Healthcare Department, Region of Jönköping, Jönköping, Sweden.
    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.
    Collaboratively improving diabetes care in Sweden using a National Quality Register: Successes and challenges-A Case Study2015In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 24, no 4, p. 2012-221Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Since 1996, the Swedish National Diabetes Register (NDR) enabled health care providers to monitor their clinical performance over time and compare it with the national average. All health systems of Swedish county councils report data. By 2014, the NDR included data from 360 000 patients. Comparisons among county councils show significant variations in clinical outcomes and in adherence to evidence-based national guidelines. The purpose of this study was to evaluate whether and how a quality improvement collaborative could influence clinical practice and outcomes.

    METHODS: Twenty-three diabetes teams from all over Sweden, both primary care units and internal medicine departments, joined a quality improvement collaborative. The project was inspired by the Breakthrough Collaborative Model and lasted for 20 months. Evaluation data were collected from the teams' final reports and the NDR throughout the study period.

    RESULTS AND CONCLUSION: The teams reported improved patient outcomes significantly compared with the national average for systolic blood pressure and low-density lipoprotein levels. In contrast, glycated hemoglobin A1c levels deteriorated in the whole NDR population. Five themes of changes in practice were tested and implemented. Success factors included improved teamwork, with active use of register data, and testing new ideas and learning from others.

  • 148.
    Rejler, Martin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Höglandssjukhuset, Eksjö, Sweden .
    Fabisch, Anna
    Qulturum, Region Jönköpings län, Sweden .
    Petersson, Christina
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD. 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).
    Henriks, Göran
    Qulturum, Region Jönköpings län, Sweden.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Ersätt kvalitetsregistren med förbättringsnätverk: Registerbaserade förbättringsnätverk bör ersätta nuvarande nationella kvalitetsregister2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 17, p. 760-762Article in journal (Other (popular science, discussion, etc.))
  • 149.
    Restom, Fadia
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hälsobokslutet för att ge chefer stöd i att främja personalens Välbefinnande  _ utvärdering av ett förbättringsinitiativ inom hälso- och sjukvården: _ utvärdering av ett förbättringsinitiativ inom hälso- och sjukvården2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Work environment and employee´s health are not new studied areas as it characterizes the production and quality of the labor market, and especially in the public sector as the county council. A new mindset, to measure the health effects and to follow them up, started to appear. Consequently, a new concept arrived and began to get a foothold, called health accounts. It is believed that the visibility of the relationship between health and economy is crucial to succeed in reducing ill health.

    Aim: The purpose is to study and understand the possibility of introducing health accounts in health care and to study its benefits. The purpose is answered by the following questions: - What are the manager’s attitudes to health care on health promotion projects and how do they monitor their results? – To what use will health accounts give the managers? - How do health accounts support the evaluation of health promotion actions?

    Method: The study has an interaction research approach as well as an inductive and qualitative approach with descriptive design. Two clinics in the HighlandHospital were included in the study because they both had ongoing health promotion actions directed towards its employees. Knowledge from these actions improvement results were used in the implementation of health accounts. Seven managers from these two clinics were interviewed in semi-structured interviews and the data then analyzed thru qualitative content analysis with the above questions in aim.

    Results: A dialogue was made with the managers where I reported some key data that both already existed and were developed during the study. The managers experienced health accounts as information longed for and therefore wanted to continue on the same track.

    Conclusions and Discussion: In order to create a workplace that promotes it requires a serious and long-term work, such as the work based health accounts model. Support in the form of a dialogue with the managers, plays an important role. The result also indicates that using health accounts can support managers with their leadership promoting health, but it can’t get health leadership.

    Keywords: Health accounting, workplace health promotion, health promotion leadership, human health, improvement of knowledge, improvement efforts.

  • 150.
    Robert, Glenn
    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). Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
    Cornwell, Jocelyn
    Point of Care Foundation, London, United Kingdom.
    Black, Nick
    London School of Hygiene and Tropical Medicine, London, United Kingdom.
    Friends and family test should no longer be mandatory2018In: BMJ. British Medical Journal (International Ed.), ISSN 0959-8146, E-ISSN 0959-535X, Vol. 360, article id k367Article in journal (Other academic)
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