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  • 101.
    Kilander, Helena
    et al.
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Berterö, Carina
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Thor, Johan
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Brynhildsen, Jan
    Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Alehagen, Siw
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Women's experiences of contraceptive counselling in the context of an abortion – An interview study2018Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 17, s. 103-107Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To identify and understand women's lived experiences of contraceptive counselling given at the same time as abortion counselling.

    Methods: We interviewed 13 women aged 20–39 who had experienced an abortion and the related counselling. The women were recruited from five hospitals in Sweden. Interviews were analysed using an interpretative phenomenological approach.

    Results: We identified two themes: need for respectful counselling and needs for guidance and access to contraceptives. The essence “Being in a state of limbo and feeling sceptical” was coalesced from the themes. The women described a state of limbo, as being caught in an unwanted and emotionally charged situation. They reported that respectful counselling and meeting a skilled health professional helped to dispel their scepticism and influenced their plans for contraceptive use post abortion. Furthermore, women who wanted an intrauterine device described difficulties in access post abortion.

    Conclusion: The women seem to have a limited receptivity to contraceptive counselling when they have an unwanted pregnancy and are sceptical about contraceptives. Women, who experience respect in the counselling, report being helped in contraceptive decision-making. To receive respectful counselling and to have good access to intrauterine devices emerged as central needs among women at the time of an abortion.

  • 102.
    Kilander, Helena
    et al.
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Brynhildsen, Jan
    Obstetrics and Gynecology, Clinical and Experimental Medicine, Linköping, Sweden.
    Alehagen, Siw
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Fagerkrantz, Amanda
    Department of Obstetrics and Gyneacology, Norrköping, Region Ostergotland, Linköping, Sweden.
    Thor, Johan
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Collaboratively seeking to improve contraceptive counselling at the time of an abortion: A case study of quality improvement efforts in Sweden2019Ingår i: BMJ Sexual and Reproductive Health, ISSN 2515-1991, Vol. 45, nr 3, s. 190-199Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Many women find it difficult to choose and initiate a contraceptive method at the time of an abortion. There is a gap between regular clinical practice and existing evidence on motivational and person-centred counselling, as well as on use of long-acting reversible contraception (LARC). This study aims to describe and evaluate a Quality Improvement Collaborative (QIC) designed to enhance contraceptive services, with regard to changes in healthcare professionals' (HCPs') counselling in clinical practice, and in women's subsequent choice of, and access to, contraception. Methods Three multiprofessional teams working in abortion services from three hospitals in Sweden, and two women contributing with user experience, participated in a QIC during the period March-November 2017. Using a case study design, we collected and analysed both quantitative and qualitative data. Results Teams agreed on QIC goals, including that ≥50% of women would start LARC within 30 days post-abortion, and tested multiple evidence-based changes, aided by the two women's feedback. During the QIC, participating HCPs reported that they gained new knowledge and developed skills in contraceptive counselling at the time of an abortion. The teams welcomed the development of a performance feedback system regarding women's post-abortion contraception. While the majority of women counselled during the QIC chose LARC, only 20%-40% received it within 30 days post-abortion. Conclusion The QIC, incorporating user feedback, helped HCPs to develop capability in providing contraceptive services at the time of an abortion. Timely access to LARC remains a challenge in the present setting.

  • 103.
    Kilander, Helena
    et al.
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Salomonsson, Birgitta
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden .
    Thor, Johan
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Brynhildsen, Jan
    Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden .
    Alehagen, Siw
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden .
    Contraceptive counselling of women seeking abortion – a qualitative interview study of health professionals’ experiences2017Ingår i: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 22, nr 1, s. 3-10Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: A substantial proportion of women who undergo an abortion continue afterwards without switching to more effective contraceptive use. Many subsequently have repeat unintended pregnancies. This study, therefore, aimed to identify and describe health professionalś experiences of providing contraceptive counselling to women seeking an abortion.

    Methods: We interviewed 21 health professionals (HPs), involved in contraceptive counselling of women seeking abortion at three differently sized hospitals in Sweden. The interviews were recorded and transcribed verbatim and analysed using conventional qualitative content analysis.

    Results: Three clusters were identified: ‘Complex counselling’, ‘Elements of counselling’ and ‘Finding a method’. HPs often experienced consultations including contraceptive counselling at the time of an abortion as complex, covering both pregnancy termination and contraceptive counselling. Women with vulnerabilities placed even greater demands on the HPs providing counselling. The HPs varied in their approaches when providing contraceptive counselling but also in their knowledge about certain contraception methods. HPs described challenges in finding out if women had found an effective method and in the practicalities of arranging intrauterine device (IUD) insertion post-abortion, when a woman asked for this method.

    Conclusions: HPs found it challenging to provide contraceptive counselling at the time of an abortion and to arrange access to IUDs post-abortion. There is a need to improve their counselling, their skills and their knowledge to prevent repeat unintended pregnancies.

  • 104.
    Kilström, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Mot en rättssäker bedömning: Kvalitetsförbättringar av klinisk träning inom sjuksköterskeutbildningen utifrån en programteoretisk ansats med studie av samsyn mellan lärare2019Självständigt arbete på avancerad nivå (masterexamen), 80 poäng / 120 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Sjuksköterskors praktiska kunskaper är avgörande för säker vård. Inom sjuksköterskeutbildningen kontrolleras färdigheter genom färdighetsexaminationer. Utifrån kartlagda brister i rättssäkerhet och arbetsmiljö vid färdighetsexaminationer initierades ett förbättringsarbete.

    Syftet med förbättringsarbetet var att förbättra processen för klinisk träning inom sjuksköterskeprogrammet genom att utveckla färdighetsexaminationer.

    En studie av förbättringsarbetet genomfördes i syfte att:

    • Undersöka samsyn mellan lärare kring färdighetsexamination som pedagogisk aktivitet.
    • Analysera och utveckla initial programteori utifrån intervjudata.

    Förbättringsarbete har utformats efter förbättringsmodellen, förbättringsrampen och programteoretisk ansats. Studie genomfördes med kvalitativa intervjuer och innehållsanalys utifrån en interaktiv och abduktiv ansats.

    Förbättringsarbetet resulterade i minskad variation mellan lärare i bedömningen av färdighetsexaminationer. Nya arbetssätt har lett till ökad samsyn mellan lärare och bättre arbetsmiljö. Programteorin reviderades utifrån intervjudata.

    Minskad variation visar på en ökad rättssäkerhet. Reviderad programteori har ökat möjligheten att dra lärdom av förbättringsarbetet såväl lokalt som generellt.

    Arbetet har bidragit till en utveckling av sjuksköterskeutbildningen och dess bidrag till en god och säker hälso- och sjukvård.

  • 105.
    Kinsman, Leigh
    et al.
    Monash University, Victoria, Australia.
    Rotter, Thomas
    University of Saskatchewan.
    Stevenson, Katherine
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd. University of Saskatchewan.
    Bath, Brenna
    University of Saskatchewan.
    Goodridge, Donna
    University of Saskatchewan.
    Harrison, Liz
    University of Saskatchewan.
    Dobson, Roy
    University of Saskatchewan.
    Sari, Nazmi
    University of Saskatchewan.
    Jeffery, Cathy
    University of Saskatchewan.
    Bourassa, Carrie
    First Nations University of Canada.
    Westhorp, Gill
    Community Matters, Unley, South Australia.
    "The largest Lean transformation in the world": the implementation and evaluation of lean in Saskatchewan healthcare2014Ingår i: Healthcare Quarterly, ISSN 1710-2774, Vol. 17, nr 2, s. 29-32Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Saskatchewan Ministry of Health has committed to a multi-million dollar investment toward the implementation of Lean methodology across the province's healthcare system. Originating as a production line discipline (the Toyota Production System), Lean has evolved to encompass process improvements including inventory management, waste reduction and quality improvement techniques. With an initial focus on leadership, strategic alignment, training and the creation of a supportive infrastructure (Lean promotion offices), the goal in Saskatchewan is a whole health system transformation that produces "better health, better value, better care, and better teams." Given the scope and scale of the initiative and the commitment of resources, it is vital that a comprehensive, longitudinal evaluation plan be implemented to support ongoing decision-making and program design. The nature of the initiative also offers a unique opportunity to contribute to health quality improvement science by advancing our understanding of the implementation and evaluation of complex, large-scale healthcare interventions. The purpose of this article is to summarize the background to Lean in Saskatchewan and the proposed evaluation methods.

  • 106.
    Kjellström , Sofia
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Högskolan i Jönköping, Hälsohögskolan, HHJ. Åldrande - livsvillkor och hälsa.
    Idéer om ansvar för hälsa: forskning och metoder utifrån ett vuxenlivsutvecklingsperspektivManuskript (Övrigt vetenskapligt)
  • 107.
    Kjellström, Sofia
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Högskolan i Jönköping, Hälsohögskolan, HHJ. Åldrande - livsvillkor och hälsa.
    Människors olika komplexa förhållningssätt till hälsa och ansvar2008Konferensbidrag (Övrigt vetenskapligt)
  • 108.
    Kjellström, Sofia
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Andersson, Ann-Christine
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Applying adult development theories to improvement science2017Ingår i: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 30, nr 7, s. 617-627Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    The purpose of this paper is to address how adult development (AD) theories can contribute to quality improvement (QI).

    Design/methodology/approach

    A theoretical analysis and discussion on how personal development empirical findings can relate to QI and Deming's four improvement knowledge domains.

    Findings

    AD research shows that professionals have qualitatively diverse ways of meaning-making and ways to approach possibilities in improvement efforts. Therefore, professionals with more complex meaning-making capacities are needed to create successful transformational changes and learning, with the recognition that system knowledge is a developmental capacity.

    Practical implications

    In QI and improvement science there is an assumption that professionals have the skills and competence needed for improvement efforts, but AD theories show that this is not always the case, which suggests a need for facilitating improvement initiatives, so that everyone can contribute based on their capacity.

    Originality/value

    This study illustrates that some competences in QI efforts are a developmental challenge to professionals, and should be considered in practice and research.

  • 109.
    Kjellström, Sofia
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Areskoug Josefsson, Kristina
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson, Ann-Christine
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Ockander, Marlene
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Käll, Jacob
    Djursdala samhällsförening, Djursdala, Sweden, Sweden.
    McGrath, Jane
    London, United Kingdom.
    Donetto, Sara
    Florence Nightingale Faculty of Nursing, King's College London, London, United Kingdom.
    Robert, Glenn
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, King's College London, London, United Kingdom.
    Exploring, measuring and enhancing the coproduction of health and well-being at the national, regional and local levels through comparative case studies in Sweden and England: the 'Samskapa' research programme protocol2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 7, artikel-id e029723Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION:

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

    METHODS AND ANALYSIS:

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

    ETHICS AND DISSEMINATION:

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

  • 110.
    Kjellström, Sofia
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Avby, Gunilla
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson Bäck, Monica
    Gothenburg University.
    Financial incentives and motivation: "What we do is the same but how we do it is different"2016Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

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

  • 111.
    Kjellström, Sofia
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Avby, Gunilla
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    University of Gothenburg.
    Areskoug Josefsson, Kristina
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Leadership as a driver for work motivation: a study of well-functioning primary healthcare centers in Sweden2017Konferensbidrag (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 112.
    Kjellström, Sofia
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Avby, Gunilla
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Areskoug Josefsson, Kristina
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    University of Gothenburg.
    Research on successful and well-functioning organizations: The role of qualitative studies for theoretical and practical use. Workshop.2017Konferensbidrag (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 113.
    Kjellström, Sofia
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Avby, Gunilla
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Areskoug Josefsson, Kristina
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    Department of Social Work, University of Gothenburg, Gothenburg, Sweden.
    De komplexa drivkrafterna inom vård och omsorg - en fallstudie av finansiella incitament och dess konsekvenser ur ett arbetsmiljöperspektiv: Slutrapport2017Rapport (Övrigt vetenskapligt)
    Abstract [sv]

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

  • 114.
    Kjellström, Sofia
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Sjölander, Per
    Arctic Research Centre, Umeå University, Umeå, Sweden.
    Almers, Ellen
    Högskolan i Jönköping, Högskolan för lärande och kommunikation, HLK, Skolnära forskning, Hållbar utveckling & naturvetenskapens didaktik.
    McCall, Mary E.
    Samuel Merritt University, USA.
    Value systems among adolescents: Novel method for assessing level of ego-development2017Ingår i: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 58, nr 2, s. 150-157Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Children's value systems develop through youth and influence attitudes and actions. But there is a lack of appropriate measures for children and adolescents. The objective of this study was to construct and validate a questionnaire that reveals distinct value systems among adolescents, and to evaluate the identified value systems’ relationship to degree of ego-development and moral development. A quantitative study in a Swedish School with ages 12 through 16 (grades 6 to 9) was performed (N = 204). A set of pattern recognition statistical analyses has been used to identify different profiles of values systems and demonstrate that these systems can be arranged in a hierarchical order similar to other development. Results revealed three value systems in this sample. The identified value systems reflect different degrees of moral and ego-development among children in the study. Three distinct value systems were identified: the first (n = 9) and the second value systems (n = 35) correspond to pre-conventional stages, and the third value system (n = 155) corresponds to early conventional stages of ego development. Ego development scoring of test statements to assess stages. The value system was significantly related to moral development in the personal interest and the maintaining norms schemas of the Defining Issues Test (DIT). However, many students did not complete the entire DIT, so those results should be looked at with caution. It appears that this new test (Test for Adolescent Value Systems – TAVS) does relate to an established ego development rating scale.

  • 115.
    Kjellström, Sofia
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Stålne, Kristian
    Malmö universitet.
    Törnblom, Oskar
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. KTH Royal Institute of Technology, Stockholm, Sweden.
    Nya perspektiv på individuell och kollektiv ledarskapsutveckling i komplexa organisationer2019Rapport (Refereegranskat)
    Abstract [sv]

    Detta forskningsprojekt om ledarskapsutveckling i företag finansierades av KK-stiftelsen och genomfördes under 2017-2019 av forskare från Jönköping University, från Malmö universitet och med de deltagande företagen Sandvik, Svenska Spel och NCC. Syftet med forskningsprojektet var att undersöka hur ledarskapsutveckling kan bedrivas och användas för att utveckla företagens förmåga att hantera en komplex omgivning. Forskningsprojektet var samproducerande i och med att forskare tillsammans med företagen utforskade olika perspektiv på hur ledarskapsutveckling bedrivs och kan bedrivas på ett systematiskt vis. Ledarskapsutvecklingen studerades i ett avgränsat sammanhang hos Sandvik och Svenska Spel gällande nyligen genomförda organisationsförändringar och hos NCC gällande hur man organiserar för att hantera stora projekt.Ledarskapsutveckling kan dels innebära en utveckling av ledarna som individer i termer av kompetenser som krävs för att utföra sitt arbete som ledare eller av vidare förhållningssätt till ledarrollen som kan vara formell eller informell. Begreppet involverar även utvecklingen av ett kollektivt ledarskap där ledarskapet fördelar sig över en grupp, avdelning eller hel organisation. Forskningsprojektets samproducerande forskningsansats kan ses som ett exempel på när sådant kollektivt ledarskap utövas av deltagarna.

    Forskningsprojektet resulterade i akademiska publikationer såväl som ett antal utvecklingsprojekt i företagen. De akademiska resultaten var följande fyra forskningsartiklar:

    Studie 1: Perspektiv på ledarskapsutveckling, som bygger på intervjuer med ledare från de olika företagen och beskriver sex olika perspektiv och sätt att förstå ledarskapsutveckling som ordnats efter ökad komplexitet.

    Studie 2: Metoder för ledarskapsutveckling, som ger en översikt över olika metoder för ledarskapsutveckling. En pilotversion av en dialogkarta skapades som kan vara användbar för att ledare såväl som HR-personal ska kunna få en överblick över möjliga sätt att systematiskt stödja ledarskapsutvecklingen.

    Studie 3: Komplexa organisationer som driver ledarskapsutveckling, som beskriver hur två av företagen, Sandvik och Svenska Spel, har genomfört organisationsförändringar som ökat komplexiteten i organisationsstrukturerna på ett liknande sätt. Förändringarna har gett upphov till nya ledarroller och tillfällen för utveckling av ledarna som berörs samt utveckling av ett mer kollektivt ledarskap.

    Studie 4: Ett ramverk för ledarskapsutveckling, som introducerar hur ledarskapsutvecklingen kan förstås ur fyra olika perspektiv: individens utveckling, kollektivets utveckling, den strukturella utvecklingen och uppgiftens komplexitet.

    För företagen resulterade forskningsprojektet i utvecklingsaktiviteter och lärande. Några lärdomar och rekommendationer är att organisationer bör involvera inte bara ledare utan även medarbetare i aktiviteter kring ledarskapsutveckling, initiera6diskussioner kring vad gott ledarskap och ledarskapsutveckling innebär, utveckla inte bara individer utan också det kollektiva ledarskapet, samt att ledarskapsutveckling inte bara sker vid enstaka kurser eller insatser utan kan ske vid det dagliga arbetet, exempelvis vid förändringar i arbetsuppgifter, roller eller organisatoriska förändringar. I detta forskningsprojektet har vi sett det som en central uppgift för en ledare, utöver att leda och bidra till verksamhetens mål, att kontinuerligt och systematiskt stödja den egna och kollegors ledarskapsutveckling. I en föränderlig värld finns inte något slutgiltigt svar på vad ett önskvärt ledarskap är – ledarskapet behöver ständigt utvecklas.

  • 116.
    Knighton, Andrew J.
    et al.
    Intermountain Institute for Health Research, Intermountain Healthcare, Salt Lake City, UT, United Statesthcare Delivery Rese.
    Kristiansson, Robert S.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Habilitation Services, Uppsala County, Uppsala, Sweden.
    Belnap, Tom
    Intermountain Institute for Health Research, Intermountain Healthcare, Salt Lake City, UT, United States.
    Daneryd, Peter
    Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Intermountain Institute for Health Research, Intermountain Healthcare, Salt Lake City, UT, United States.
    From the Intermountain Institute for Health Care Delivery Research2017Ingår i: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 26, nr 1, s. 51-52Artikel i tidskrift (Refereegranskat)
  • 117.
    Kullingsjö, Erik
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Rätt behandling med hjälp av prioriteringsriktlinjer: En kvalitativ studie inom Habiliteringen för att beskriva ett pågående förbättringsarbete där beslutstöd används2016Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Bakgrund

    I svensk hälso- och sjukvård skall prioriteringar utgå från de tre principerna i den etiska plattformen.

    Habiliteringen i Västra Götaland har utvecklat ett beslutstöd för prioriteringar med utgångspunkt från den nationella modellen för öppna prioriteringar vars syfte är att omsätta den etiska plattformen till praktiken.

     

    Syfte

    Syftet med förbättringsarbetet var att börja använda beslutsstöd vid val av behandlingsmetoder, och hypotesen var att om beslut tas strukturerat ökar förutsättningarna för en mer likvärdig vård.

    Studiens syfte var att beskriva medarbetarnas upplevelser av förbättringsarbetet.

     

    Metod

    I det pågående förbättringsarbetet har Nolans förbättringsmodell använts.

    Studien genomfördes som en deskriptiv kvalitativ studie och fokusgrupper genomfördes i två omgångar med deltagande team.

     

    Resultat

    Medarbetarna upplever att arbete utifrån prioriteringsriktlinjer är viktigt men är beroende av beslutsstödet utformning och yttre faktorer. Att prioritera blir enklare om åtgärderna på väntelistan är rangordnade.

    Det går än inte att utläsa att mer likvärdig vård uppnåtts men när medarbetarna får styra över förbättringsarbetet minskar väntetiden från beslut till behandlingsstart.

     

    Slutsatser

    Nolans förbättringsmodell fungerar vid införande av beslutsstöd för prioritering.

    Det återstår att se om beslutsstödet bidrar till en mer likvärdig vård.

  • 118.
    Kuziemsky, Craig E.
    et al.
    Telfer School of Management, University of Ottawa, ON, Canada.
    Vimarlund, Vivian
    Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Informatik. Högskolan i Jönköping, Hälsohögskolan, 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 delivery2018Ingår i: 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, s. 626-630Konferensbidrag (Refereegranskat)
    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. 

  • 119.
    Källvant, Jonas
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Lundh, Theres
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Värdeskapande användning av radiologi: - Utbildning och mätning för förbättring2013Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Introduktion

    Medicinsk vetenskap och sjukvårdens möjligheter att hjälpa utvecklas ständigt. Sjukvården idag kan i många fall ställa rätt diagnos och ge en effektiv behandling för att bota den som drabbats av ohälsa. Radiologiska undersökningar är ett viktigt hjälpmedel men innebär också risker i form av strålning samt felaktigt resursanvändande.

    Syfte

    Syftet med förbättringsarbetet var att skapa en bättre användning av radiologi och följsamhet till medicinska riktlinjer så att patienten får rätt undersökning utifrån sitt behov samt att resur-ser nyttjas mer optimalt. Målsättningen var att öka andelen berättigade undersökningar.

    Syftet med studien av förbättringsarbetet var att få en förståelse för

    • vilka faktorer som påverkar remittentens val av radiologisk undersökning och därmed berättigandegraden
    • vilka aktiviteter i förbättringsarbetet påverkar berättigandegraden och på vilket sätt

    Metod

    Interventioner i form av utbildning och mätningar användes för att höja berättigandegraden. Bedömning av berättigandegraden gjordes av en ST-läkare.

    En fallstudie med kvalitativ ansats genomfördes och fokusgruppintervju användes för att stu-dera förbättringsarbetet.

    Resultat

    Studien visar att berättigandegraden ökar något som ett resultat av de valda interventionerna. Utbildningen på plats gav också upplevda positiva effekter i form av bättre kunskap och lä-rande för deltagare.

    Analysen visade att osäkerhet som läkare upplever i sitt arbete med patienten kan härledas till kategorierna kunskap och krav.

    Diskussion/Slutsats

    Utbildning genomförd av radiologispecialist har visat sig vara framgångsrikt koncept. Mät-ningar som metod för lärande och förändring uppfattades istället som mätning för uppföljning.

    Förbättrad kunskap kring vilka faktorer som styr läkares val av undersökning har uppnåtts och områden för fortsatt förbättring har identifierats

  • 120.
    Lind, Susanne
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of nursing, Karolinska Institutet, Sweden.
    Sandberg, Jonas
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, 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 study2018Ingår i: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 16, nr 6, s. 698-705Artikel i tidskrift (Refereegranskat)
    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.

  • 121.
    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
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi.
    Implementation of national palliative care guidelines in Swedish acute care hospitals: A qualitative content analysis of stakeholders' perceptions2017Ingår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 121, nr 11, s. 1194-1201Artikel i tidskrift (Refereegranskat)
    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. 

  • 122.
    Lindberg, Susanne
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd. Hälsohögskolan Jönköping.
    Ett kommunikationsverktyg utvecklat för och med nyblivna föräldrar: – en fallstudie inom postpartum vården2014Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 123. Lindgren, Åsa
    et al.
    Tengelin, Ellinor
    Dellve, Lotta
    Utformning av ett webbaserat verktyg för stresshantering2012Rapport (Övrigt vetenskapligt)
  • 124.
    Ljungberg, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Telemedicin inom barnsjukvård: Familjers och professionellas upplevelser och medverkan vid pilotinförandet av videokonsultationer2016Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    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. 

  • 125.
    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
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, 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 improvement2019Ingår i: Research in Social Science and Disability, ISSN 1479-3547, E-ISSN 2056-7529, Vol. 5, nr 1Artikel i tidskrift (Refereegranskat)
    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.

  • 126.
    Lundberg, Elisabeth
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Oral hälsa.
    Gard, Fanny
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Oral hälsa.
    Förekomst av karies och plack hos vuxna personer med funktionsnedsättning på ett vårdhem i Ga-Rankuwa, Sydafrika: En tvärsnittsstudie2019Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Bakgrund:I Sydafrika skiljer sig den orala hälsan mellan olika befolkningspopulationer och personer med funktionsnedsättning är en grupp som har en ökad risk för orala sjukdomar. Undermålig oral hygien är en orsak till plackbildning på tänder och dess omgivande vävnader vilket i sin tur kan leda till orala sjukdomar såsom karies, gingivit och parodontit. Syfte:Syftet med studien var att undersöka förekomsten av karies och plack hos personer med funktionsnedsättning på ett vårdhem i Ga-Rankuwa, Sydafrika. Metod:Studien var en kvantitativ tvärsnittsstudie baserad på utförda kliniska tandundersökningar av manifest karies och plack. Resultat:Populationen var 50 personer i åldrarna 18–46 år, av dessa hade 92 % karies. Antal karierade tänder var fler hos männen jämfört med kvinnorna (statistiskt signifikant). Gällande karies- och plackförekomst vid jämförelse mellan olika åldersgrupper fanns ingen statistisk signifikant skillnad. Ingen skillnad kunde ses mellan könen avseende plackförekomst. Medelvärdet för plackförekomsten var 1,8 vilket innebär att merparten hade plack som täckte mer än ⅓, men inte mer än ⅔. Slutsatser: Förekomsten av karies och plack är hög hos personer med funktionsnedsättning på vårdhemmet i Ga-Rankuwa. Vidare och mer omfattande studier hos en större population behövs för att öka kunskapen kring denna grupp och deras orala hälsa.

  • 127.
    Lupaszkoi Hizden, Thomas
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Creating a community of practice to prevent readmissions: An improvement work on shared learning between an intensive care unit and a surgical ward2016Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    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.

  • 128.
    Lång, Elisabeth
    et al.
    FOI, Swedish Defence Research Agency, Stockholm, Sweden.
    Nystedt, Paul
    Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Nationalekonomi. Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Blowing up money? The earnings penalty of smoking in the 1970s and the 21st century2018Ingår i: Journal of Health Economics, ISSN 0167-6296, E-ISSN 1879-1646, Vol. 60, s. 39-52Artikel i tidskrift (Refereegranskat)
    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.

  • 129.
    Löfgren, Oskar
    et al.
    Högskolan i Jönköping, The Jönköping Academy for Improvement of Health and Welfare.
    Österström, Anna
    Högskolan i Jönköping, The Jönköping Academy for Improvement of Health and Welfare.
    Lessons learnt from quality improvement in radiological service: Four key factors for sucess2012Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    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.

  • 130.
    Magnusson, Karin
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Kan förbättringsarbete ge ökad kunskap och bättre kvalitet?: Ett förbättringsprojekt om Non-Invasiv-Ventilation på en akutvårdsavdelning2016Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Detta förbättringsarbete syftade till att genom utbildning, arbete med rutiner och diskussioner av patientfall öka kunskapsläget hos personalen vad gäller Non Invasiv Ventilations behandling (NIV) för andningssviktspatienter på akutvårdsavdelningen och att öka följsamheten till gällande rutin. Arbetet var en del i avdelningens arbete för en god och säker vård. I studien av förbättringsarbetet undersöktes upplevelser av hur arbetet påverkat kunskaps-läget och vilka effekter personalen upplevde att detta hade vad gällde att arbeta efter rutiner samt effekter på förståelsen för patientens vård och behandling. Förbättringsarbetet utfördes med stöd i Nolans förbättrings modell genom interventioner i fyra PDSA-cykler. Studien av förbättrings-arbetet genomfördes som individuella intervjuer som analyserades med kvalitativ innehållsanalys utifrån Graneheim-Lundman. Förbättringsarbetet förbättrade det skattade kunskapsläget hos personalen men påverkade inte följsamheten till befintlig rutin. Att arbeta i PDSA-cykler kan anses som effektivt då förbättringen kan ses gradvis genom projektet. Genom studien belystes vikten av repetitiv utbildning, diskussioner och stöd från så väl kollegor som chefer. Vidare belystes vikten av att ledningen klargjorde vilken kunskap som förväntades, följde upp utvecklingen samt att det fanns en tydlighet i rutiners mening, innehåll och vem som ansvarade för dessa.

  • 131.
    Magnusson, Lina
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering.
    Ramstrand, Nerrolyn
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform.
    Fransson, Eleonor
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Ahlström, Gerd
    Lund University.
    Mobility and satisfaction with lower-limb prostheses and orthoses among users in Sierra Leone: A cross-sectional study2014Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, nr 5, s. 438-446Artikel i tidskrift (Refereegranskat)
    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.

  • 132.
    Malm, Dan
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Rolander, Bo
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för beteendevetenskap och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd). 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
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Reducing the prevalence of catheter-related infections by quality improvement: Six-year follow-up study2016Ingår i: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 6, nr 2, s. 79-87Artikel i tidskrift (Refereegranskat)
    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.

  • 133.
    Maslan, Alma
    Högskolan i Jönköping, Hälsohögskolan.
    Personalens sjukfrånvaro som en kvalitetsaspekt i vård och omsorg: en kvalitativ studie av sjukfrånvaro och dess betydelse för hållbar kompetensförsörjning i hemtjänsten2017Självständigt arbete på avancerad nivå (magisterexamen), 40 poäng / 60 hpStudentuppsats (Examensarbete)
    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.

  • 134. Mazzocato, Pamela
    et al.
    Holden, Richard
    Brommels, Mats
    Aronsson, Håkan
    Bäckman, Ulrika
    Elg, Mattias
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Thor, Johan
    Högskolan i Jönköping, Hälsohögskolan, 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, Sweden2012Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 12, nr 1, s. 28-Artikel i tidskrift (Refereegranskat)
    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).

  • 135.
    Mazzocato, Pamela
    et al.
    Karolinska Institutet.
    Thor, Johan
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd. 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 services2014Ingår i: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 28, nr 2, s. 266-288Artikel i tidskrift (Refereegranskat)
    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.

  • 136.
    Migotto, Sandra
    et al.
    Hospital Nursing Service, AULSS 2 - Marca Trevigiana, Treviso, Italy.
    Garlatti Costa, Grazia
    Department of Economics and Statistics, University of Udine, Udine, Italy.
    Ambrosi, Elisa
    Department of Clinical Medicine, University of Bologna, Bologna, Italy.
    Pittino, Daniel
    Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Företagsekonomi. Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Center for Family Enterprise and Ownership (CeFEO).
    Bortoluzzi, Guido
    Department of Economics, Business, Mathematics and Statistics, University of Trieste, Trieste, Italy.
    Palese, Alvisa
    Nursing Science, Department of Medical Sciences, University of Udine, Udine, Italy.
    Gender issues in physician-nurse collaboration in healthcare teams: Findings from a cross-sectional study.2019Ingår i: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: The aims of the study were (a) to assess whether the proportion of female nurses and female physicians in a given unit influences the attitude of collaboration between nurses and physicians as reported by nurses, and (b) to examine how these two dimensions interact to influence attitudes towards cooperation.

    BACKGROUND: Available studies have documented that gender influences the collaboration between physicians and nurses, but no have explored the influence of specific combinations-such as a high proportion of female nurses and a high proportion of female physicians.

    METHODS: A cross-sectional study involving 700 nurses working in 36 hospital units in Italy. The validated Italian version of the Jefferson Scale of Attitudes towards Physician-Nurse Collaboration was used. A three stages hierarchical linear regression was performed by entering: (a) the control variables at the individual and at the unit levels, (b) the proportion of female nurses and physicians and (c) the two-way interaction.

    RESULTS: A total of 430 nurses participated; the average Jefferson Scale of Attitudes towards Physician-Nurse Collaboration total score was 48.64 ± 5.27. At the second and third stages of the hierarchical linear regression model (explaining 12.8% and 14.1% of the Jefferson Scale of Attitudes towards Physician-Nurse Collaboration variance, respectively), having more female RNs as staff (model two: ß = 0.61, p =< .1; model three: ß = 0.69, p =< .05) was significantly associated with higher Jefferson Scale of Attitudes towards Physician-Nurse Collaboration scores; differently, higher physician-nurse ratios (model two: ß = -4.09, p =< .05; model three: ß = -4.54, p =< .01), and more female physicians (model two: ß = -1.06, p =< .05; model three: ß = -1.29, p =< .01) were associated with lower Jefferson Scale of Attitudes towards Physician-Nurse Collaboration scores.

    CONCLUSION: There is a decreased collaboration as reported by nurses when predominantly male nursing teams interact with teams with more female physicians. However, in units lead by female physicians, having more female members among the nursing team, ensures increased attitudes of collaboration as reported by nurses.

    IMPLICATIONS FOR NURSING MANAGEMENT: With the increasing proportion of female physicians and male nurses, unit mangers should be prepared to manage their influence on interprofessional cooperation.

  • 137.
    Moberg, Anne-May
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Från lag till handling: En fallstudie av hur lagkravet om patientsäkerhetsberättelse nyttiggjordes i Stockholms läns landsting2013Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Bakgrund: Enligt patientsäkerhetslagen 2010:659 ska vårdgivare årligen skriva en patientsäkerhetsberättelse. Granskning av 76 patientsäkerhetsberättelser i Stockholms läns landsting (SLL) visade bristande kunskap om hur den skrivs och bristfällig förståelse för patientsäkerhet, främst bland mindre vårdgivare. Hälso- och sjukvårdsadministratörer kunde inte besvara vårdgivarnas frågor om patientsäkerhetsberättelsen, varför ett förbättringsprojekt initierades för att skapa stödmaterial samt nyttiggöra patientsäkerhetsberättelsen.

     

    Syfte: Att belysa hur ett statligt styrinitiativ hanterades i praktiken i SLL och vilka erfarenheter som kunde knytas till praktikprojektet i hälso-och sjukvårdsadministrationen, hos vårdgivare och i interaktionen dem emellan samt om insatserna bidrog till ökad förståelse för patientsäkerhet.

     

    Metod: Studien var en deskriptiv fallstudie. Datainsamlingen bestod av intervjuer med vårdgivare och hälso-och sjukvårdsadministratörer och dokumentanalys. Analyserna var kvalitativ och kvantitativ innehållsanalys.

     

    Resultat: I uppföljning av vårdgivare nyttiggjordes patientsäkerhetsberättelsen med stöd av mall och manual. Interaktionen mellan vårdgivare och hälso- och sjukvårdsadministratör gick från kontroll till dialog. Lärande, och i viss mån förståelse för patientsäkerhet, ökade.

     

    Slutsats: Genom att vara proaktiv och bereda stöd för vårdgivare att fullfölja sitt åtagande avseende patientsäkerhetsberättelse kunde flera vårdgivare bli varse sitt ansvar och skyldigheter. Förbättringsprojektet genomfördes med stöd av förbättringskunskap och hög delaktighet, ett arbetssätt som rekommenderas. Fortsatt forskning av styrningens effekter föreslås.

  • 138.
    Mugabe, Gabriel Nzarama
    et al.
    University of Rwanda, College of Business and Economics, Rwanda.
    Vimarlund, Vivian
    Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Informatik. Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Centre for Information Technology and Information Systems (CenITIS). Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Wass, Sofie
    Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Informatik.
    Implementation of ict based innovations as electronic medical record in sub-sahara Africa: Issues of relevance for future implementations2017Ingår i: 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, s. 95-101Konferensbidrag (Refereegranskat)
    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.

  • 139.
    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
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, 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 collaboration2019Ingår i: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 22, nr 3, s. 284-297Artikel i tidskrift (Refereegranskat)
    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.

  • 140.
    Møllerhøj, Jette
    et al.
    Competence Centre for Forensic Psychiatry, Mental Health Centre Sct. Hans, Roskilde, Denmark.
    Stølan, Liv Os
    Competence Centre for Forensic Psychiatry, Mental Health Centre Sct. Hans, Roskilde, Denmark.
    Erdner, Anette
    Department of Health Care Sciences, Ersta Sköndal Bräcke University, Stockholm, Sweden.
    Hedberg, Berith
    Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Stahl, Katja
    Medical Department, Janssen Cilag AS Norway, Oslo, Norway.
    Riise, Jesper
    Medical Department, Janssen Cilag AS Denmark, Birkerød, Denmark.
    Jedenius, Erik
    Medical Department, Janssen Cilag AS Sweden, Stockholm, Sweden.
    Rise, Marit B.
    Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
    "I live, I don’t work, but I live a very normal life" - A qualitative interview study of Scandinavian user experiences of schizophrenia, antipsychotic medication, and personal recovery processes2019Ingår i: Perspectives in psychiatric care, ISSN 0031-5990, E-ISSN 1744-6163Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To illuminate user experiences of schizophrenia, reasons for receiving antipsychotic medication, and encounters with mental health services.

    Design and Methods: 24 semistructured qualitative research interviews with schizophrenia patients treated with 3-monthly paliperidone palmitate across Scandinavia were synthesized in qualitative content analysis.

    Findings: Participants describe considerable challenges in everyday functioning. Simultaneously, they rate their current mental and physical well-being high and seem satisfied with their lives. These pathways indicate personal recovery.

    Practice Implications: The participants emphasize the importance of trustful relations with healthcare professionals, therapeutic conversations, antipsychotic medication in a 3-monthly formulation, and support from relatives.

  • 141.
    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
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nygårdh, Annette
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, 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.2017Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S52-S53Artikel i tidskrift (Refereegranskat)
    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.

  • 142.
    Nejati, Babak
    et al.
    Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
    Lin, Chien-Chin
    Department of Laboratory Medicine and Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
    Imani, Vida
    Pediatric Health Research Center, Tabriz University of Medical Sciences Tabriz, Iran.
    Browall, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Lin, Chung-Ying
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Validating patient and physician versions of the shared decision making questionnaire in oncology setting2019Ingår i: Health Promotion Perspectives, ISSN 2228-6497, Vol. 9, nr 2, s. 105-114Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: This study investigated the psychometric properties of the 9-Item Shared Decision Making Questionnaire (SDM-Q-9) and the 9-Item Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) using comprehensive and thorough psychometric methods in an oncology setting.

    Methods: Cancer survivors (n=1783; 928 [52.05%] males) and physicians (n=154; 121[78.58%] males) participated in this study. Each cancer survivor completed the SDM-Q-9. Physicians completed the SDM-Q-Doc for each of their cancer patient. Confirmatory factor analysis (CFA) and Rasch model were used to test the psychometric properties of SDM-Q-9 and SDM-Q-Doc.

    Results: SDM-Q-9 and SDM-Q-Doc demonstrated unidimensional structure in CFA and Rasch model. In addition, the measurement invariance was supported for both SDM-Q-9 and SDM-Q-Doc across sex using the multigroup CFA. Rash analysis indicates no differential item functioning (DIF) across sex for all the SDM-Q-9 and SDM-Q-Doc items. SDM-Q-9 and SDM-Q-Doc were moderately correlated (r=0.41; P<0.001).

    Conclusion: SDM-Q-9 and SDM-Q-Doc are valid instruments to assess shared decision making in the oncology setting.

  • 143.
    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.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, 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 science2016Ingår i: BMJ. British Medical Journal (International Ed.), ISSN 0959-8146, E-ISSN 0959-535X, Vol. 354, artikel-id i3319Artikel i tidskrift (Refereegranskat)
  • 144.
    Neubeck, Truls
    Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Quality improvement within nonprofit social service providers2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

  • 145.
    Neubeck, Truls
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Elg, Mattias
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Linköping University.
    Quality improvement in the case of sheltered housingIngår i: Artikel i tidskrift (Övrigt vetenskapligt)
  • 146. Neubeck, Truls
    et al.
    Elg, Mattias
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Linköping University.
    Andersson, A.
    Process or result-oriented performance measures in improvement of Not for ProfitsManuskript (preprint) (Övrigt vetenskapligt)
  • 147.
    Nilsson, Magnus
    et al.
    University of Gothenburg, Sweden.
    Jönson, Håkan
    Lund University, Sweden.
    Carlstedt, Elisabeth
    Lund University, Sweden.
    Harnett, Tove
    Lund University, Sweden.
    Nursing homes with lifestyle profiles - part of the marketisation of Swedish eldercare2018Ingår i: International Journal of Care and Caring, ISSN 2397-8821, Vol. 2, nr 1, s. 49-63Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Swedish nursing home residents are very frail, but a new trend is for nursing homes to adopt a lifestyle profile. Based on interviews with 16 representatives of care organisations, this study investigates the reasons for adopting profiles in this way. The analysis shows that the existence of lifestyle profiles is strongly linked to a market discourse centred on freedom of choice. It is concluded that lifestyle profiles are used as a differentiation strategy in order to justify marketisation, exposing the Swedish eldercare system – which does not permit competition on the basis of price or standards of care – to market forces.

  • 148.
    Nordenström, Jörgen
    et al.
    Karolinska institutet.
    Thor, Johan
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Karolinska institutet.
    Bästa praxis - en nyckel till bättre vårdkvalitet och mer effektiv vård2016Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, s. 34-37, artikel-id DWYWArtikel i tidskrift (Övrigt vetenskapligt)
    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«.

  • 149.
    Nordin, Annika
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, 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 care2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

  • 150.
    Nordin, Annika
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Intangible outcomes of the work with a doctoral thesis2018Konferensbidrag (Refereegranskat)
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