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  • 151.
    Sjöström, Katarina
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. TioHundra AB.
    Att förbättra för patienten med patienten: Aktionsforskning med syftet att studera effekterna av en utbildningsinsats ”Förbättringsarbete med fokus på patientsamverkan” på sjukhus och i primärvård i vårdbolaget TioHundra AB2017Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    Background: Patient partnership in care is important to deliver high quality of care. Citizens are invited to participate in improving care, but it is often unclear how this can work in practice. TioHundra AB: s (THAB) strategy is to partnership with citizens and to increase the number of quality improvement work (QI) with patient partnership. A training program, "QI focusing on patient partnership" was conducted in THAB in collaboration with Quality Register Center Stockholm (QRC).

    Purpose: To provide knowledge about methods and tools for patient partnership in QI and to produce experiences for the creation of a company-wide patient partnership guideline. The purpose of the study was to study the effects of the training program.

    Methods: In the study, deductive action research has been used. Qualitative and quantitative data from position reports, focus groups and questionnaires were collected and analyzed based on a theoretical framework, Kirkpatrick's model for evaluation of education. A number of process- and result measures were followed during the training program.

    Results: The number of patient partnership in QI has increased and all participants have tested several different methods/tools. They describe increased knowledge, multiple lessons learned and behavioral changes regarding patient partnership in QI.

    Conclusions: The result indicates that it is possible to bring about a change in behavior when working with and thinking about patient partnership in QI, even in a relatively short period of time. How the training program has been tailored to fit the context and adapted during the program is likely to be a success factor, as well as how it was embedded and communicated in the leadership and in the operational plan.

  • 152.
    Skarstedt, Marita
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Reduced turnaround time for blood culture:: Experiences from an improvement process2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background

    Customer satisfaction is important for clinical microbiology laboratories and the most important service aspect is the reliability of responses. One important indicator of the quality of care is turnaround time for a sample referred to a laboratory.

    Aim

    This study describes and evaluates an improvement of the blood culture process and evaluates the staff’s experiences of the changes brought by the improvement project.

    Methods

    The blood culture process during evenings and nights was re-designed in a cooperation project between the laboratories of clinical microbiology and clinical chemistry in a mid-size Swedish county council. Typing with matrix-assisted laser desorption/ionization time of flight (MALDI ToF) and rapid antibiotic susceptibility testing were also introduced. To describe staff experi-ences semi-structured interviews were performed with twelve of the staff involved.

    Results

    The time from sampling to susceptibility testing and typing, for patients with cefotaxime resistant enterobacteriaceae, was before the improvement project on average 55 hours compared to 43 hours after closure of the project. In the qualitative content analysis four categories were found which represented the experience of the staff: patient focus, changed knowledge, cooperation and driving forces.

    Discussion

    The study of the implementation of the improvement showed that laboratory staff could handle the change well. The change from traditional biochemical typing, used for over 50 years, to MALDI ToF is indeed a paradigm shift. Nevertheless, nobody was disappointed over the fact that some of the fundamental previous microbiological laboratory work routines were laid to rest.

  • 153.
    Staines, Anthony
    et al.
    University Lyon III, France and Fédération des hôpitaux vaudois, Prilly, Switzerland.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Karolinska Institutet.
    Robert, Glenn
    National Nursing Research Unit, King’s College, London, United Kingdom.
    Sustaining improvement? The 20-year Jönköping Quality Improvement program revisited2015In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 24, no 1, p. 21-37Article in journal (Refereed)
    Abstract [en]

    Background: There is scarce evidence of organization-wide and sustained impact of quality improvement (QI) programsin health care. For 20 years, the Jönköping County Council’s (Sweden) ambitious program has attracted attention from practitioners and researchers alike. Methods: This is a follow-up case of a 2006 study of Jönköping’s improvement program, triangulating data from 20 semi-structured interviews, observation and secondary analysis of internal performance data. Results: In 2010, clinical outcomes had clearly improved in 2 departments (pediatrics, intensive care), while process improvements were evident in many departments. In an overall index of the 20 Swedish county councils’ performance, Jönköping had improved its ranking since 2006 to lead in 2010. Five key issues shaped Jönköping’s improvement program since 2006: a rigorously managed succession of chief executive officer; adept management of a changing external context; clear strategic direction relating to integration; a broadened conceptualization of “quality” (incorporating clinical effectiveness, patient safety, and patient experience); and continuing investment in QI education and research. Physician involvement in formal QI initiatives had increased since 2006 but remained a challenge in 2010. A new clinical information system was being deployed but had not yet met expectations. Conclusions: This study suggests that ambitious approaches can carry health care organizations beyond the sustainability threshold.

  • 154.
    Stefansson, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Med fokus på det sannolika: En fallstudie av ett analytiskt förbättringsarbete för att minska återinskrivning inom 30 dagar på sjukhus2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 155.
    Sterwin, Carl
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Kortare väntan för patienter som behöver käkkirurgisk operation: En fallstudie av införande av kapacitets- och produktionsstyrning inom käkkirurgisk verksamhet2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background:

    The waiting time for oral surgery in the form of wisdom teeth and dental implant operations at Jönköping department for oral and maxillofacial surgery was too long and was a driver for improvement project with the aim of improving accessibility.

     

    Purpose:

    The global aim of the improvement project was to reduce the suffering for patients by shortening the waiting time for oral surgery.

    The specific purpose of the improvement project was to increase efficiency and reduce lead times in the processes involved in wisdom and dental implant surgery by increasing production volume by 50% to April 2018. The aim of the improvement work was to provide care when the need arises without unwanted waiting time. The purpose of the study of the improvement work was to clarify the experiences as evidenced by capacity and production management in order to improve accessibility to oral surgery.

     

    Method:

    Introduction of improvement knowledge in a systematic improvement work together with the method capacity and production management were used to increase production volume. Ideas for increasing production were tested in PDSA wheels and evaluated with quantitative measurements of results. The study used qualitative methods in the form of semi structured interviews with individual staff and focus group interviews with the improvement team.

     

    Results:

    Production volume increased for third molar surgery by 73% ​​and for dental implant surgery 54% without increased resources in the form of more staff or premises. The waiting time for the patients was reduced from 30 months to 21 months.

    The study showed that capacity and production management experienced by employees and management work well in oral and maxillofacial units with mixed funding.

  • 156.
    Ström, Anna
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Samverkan för trygg hemgång: Ett förbättringsarbete om övergången mellan geriatrik, ASIH och primärvård för den multisjuka patienten2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Patients with multiple illnesses are individuals with complex needs of care. For this group of patients, continuity of care and their sense of security is is of great importance.

    Improvement work objective: To create secure and accessible ASIH for elders with multiple illnesses by¨develop ways of working to enable re-admittance and secure discharges for this group of patients.

    Case study objective: To Investigate and analyze team members’ common experiences.

    Method: Implementation using Nolan’s improvement model. A case study using qualitative contents analysis.

    Result: The improvement work resulted in an even flow of referrals and shortened admission times to ASIH. Patients’ sense of security were rated to 76%. Seven Seven patients had the possibility towere be  re-admitted 1-7 times 1-7 times during the project.

    Casestudy summary: ”Conditions for cooperationfor a common goal”. A clear pattern with the following significant conditions emerged from the focusgroups interviews: continuity, learning, cooperation, and communication.

    Discussion: ASIH can be an option to facilitate the transition home for elderly patients with multiple illnesses. ASIH provides a sense of security and may prevent re-hospitalization. This model of cooperation requires clear, common goals and opportunities for feedback to enable learning contributes to measurable results.

  • 157.
    Ståhl, Ylva
    et al.
    Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Granlund, Mats
    Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Education and Communication, HLK, CHILD.
    Simeonsson, Rune
    University of North Carolina at Chapel Hill, NC, USA.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Enskär, Karin
    Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Psychosocial health information in free text notes of Swedish children's health records2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 3, p. 616-623Article in journal (Refereed)
    Abstract [en]

    Background: High-quality documentation of children’s health is an important priority in health care given trends of declining mental health and reduced well-being in children. There is a lack of information concerning psychosocial health in the standardized part of the national health record in the Child Health Service and the School Health Service in Sweden. Further, little is known if the free text notes in the health record, besides information on physical health, also include information on children’s psychosocial health. The aim of this study was to describe what is recorded concerning children’s health and development in free text notes.

    Methods: The study was based on a retrospective analysis of text using an inductive approach for qualitative analyses of content.

    Results: The analysis of the free text notes in the health records yielded seven categories: development, family, health problems, living habits, medical issues, preschool/school and leisure, and well-being. The categories mainly covered psychosocial aspects of health and were not only about health and development problems of the child but also what was covered during the visits. The information was unevenly distributed across the ages. A stronger focus on the youngest age groups within a family and preschool setting is needed. There was novel information in the free text notes such as pain, general health, emotions, mother’s mental health and leisure activities, which was not covered in the standardized part of the health records.

    Conclusion: The free text notes mainly reflected a psychosocial perspective on health. The findings of this study suggest that requesting more information on children’s psychosocial health in the standardized part of the health records could contribute to more comprehensive and informative health records in the Child health Service and the School Health Service in Sweden.

  • 158.
    Stålkrantz, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Wiberg, Jan
    Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Svanborg, Eva
    Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Everyday life for the spouses of patients with untreated OSA syndrome2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 2, p. 324-332Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to generate a theoretical model describing concerns for spouses of patients with untreated obstructive sleep apnoea syndrome (OSAS) and how they manage these concerns in their everyday life. Twelve spouses were interviewed about their experiences and how they manage everyday life. The interviews were analysed according to the Grounded Theory method as described by Strauss and Corbin. Two main categories emerged from the data: ‘Social adjustment’ and ‘New feelings’. ‘Social adjustment’ reveals how the spouses made adjustments in their daily lives, both according to their partners’ tiredness and owing to their own fatigue. ‘New feelings’ reveals emotional reactions related to the effects of their partner’s illness and the impact it had on the spouse’s everyday life. These two main categories could be seen in relation to four dimensions describing how the spouses manage their everyday life: ‘Sacrificing’, ‘Controlling’, ‘Changing’ and ‘Understanding’. The results show how the spouses made adjustments in everyday life and how their feelings were affected by their partner’s OSAS. Healthcare personnel could use information from this study to gain a deeper understanding and knowledge of what spouses of untreated patients with OSAS experience as their main concerns and how they manage their everyday life. This knowledge can be used to improve the support to the spouses, as well as in the educational situation concerning the illness, as well as the treatment.

  • 159.
    Sundkvist, Eva-Marie
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Metodstöd för koordinering av sjukskrivning och rehabilitering: En studie av ett förbättringsarbete med syfte att stärka koordineringen av sjukskrivning och rehabilitering i Region Jönköpings län2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Rehabkoordinatorn är en resurs i det försäkringsmedicinska arbetet i vården. Rehabkoordinering kan ske på olika nivåer (nivå 1-8). Den högsta bedöms ge bäst effekt på patientens sjukskrivning/rehabilitering. För att nå högsta nivån behövs tydliga rutiner, stöd från chef och tid för uppdraget. Syftet med förbättringsarbetet var att genom att utveckla ett metodstöd för rehabkoordinering skulle fler vårdenheter erbjuda patienter stöd enligt nivå 7-8. På sikt var förhoppningen att minska sjukskrivningarna. Studiens syfte var att beskriva hur metodstödet påverkar rehabkoordinatorns professionella utveckling. Med hjälp av förbättringsverktyg utvecklades ett webbaserat metodstöd som utvärderades med hjälp av enkäter. För att fånga rehabkoordinatorernas erfarenheter genomfördes en kvalitativ studie med hjälp av fokusgruppsmetod. Nivå 7-8 uppnåddes av 81 procent av vårdenheterna med rehabkoordinator. Ingen påverkan på sjukskrivningar upptäcktes. Rehabkoordinatorn upplevdes stödja patienter och det interna arbetet med sjukskrivningar på vårdenheten samt beskrevs fungera som samarbetspartners till externa aktörer (Försäkringskassan/Arbetsförmedlingen och arbetsgivare). Metodstödet upplevdes skapa tydlighet för uppdraget och fungerade som ett stöd i det dagliga arbetet. Metodstödet är implementerat och används. Den del av metodstödet som handlar om det patientnära arbetet behöver fortsatt utvecklas och förbättras för att säkerställa att rehabkoordinatorerna arbetar med rätt patienter i rätt tid.

  • 160.
    Suutari, Anne-Marie
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Förbättrad vård för ökad trygghet hos patienter med förmaksflimmer: En organisatorisk fallstudie av ett kvalitetsförbättringsprojekt på en kardiologisk vårdenhet2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 161.
    Svedberg, Petra
    et al.
    School of Social and Health Sciences Halmstad University, Halmstad.
    Johansson, Ingela
    Division of Nursing Sciences, Department of Medical and Health Sciences, Linköping University, Linköping.
    Persson, Sylvie
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Roxberg, Åsa
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Baigi, Amir
    General Practice and Public Health, Halland County Council, Falkenberg.
    Brunt, David
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Roijer, Carin Alm
    The Faculty of Health and Society, Malmö University, Malmö.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Rask, Mikael
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Nilsson, Ulrica
    Centre of Heath Care Sciences Örebro County Council and School of Health and Medical Sciences, Örebro University, Sweden.
    Psychometric evaluation of 'The 25-item Sex after MI Knowledge Test' in a Swedish context2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 1, p. 203-208Article in journal (Refereed)
    Abstract [en]

    The patients' sexual life after a myocardial infarction is important for his/her quality of life. In spite of this, many patients are in doubt regarding their sex life after a myocardial infarction (MI) and the sexual information received, and counselling from health care providers has been seen to be insufficient. The purpose of this study was to evaluate the psychometric properties of 'The 25-item Sex after MI Knowledge Test' in a Swedish context. A convenience sample was recruited. The scale was translated into Swedish and completed by 79 former patients from The Heart and Lung Patients' National Association on two occasions, with an interval of 2 weeks. The scale was tested for face and content validity, internal consistency and test-retest reliability. The result in this study indicates that the instrument has good face and content validity and displayed a moderate internal consistency (alpha 0.61). The instrument showed some level of instability in test-retest reliability with 60% of the items presenting moderate or strong agreement between the test and retest. Further studies that use this instrument in larger and more diverse samples are thus needed.

  • 162.
    Szopa, Elisabeth
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Från misstanke till diagnos - effektivare utredningsprocess för patienter med demenssjukdom.: Ett förbättringsarbete i primärvården.2018Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

     

    Background Dementia is not curable, although provided adequate examination one can relive symptoms and improve the quality of life of patients. However, the excessive time taken for basic assessment in Swedish primary care today is causing distress for the patient and their kin.

    Purpose The overall purpose of this improvement project was to enable earlier care for dementia patients, thus improving their quality of life. The specific purpose was to enable diagnosis or completed assessment within 12 weeks. The project also analysed the experience of staff during the project, as well as the experience of the patients’ relatives throughout the assessment process.

    Method A PDSA cycle was implemented when adjusting working methods related to booking of appointments with physicians. Semi-structured focus group interviews were also used.    

    Results The number of cases completed within 12 weeks increased from 62% to 93% and 61% to 95% at the two health centers respectively. Staff saw improved collaboration between teams and units as a key success factor. Patients’ relatives experienced the assessment process as smooth, and that shorter process times led to improved quality of life for the patient and their kin.

  • 163.
    Sällvin, Maja
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Habiliteringsplanering - begripligt, hanterbart och meningsfullt: Förbättringsarbete för att öka familjernas delaktighet i habiliteringsplanering2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: The work process of Habilitation planning embraces several central aspects in healthcare today, such as person centered care, participation, shared decision-making, co-production and individual planning. The work process represents a view that combines the patient’s knowledge and experience with the clinician’s professional knowledge, to create good care. 

     

    Aim: An improvement project was conducted at a habilitation center, aiming to increase families’ perceived participation in Habilitation planning. The aim of the study was to explore the co-workers’ experiences of Habilitation planning.

     

    Method: A local improvement project was conducted based on the Improvement model. A case study with focus group interviews and a qualitative content analysis was performed. The analysis was connected to espoused theory and theory-in-use.

     

    Result: All nine parents asked, perceived themselves as involved and the percentage of Habilitation planning judged as being of good quality increased from 14 to 19%. The study results showed great gaps between espoused theory and theory-in-use, e.g. for team work.

     

    Conclusion: To make Habilitation planning a work process really adding value to the patients, the gap between espoused theory and theory-in-use needs to decrease. Addressing this with improvement knowledge requires useful measurements.

  • 164.
    Tellmo Jung, Anneli
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Bättre kost till äldre på särskilt boende i Sävsjö kommun: en studie av ett förbättringsarbete2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Summary

    Aim

    The aim of this improvement project was to offer the elderly at special accommodations a better suited diet in accordance with the National Food Administration recommendations.

    The aim of the study was to describe how the improvement project has been implemented, perceived and affected the diet to the elderly at special accommodations and personnel from the diet organization.

    Method

    The method of this improvement project has been to use questionnaire to all the elderly at special accommodations before and after the changed diet. Semi structured interviews with personnel from the diet organization has been done and then analyzed with the help of content analysis. One further method to evaluate this improvement project has been to use statistics from senior alert quality register.

    Result

    With the use of lean and National Food Administration recommendations as premises several improvements has been done within the diet organization in Sävsjö municipality to create a more effective and standardized organization that can offer the client a diet that are more suited to their needs. The result from the interviews with the personnel from the diet organization was five themes: specialization of the kitchen, the working environment, the elderly’s experience, and the menu. 

    Conclusions

    Conclusions from this improvement project is that the elderly already before the improvement were satisfied with the food that they were offered. The result from the questionnaire shows no improvement regarding the satisfaction from the elderly. The share of elderly with risk of malnutrition did not decrease either. On the other hand, the diet personnel were satisfied with the change considering the aspect of working environment.

  • 165.
    Thidell, Fredrik
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Kvalitetssäkring av utbildningar vid Hälsohögskolan2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Från och med 2016 tillämpas ett nytt sätt att utvärdera utbildningar på högre nivå i Sverige. Universitetskanslersämbetet (UKÄ) har ansvar för uppdraget efter beslut i Sveriges riksdag. Fokus kommer att till stor del att ligga på lärosätenas egna kvalitetssäkringssystem. ESG, European Standards and Guidelines for Quality Assurance in the European Higher Education Area, kommer att ligga som grund för det nya systemet. Förbättringsarbetet som i denna rapport är utfört på mesosystemnivå vid Hälsohögskolan, HHJ, har inneburit att dels följa utvecklingen nationellt från UKÄ:s sida, dels att kartlägga det kunskapsläge som programansvariga vid HHJ har om kvalitetsfrågor. Det övergripande syftet med förbättringsarbetet har varit att vara med och förbättra Hälsohögskolans arbete med kvalitetssäkring samt vara delaktig i förberedelsen inför nytt granskningssätt. Det specifika syftet är att säkerställa att HHJ skall kunna arbeta med bästa möjliga kvalitet i det nya kvalitetssäkringssystemet samt att programansvariga har stöd i sitt kvalitetssäkringsarbete.

    En baslinjemätning i form av en fokusgruppsintervju har utförts och analyserats. Resultatet av analysen sade att kunskap och intresse finns för kvalitetsfrågor men att stöd från ledningen saknas i dessa frågor. Utifrån detta resultat rekommenderades det att ett kvalitetsutskott skapades inom HHJ som kan vara just detta stöd.

     

    Syftet med studien av förbättringsarbetet var att undersöka om förbättringsarbetet leder till ett ökat dagligt kvalitetsarbete för HHJ programansvariga. För att studera detta utfördes individuella intervjuer med programansvariga för att avgöra ifall genomförda förändringar lett till förbättringar. Resultatet efter analys blev att genomförda åtgärder sannolikt kommer leda till nya rutiner och ökad medvetenhet när det gäller kvalitetssäkringsarbete samt att förändringarna kan anses som förmodade förbättringar. HHJ står redo för implementering av nytt kvalitetssystem för att klara utvärdering från UKÄ. 

  • 166.
    Thor, Johan
    Jönköping University, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare. Karolinska Institutet.
    Förbättringsarbete och förändringsprocessen2012In: Kvalitetsarbete för bättre och säkrare vård / [ed] Gun Nordström, Bodil Wilde Larsson, Lund: Studentlitteratur AB, 2012, 1, p. 89-109Chapter in book (Other academic)
  • 167.
    Thor, Johan
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Lundgren, Charlotte
    Batalden, Paul B.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Henriks, Göran
    Sjödahl, Rune
    Gabrielsson Järhult, Felicia
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Collaborative improvement of cancer services in Southeastern Sweden – striving for better patient and population health, better care, and better professional development2012In: Sustainably Improving Health Care: Creatively linking care outcomes, system performance, and professional development / [ed] Paul Batalden, Tina Foster, London: Radcliffe Publishing, 2012, p. 175-192Chapter in book (Other academic)
  • 168.
    Thor, Johan
    et al.
    Jönköping University, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare. Karolinska Institutet.
    Peterson, Anette
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, The Jönköping Academy for Improvement of Health and Welfare.
    Lindahl, Bertil
    Kvalitetsregistrens roll i förbättringsarbete2015In: Nationella kvalitetsregister i hälso- och sjukvården / [ed] Gunilla Jacobsson-Ekman, Bertil Lindahl, Annika Nordin, Stockholm: Karolinska Institutet University Press , 2015, p. 50-63Chapter in book (Other academic)
  • 169.
    Thureson, Jenny
    Jönköping University, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Reducing the turnaround time in the histopathology service: - Experiences of an improvement process2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Today great efforts are made to record and reduce waiting times in cancer care. Long and variable turnaround times (TATs) delay the start of treatment and waiting contributes to mental anguish. The purposes of the QI intervention were to establish an effective and streamlined histopathology process with shorter TATs, to extend customer collaboration and to build knowledge of internal processes in order to lay the foundation for a learning environment. The goal was to raise the proportion of reported tissue samples from 50% to 90% within a 15 day period, ending 31th December 2014. The study of the QI intervention intended to identify factors that affect the introduction of novel working methods. Both quantitative and qualitative methods were used to achieve the goals. Improvement knowledge was combined with lean-inspired methods, and two focus groups were arranged in which data were analysed using qualitative content analysis.

    The goal to report 90% of tissue samples within 15 days was not achieved for all sample types, but improved TATs were clearly noted. Customer collaboration and visualisation of the processes had a positive effect on staff. The study resulted in six key factors important working with QI interventions; competence, compliance, feedback, interaction, patient- and customer focus and resources. Having motivated and dedicated staff is a key success factor for improvement work, in contrast to a lack of resources, and people that oppose change. To achieve future ambitious goals requires continuous improvement initiatives that involve optimisation of both human resources and equipment.

  • 170.
    Thörne, Karin
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Faculty of Health Sciences, Linköping University.
    Hult, Håkan
    Center for Educational Development and Research, Linköping University.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Abrandt Dahlgren, Madeleine
    Faculty of Health Sciences, Linköping University.
    The dynamics of physicians’ learning and support of others’ learning2014In: Professions & Professionalism, ISSN 1893-1049, E-ISSN 1893-1049, Vol. 4, no 1, p. 1-15Article in journal (Refereed)
    Abstract [en]

    Learning has been defined as a condition for improving the quality of healthcare practice. The focus of this paper is on physicians’ learning and their support of others’ learning in the context of Swedish healthcare. Data were generated through individual and focus group interviews and analyzed from a socio-material practice theory perspective. During their workday, physicians dynamically alternated between their own learning and their support of others’ learning in individual patient processes. Learning and learning support were interconnected with the versatile mobility of physicians across different contexts and their participation in multiple communities of collaboration and through tensions between responsibilities in healthcare. The findings illustrate how learning enactments are framed by the existing “practice architectures.” We argue that productive reflection on dimensions of learning enactments in practice can enhance physicians’ professional learning and improve professional practice.

  • 171.
    Tunér, Hans
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Rätt temperatur på maten: En fallstudie av ett förbättringsarbete på ett sjukhus med brickdukningssystem2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction

    Tasty and hygienically safe food is essential to the treatment and comfort of the patient. Patients are commonly weak or impaired and more vulnerable to infections. Food hygiene is a matter of patient safety in hospitals where food temperature is the single most important factor. Meal tray as food distribution system in hospitals offers many advantages but one disadvantage is its ability to maintain proper temperature of the food. Measurements at the studied hospital display substantial variations and significant deviations from acceptable temperatures. Hence, an improvement project was completed in order to improve and stabilize temperatures.

    Purpose

    The improvement project was studied in order to describe what phenomena was important to the success for the improvement, according to staff involved and also how patients experience of the food. The aim of the improvement project was to achieve a stable process with proper food temperatures.

    Methods

    The quality improvement completed with the PDSA improvement model as overarching theory and method The study was conducted as a descriptive case study with an inductive approach and deductive ingredients. Focus group interview and questionnaires was used for data collection. Qualitative content analysis an descriptive statistics was used for analysis of data.

    Results

    The improvement project resulted in substantially temperature improvement, a stable process with desired temperatures was achieved. Yet the focus and the aims for the improvement were adjusted under the project period, the original aims were not achieved completely. The improved temperatures decreased the risk for patients getting infected with food poisoning. The study displayed phenomena that to a great extent are within the influence of the microsystem, as important for the success of the improvement. These where summarized in four categories: Utilization of resources, Interaction and communication, Improvement capability and Participation/involvement.

    Conclusions

    A hospital with meal tray distribution system can achieve substantial improvements in food temperature using structured improvement methods. The results of the changes were mainly affected by phenomena that already are described in the quality improvement litterature. Future studies may combine inductive, qualitative approaches with deductive comparisons to phenomena described in literature.

  • 172.
    Törnered, Anna
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Bytestid på operation: En beskrivning av medarbetarnas förväntningar på ett kommande förbättringsarbete2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 173.
    Törnkvist, Åsa
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Akademiska sjukhuset.
    Att leda systematiskt förbättringsarbete: Framgångsfaktorer och svårigheter enligt chefer och ledare2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Title

    To lead systematic improvement – success factors and difficulties according to managers and leaders.

    Background

    Healthcare in Sweden is facing great challenges. The body of knowledge grows faster than the economic resources for healthcare, there is a gap between what we know should be done and what we actually do, and there are differences between different care givers in results for the same medical problems. One of many ways for healthcare to manage to develop and improve, despite limited economic resources, is that managers and leaders know how and are able to lead systematic quality improvement.

    Aim

    This study explores what managers and leaders in healthcare describes as success factors and difficulties in leading systematic quality improvement.

    Method

    Focus group interviews were used to gather information, which was analyzed with qualitative content analysis.

    Results

    The results show that the most important success factor described is enough time for quality improvement, followed by easily accessed and valid outcome data, competence in quality improvement, accessible decision support and a mandate to lead quality improvement.

     

    Keywords: healthcare, managers, micro systems, quality improvement, time.

  • 174.
    Törnquist, Louise
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Näringsriktiga mellanmål och tätare viktkontroller minskade ofrivilligviktnedgång: En kvalitativ studie om ett förbättringsarbete på ett äldreboende2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Det finns omfattande belägg om nutritionens betydelse för äldres hälsa och livskvalitet. För äldre patienter som bor på äldreboenden förekommer undernäring och ofrivillig viktnedgång vilket kan leda till ökade komplikationer såsom fall, trycksår och dödlighet.Syfte: Syftet i denna uppsats består av två delar. Syfte i det genomförda förbättringsarbetet: Att alla patienter på Solgården erbjuds bästa möjliga förutsättningar för att inta en god och näringsriktig kost. På lång sikt är målet att alla patienter ska ha ett gott nutritionsstatus. Syftet med studien av förbättringsarbetet: var att beskriva om och i så fall på vilket sätt personalen upplevde att förbättringsarbetet resulterade i förbättringar (i vården) för personer med demenssjukdom samt beskriva hur personalens erfarenheter av förbättringsarbetet kan bidra till förbättrad nutritionsvård för personer med demenssjukdom.Metod: Förbättringsarbetet genomfördes utifrån Nelson, Batalden och Godfreys (2011) Improvement ramp. I studien användes fallstudie med kvalitativ, induktiv metod och datainsamlingen bestod av intervjuer.Resultat: Förbättringsarbetets resultat visade att andelen mellanmål som innehöll tillräckligt mycket kalorier ökade och att journalförda viktuppföljningar gjordes i högre utsträckning. Studiens resultat bestod av fem kategorier som beskrev erfarenheter av förbättringsarbetet och på vilket sätt det upplevdes ha resulterat i förbättringar för patienterna.

  • 175.
    Ulhassan, Waqar
    et al.
    Karolinska Institutet.
    Sandahl, Christer
    Karolinska Institutet.
    Westerlund, Hugo
    Stockholm University.
    Henriksson, Peter
    Karolinska Institutet.
    Bennermo, Marie
    Karolinska Institutet.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Karolinska Institutet.
    Antecedents and Characteristics of Lean Thinking Implementation in a Swedish Hospital: A Case Study2013In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 22, no 1, p. 48-61Article in journal (Refereed)
    Abstract [en]

    Despite the reported success of Lean in health care settings, it is unclear why and how organizations adopt Lean and how Lean transforms work design and, in turn, affects employees' work. This study investigated a cardiology department's journey to adopt and adapt Lean. The investigation was focused on the rationale and evolution of the Lean adoption to illuminate how a department with a long quality improvement history arrived at the decision to introduce Lean, and how Lean influenced employees' daily work. This is an explanatory single case study based on semistructured interviews, nonparticipant observations, and document studies. Guided by a Lean model, we undertook manifest content analysis of the data. We found that previous improvement efforts may facilitate the introduction of Lean but may be less important when forecasting whether Lean will be sustained over time. Contextual factors seemed to influence both what Lean tools were implemented and how well the changes were sustained. For example, adoption of Lean varied with the degree to which staff saw a need for change. Work redesign and teamwork were found helpful to improve patient care whereas problem solving was found helpful in keeping the staff engaged and sustaining the results over time.

  • 176.
    Ulhassan, Waqar
    et al.
    Karolinska Institutet.
    Westerlund, Hugo
    Stockholm University.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Karolinska Institutet.
    Sandahl, Christer
    Karolinska Institutet.
    von Thiele Schwarz, Ulrica
    Karolinska Institutet.
    Does Lean Implementation interact with group functioning?2014In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 28, no 2, p. 196-213Article in journal (Refereed)
    Abstract [en]

    Purpose: As healthcare often is studied in relation to operational rather than socio-technical aspects of Lean such as teamwork, this study aims to explore how a Swedish hospital Lean intervention related to changes in teamwork over time.

    Design/methodology/approach: Teamwork was measured with the Group Development Questionnaire (GDQ) employee survey during Lean implementation at three units, in 2010 (n=133) and 2011 (n=130). Qualitative data including interviews, observations and document analysis were used to characterize the Lean implementation and context. Based on this, expected teamwork change patterns were documented and tested with GDQ-data through linear regression analysis.

    Findings: At Ward-I, Lean implementation was successful and teamwork improved. At Ward-II, Lean was partially implemented and teamwork improved slightly, while both Lean and teamwork deteriorated at the emergency department (ED). The regression analysis was significant at Ward-II (p=.02) and the ED (p=.04), but not at Ward-I (p=.11).

    Practical implications: Developing expected changes based on theoretically derived assumptions and qualitative data may make it possible to detect the results of a complex change. Overall, Lean may have some impact on teamwork, if properly implemented. However, this impact may be more prominent in relation to structural and productivity issues of teamwork than group members’ relational issues. Also, effects of Lean on teamwork may differ depending on the teams’ initial stage of teamwork. Practitioners should note that, with groups struggling with initial stages of teamwork, Lean may be very challenging.

    Originality/value: This study focused specifically on implications of Lean for nurse teamwork in hospital setting using both qualitative and quantitative data.

  • 177.
    Ulin, Kerstin
    et al.
    Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Nygårdh, Annette
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    What is known about the benefits of patient-centered care in patients with heart failure2015In: Current Heart Failure Reports, ISSN 1546-9530, E-ISSN 1546-9549, Vol. 12, no 6, p. 350-359Article, review/survey (Refereed)
    Abstract [en]

    Treatment for chronic heart failure (CHF) has improved, and symptom burden has been identified as an important treatment goal. Because patient-centered care may ease the burden, we need to know its benefits for patients with CHF, hence this systematic literature review. We found that one benefit of person-centered care is an increase in quality of life in patients with CHF. Improvements were found in self-care, physical and mental status, health care costs, general uncertainty regarding illness and recovery, patient dignity, treatment, and systems of care. Improvements also were observed in symptom burden, self-efficacy, and quality of life. These findings indicate that person-centered care is a powerful approach to current and future health care. However, because an appropriate tool to measure person-centered care does not yet exist, it will be a challenge to determine whether the goal has been reached from a long-term and patient perspective.

  • 178.
    Unbeck, Maria
    et al.
    Karolinska Institutet.
    Sterner, Eila
    Karolinska Institutet.
    Elg, Mattias
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Linköping University.
    Fossum, Bjöörn
    Sophiahemmet University College.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Karolinska Institutet.
    Pukk Härenstam, Karin
    Karolinska Institutet.
    Design, application and impact of quality improvement 'theme months' in orthopaedic nursing: A mixed method case study on pressure ulcer prevention2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 4, p. 527-535Article in journal (Refereed)
    Abstract [en]

    Background: While there is growing awareness of quality problems in healthcare systems, it remains uncertain how best to accomplish and sustain improvement over time.

    Objective: To report on the design and application of quality improvement theme months in orthopaedic nursing, and evaluate the impact on pressure ulcer as an example.

    Design: Retrospective mixed method case study with time series diagrams.

    Setting: An orthopaedic department at a Swedish university hospital.

    Method: The interventions were led by nursing teams and focused on one improvement theme at a time in two-month cycles, hence the term 'improvement theme months'. These included defined objectives, easy-to-use follow-up measurement, education, changes to daily routines, "reminder months" and data feedback. The study draws on retrospective record data regarding one of the theme topics, pressure ulcer risk assessment and prevalence, in 2281 orthopaedic admissions during January 2007-October 2010 through point prevalence measurement one-day per month. Data were analysed in time series diagrams and through comparison to annual point prevalence data from mandatory county council-wide measurements prior to, during and after interventions from 2003 to 2010. By using document analysis we reviewed concurrent initiatives at different levels in the healthcare organisation and related them to the improvement theme months and their impact.

    Results: The 46 monthly point prevalence samples ranged from 28 to 66 admissions. Substantial improvements were found in risk assessment rates for pressure ulcers both in the longitudinal follow-up (p<0.001) and in the annual county council-wide measurements. A reduction in pressure ulcer rate was observed in the annual county council-wide measurements. In the longitudinal data, wider variation in the pressure ulcer rate was seen (p<0.067); however, there was a significant decrease in pressure ulcer rates during the final ten-month period in 2010, compared to the baseline period in 2007 (p=0.004). Improvements were moderate the first years and needed reinforcement to be maintained.

    Conclusions: The theme month design and the way it was applied in this case showed potential, contributing to reduced pressure ulcer prevalence, as a way to conduct quality improvement initiatives in nursing. For sustainable improvement, multi component interventions are needed with regular monitoring and reminder efforts.

  • 179.
    Unné, Anna
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Smärtskattning 0 -ett värde i sig.: Ett förbättringsarbete som synliggör skillnad mellan det som sägs och görs utifrån evidensbaserade smärthanteringsrutiner inom palliativ vård.2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 180.
    Vackerberg, Nicoline
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Så snidar vi en förbättringscoach: en fallstudie av ett lokalt coachprogram2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Internal improvement coaches can support quality improvement efforts. The study is about a local interprofessional coach training program in a region in Sweden with an established culture of collaboration. The program included participants from different health care disciplines and was organized over eight days between March and October 2011. A senior citizen was involved in faculty and participated during all training sessions. The participants were introduced to basic improvement knowledge and a solution focused approach.Purpose: To explore essential elements of a local coach training program and what appears to be crucial in moving into the role of being an improvement coach.Method: The study is a mix methods case study with elements of action research and an inductive qualitative approach. Participants in the study were prospective coaches, senior citizens, the program team, and experienced coaches. Data were collected through seven semi-structured group interview sessions with a total of 17 individuals, document analysis and 4 questionnaires. Data were analyzed using a manifest content analysis and triangulation. The results were validated by all participants in the study.Results: The data suggest that the involvement of a senior citizen was essential for strengthening customer focus. Participants in the study pointed out that customer focus, developing a value base, networking skills with a solution focused approach and systems thinking were fundamental to the development of the coaching role. These factors were assessed as more important than improvement tools.Discussion: The results can be divided into those which encouraged ideas, will, execution, and endurance. Senior citizen involvement enhanced customer focus and the solution-focused approach seems to be a valuable addition to the usual improvement tools. It would be interesting to compare this program with other improvement programs or in other contexts.

  • 181.
    Vackerberg, Nicoline
    et al.
    Jönköping University, The Jönköping Academy for Improvement of Health and Welfare.
    Norman, AnnCharlott
    Jönköping University, The Jönköping Academy for Improvement of Health and Welfare. Linnéuniversitetet.
    Jutterdal, Stefan
    Thor, Johan
    Jönköping University, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare. Karolinska Institutet.
    Utveckling och förbättringsarbete är ömsesidigt beroende och berikande2015In: Att lära och utvecklas i sin profession / [ed] Gabriele Biguet, Ingrid Lindquist, Cathrin Martin, Anna Pettersson, Lund: Studentlitteratur AB, 2015, p. 169-185Chapter in book (Other academic)
  • 182.
    Vejklint, Mattias
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Mot målen med missbruksvården: En studie av förbättringsarbete rörande bedömning och systematisk uppföljning till nytta för individ och organisation i 13 kommuner2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    BackgroundSocial services do not have registers for monitoring quality. Without knowledge of what interventions the social services provide already exposed groups risk missing follow-up and improvement of care and support.

    Purpose

    Improved life situation for individuals in social services addiction care through systematic follow-up. Increase the use of Addiction Severity Index (ASI) to monitor and improve social services. Identify factors that contribute to or hamper the use of ASI.

    Method

    A program theory was developed. The improvement work was studied with a mixed method. Quantitative data with time series analysis and qualitative data with thematic analysis. Results was analysed through Model for implementation in different contexts.

    Results

    The use of ASI interviews increased but did not reach the targets. The study of the improvement gives few answers to what affects the use of ASI. Stronger coupling of factors with a negative impact on ASI usage than positive impact.

    Conclusion

    Improvement in multiple areas increased use of ASI. Improvement can be carried out simultaneously in 13 municipalities in a county. There is interest in simplified ASI interviews, but the trial did not provide evidence to draw conclusions. The study shows factors that affect the use of ASI, but that there is a need for more studies to generalize conclusions.

  • 183.
    von Plessen, Christian
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Lunge- og infektionsmedicinsk Afdeling, Hillerød hospital.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Der kan skabes patientsikkerhed i kliniske mikrosystemer2012In: Ugeskrift for læger, ISSN 0041-5782, E-ISSN 1603-6824, Vol. 174, no 45, p. 2780-2784Article in journal (Refereed)
    Abstract [en]

    Patients, health-care professionals and the public expect safe health care. The system, however, is not safe and patients are being harmed. Workplace and organizational conditions and human factors contribute to these harms and a system approach is needed to avoid them. In clinical microsystems (CMS), the frontline units of health care, staff and patients can make care safer by learning about their system, its processes, members and purposes. Approaches from patient safety should be integrated in the daily work of every member of the CMS to reduce risk, implement safe practices and learn from errors. We summarize methods for use in CMS and offer ideas for fostering a proactive culture of patient safety.

  • 184.
    von Plessen, Christian
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Säkrare vård - från teori till praktik i det kliniska mikrosystemet2012In: Kvalitetsarbete för bättre och säkrare vård / [ed] Gun Nordström, Bodil Wilde Larsson, Lund: Studentlitteratur AB, 2012, p. 49-68Chapter in book (Other academic)
  • 185.
    von Sivers, Ulrika
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Reflektion med hjälp av gröna korset ökar medvetande om patientsäkerhetsarbete: Studie av förbättringsarbete på akutvårdsavdelningen, medarbetares upplevelse av att tillämpa gröna korset.2019Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
  • 186.
    Vrang, Sophie
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Implementering av evidensbaserad omvårdnad hos fallriskpatienter genom standardiserade omvårdnadsplaner - en fallstudie2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Presently, falls account for a major national healthcare problem, which apart from the patient’s own suffering, brings costs of about 5 billion SEK annually for municipalities and regions. Research shows that an early risk assessment together with adherence to evidence based actions for fall prevention is necessary to counter this problem. Making standardized nursing care plans (SVP) for patients is in line with the nursing process. Some studies have focused on nurses’ experience and motivation to use SVP, but little research has focused on how the implementation process promote nurses learning process in relation to performance.

     

    Purpose: The aim of the improvement work was to practice evidence based nursing to prevent fall injuries and the purpose of the research was to evaluate the implementation process from a nurse’s learning- and development perspective.

     

    Method: A project group managed the intervention through 8 activities using established quality improvement methods and tools such as the PDSA-wheel and Nolans’ three questions. During a period of 6 months, the journals of 10 random patients records were reviewed two times each month to identify and map risk, implementation and adherence to the SVP. Data were analyzed with descriptive statistics. To illuminate learning in relation to the implementation process, nine nurses were interviewed,, using directed content analysis as the method. 

     

    Findings: During the period of study, both the portion of early fall risk assessments and created SVP increased. However, adherence cannot yet be seen as an improvement trend. Training, the change manager and a reminder-system were seen as most important during implementation. A simple manual and feedback of results were seen as the least important implementation factors. Time, workload, attitude and a lack of a common vision among the nursing staff were seen as the largest challenges. From a patient perspective, the benefits identified were improved patient safety, “right from the start”, early preventive actions on risk patients, collective awareness and equal care for all patients.

     

    Conclusion: An implementation taking consideration to quality improvement and activities has generated an increase in risk assessments and an increased proportion of fall risk patients with an established SVP containing evidence based nursing actions. However, this study could not verify that the identified actions were carried through. During the period and with the sample of the study, no clear relation between implementation of SVP and a reduction in fall injuries could be proven. The method of interviewing nurses about their learning and development process, prerequisites and experienced effects has provided good insights and knowledge for use in future improvement and implementation work.

     

    Keywords: evidence based nursing, fall prevention, quality improvement, implementation, learning

  • 187.
    Wagman, Petra
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Björklund, Anita
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Håkansson, Carita
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Occupational balance as used in occupational therapy: A concept analysis2012In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 19, no 4, p. 322-327Article in journal (Refereed)
    Abstract [en]

    Occupational balance is a frequently used concept in occupational therapy, but it is complex and differences in content exist. Further knowledge would be valuable for scholars, practitioners, and measurement development. Concept analysis is a way to clarify concepts. The present concept analysis used Walker and Avant's procedure for analysing the concept of occupational balance, with 43 articles included in the analysis. The results showed that occupational balance can be defined as the individual's perception of having the right amount of occupations and the right variation between occupations. Three perspectives of occupational balance were identified: in relation to occupational areas, in relation to occupations with different characteristics, and in relation to time use. The knowledge gained may guide the use of the concept, and some suggestions are made for its use and for further research.

  • 188.
    Wagman, Petra
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Håkansson, Carita
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Jacobsson, Christian
    Department of Psychology, University of Gothenburg, Sweden.
    Falkmer, Torbjörn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Björklund, Anita
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    What is considered important for life balance? Similarities and differences among some working adults2012In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 19, no 4, p. 377-384Article in journal (Refereed)
    Abstract [en]

    Life balance seems subjective, health related, and multidimensional. However, the concept is complex. Exploring what people themselves consider more or less important for their life balance and whether this differs between people would develop new knowledge. Q methodology was chosen for the present study, in which 32 working men and women without recent long-term sick leave participated. They sorted 42 statements regarding life balance according to their importance for each participant's life balance. The analysis resulted in four different viewpoints concerning life balance. All four viewpoints considered good relationships with those closest to them, as well as knowing that these people were doing well, as important. Each viewpoint also showed a unique orientation towards what was considered important for life balance: occupational balance (viewpoint 1), self-actualization (viewpoint 2), self-awareness (viewpoint 3), and reciprocal relationships (viewpoint 4). The results. showed support for life balance as being a subjective, multidimensional, and health-related phenomenon. The results demonstrated the importance of relationships for life balance and heterogeneity in what people considered important for their own life balance.

  • 189.
    Wagman, Petra
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Håkansson, Carita
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Matuska, Kathleen
    Björklund, Anita
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Falkmer, Torbjörn
    Validating the model of lifestyle balance on a working Swedish population2012In: Journal of Occupational Science, ISSN 1442-7591, E-ISSN 2158-1576, Vol. 19, no 2, p. 106-114Article in journal (Refereed)
    Abstract [en]

    An analysis of data from a previously conducted grounded theory study exploring perceptions of life balance among 19 working adults without recent long term sick leave was carried out. The aim of this secondary analysis was to use these perceptions of life balance to validate the Model of Lifestyle Balance proposed by Matuska and Christiansen. For the validation, a matrix was used. The results showed that Matuska and Christiansen's five need-based dimensions were represented by the participants’ perceptions of life balance, but also an additional aspect not included in the model. The participants stressed healthy habits in relation to sleep, exercise and eating, and good relationships as important for life balance. Furthermore, it was described as important to perceive sufficient challenge and meaningfulness in their occupations and to organize time and energy. Finally, the participants stressed financial security as important for life balance. These findings provide additional evidence of the validity of the Model of Lifestyle Balance, a model that appears to be useful in occupational science.

  • 190.
    Waller, Katarina
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    I eHälsotjänsternas tjänst.: En studie av användningen av Mina vårdkontakter på en barnmorskemottagning2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 191.
    Wieslander, Inger
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Women’s recovery after a first myocardial infarction from an organisational, a relational and an individual perspective2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to explore and describe women’s recovery after a first myocardial infarction (MI) from an organisational, a relational and an individual perspective. In this thesis a longitudinal, explorative and descriptive design combining both quantitative (papers I-II) and qualitative (papers III-IV) methods has been used. Data was collected from healthcare professionals at 18 acute hospitals (paper I), which on two occasions answered a questionnaire dealing with cardiac rehabilitation efforts. From these 18 hospitals, 240 women who had suffereda first MI (paper II) were consecutively chosen to answer a questionnaire on three occasions on the subject of social support and social network. Descriptive and inferential statistics were used to analyse data over time. Paper III and IV had an exploratory and descriptive design based on an inductive, qualitative content analysis approach. Interviews were conducted with 20 cardiac rehabilitation nurses (CRN) (paper III) and with 26 women suffering a first MI (paper IV).

    The results showed that patients with MI, and their next of kin, were offered a well-functioning cardiac rehabilitation on both measurement occasions. None of the hospitals offered a CRP that was specifically designed for women (paper I). The women perceived that the extent of general support, support from relatives, and professional support changed positively over time (paper II). The CRNs experienced that women’s recovery was influenced by their ability to cope with the stresses of life, if they wanted to be involved in their own personal care and how they related to themselves, and their opportunities to receive support (paper III). Women experienced that ability to approach the new perspective of life depended on how they embraced the three dimensions; behaviour, i.e. women’s acting and engaging in various activities, social i.e. how women receive and give support in their social environment, and psychological i.e. their way of thinking, reflect and appreciate life (paper IV).

    In conclusion, the four studies show that women’s recovery after a first MI is depending on factors emerging from an organisational, a relational and an individual perspective. Using knowledge from these three perspectives the possibility of a holistic approach to women’s recovery process to health will increase and the risk of a reductionist thinking will decrease.

  • 192.
    Wiig, Siri
    et al.
    Department of Health Studies, University of Stavanger, N-4036 Stavanger, Norway.
    Aase, Karina
    Department of Health Studies, University of Stavanger, N-4036 Stavanger, Norway.
    von Plessen, Christian
    Department of Health Studies, University of Stavanger, N-4036 Stavanger, Norway.
    Burnett, Susan
    Imperial College, London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK.
    Nunes, Francisco
    ISCTE, Lisboa, Instituto Superior de Ciências do Trabalho e da Empresa (ISCTE), Av.ª das Forças Armadas, Lisbon 1649-026, Portugal.
    Weggelaar, Anne Marie
    Department of Health Policy and Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Calltorp, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Fulop, Naomi
    Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
    Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, no 478, p. 1-12Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study.

    METHODS:

    This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics).

    RESULTS:

    The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided.

    CONCLUSION:

    The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.

  • 193.
    Winberg, Anette
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Användbar och tillgänglig webbkatalog för habiliteringens kursutbud: Ett förbättringsarbete för tillgänglig webbkatalog och en studie av vilka faktorer som har betydelse för hur den används2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background

    Knowledge about one's current disability and its consequences makes everyday life easier. The habilitation center offers approximately fifty courses each semester. The program was recently digitized which decreased costs and administration time and expected to increase accessibility and user-friendliness. Target groups and staff experienced the opposite.

    Purpose

    The QI-project aimed to improve the availability to the courses by making the e-catalogue more accessible and user-friendly.

    This study aimed to describe the staff's perception of the factors affecting the functioning of the e-catalogue at a micro, meso and macro level. The study was delimited to include the business perspective.

    Method

    The improvement ramp and the model of improvement. Focus interviews was analyzed with qualitative content analysis and linked to micro, meso and macro level with The Clinical Adoption Framework (CAF) as a theoretical reference frame.

    Results

    The QI-project didn't meet its objectives in full. The content analysis identified six factors at micro and meso level.

    Conclusions 

    For a digital tool to be perceived as useful, knowledge about the organization and its processes at a micro level is required, so that the right conditions and support can be given at a meso level.

  • 194.
    Åkerman, Eva
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Ersson, Anders
    Skåne University Hospital, Department of Intensive Care Medicine in Malmö, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Samuelson, Karin
    Division of Nursing, Department of Health Sciences, Lund University, Lund, Sweden.
    Preferred content and usefulness of a photodiary as described by ICU-patients-A mixed method analysis2013In: Australian Critical Care, ISSN 1036-7314, E-ISSN 1878-1721, Vol. 26, no 1, p. 29-35Article in journal (Refereed)
    Abstract [en]

    Many ICU-patients have memory-gaps which may affect their recovery. A tool in the recovery can be an ICU-diary to explain and clarify thoughts and events from the ICU-period. There are different standards for the content in the ICU-diary. The aim of this study was to identify the preferred content and usefulness of an ICU-diary as described by ICU-patients.

    Method: a descriptive, exploratory cohort design with a mixed method approach. The patients answered a questionnaire (n=115) and participated in an interview (n=15) six months after the ICU-stay. Data analysis was carried out in three stages; the questionnaire was analysed by descriptive statistics and categorized by content (four open-ended questions) and the interviews were analysed by manifest content analysis.

    Results: The patients explained that detailed information about daily activities and medical facts had to be included to understand and give a sense of coherence of what had happened. The content in the ICU-diary had to be chronological in order to follow the process in which photos were an important part. The patients re-read the ICU-diary during the recovery which helped them to fill in the memory gaps and used it as a tool for communication.

    Conclusion; To construct a coherent story, it was essential that the ICU-diary was complete and were amplified by photos, all appearing in a chronological order. The results of this study could form a basis for further developments of standards and guidelines for ICU-diaries

  • 195.
    Åkerman, Eva
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Samuelson, Karin
    Baigi, Amir
    Ersson, Anders
    Psychometric evaluation of 3-set 4P questionnaire2013In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 29, no 1, p. 40-47Article in journal (Refereed)
    Abstract [en]

    This is a further development of a specific questionnaire, the 3-set 4P, to be used for measuring former ICU patients’ physical and psychosocial problems after ICU and the need for follow-up. The aim was to psychometrically test and evaluate the 3-set 4P questionnaire in a larger population. The questionnaire consists of three sets: “physical”, “psychosocial” and “follow-up”. The questionnaires were sent by mail to all patients with >24 hour length of stay at four ICUs in Sweden. Construct validity was measured with exploratory factor analysis with varimax rotation resulting in “physical set” three factors, “psychosocial set” five factors and “follow-up set” four factors with strong factor loadings and a total explained variance of 62 - 77.5%. Thirteen questions in the SF-36 were used for concurrent validity showing Spearman’s rs 0.3-0.6 in eight and <0.2 in five questions. Test-retest was used for stability reliability. In set follow-up the correlation was strong to moderate and in physical and psychosocial sets the correlations were moderate to fair. This could be due to that the physical and psychosocial status changed rapidly during the test period. All three sets had good homogeneity. In conclusion, the 3-set 4P showed overall acceptable results, but it has to be further modified in different cultures before being an instrument which may be fully operational in clinical practice.

     

  • 196.
    Ödman, Linda
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Ge barnen tid!: En studie av ett förbättringsarbete för ökad tillgänglighet till barnpsykiatriska utredningar genom samordnat processflöde.2016Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [sv]

    Reducerad väntetid till barnpsykiatrisk vård är ett prioriterat område då försenad vård har negativ inverkan på barns liv och hälsa.

    Syftet med förbättringsarbetet: Ökad tillgänglighet till barnpsykiatrisk utredning samt sammanhållen utredningstid med stöd av förbättringsmetoder.

    Syftet med studien: Beskriva användarnas, utredningsteamets, upplevelser av införandet av samordnat tvärprofessionellt processflöde för barnpsykiatrisk utredning.

    Förbättringsarbetet genomfördes med stöd av förbättringsmetoder. Förbättringsidén utgörs av ett tvärprofessionellt samordnat processflöde, där barnpsykiatrisk utredning skall vara planerad, genomförd och återlämnad inom fem veckor.

    Studiens metod: Kvalitativ och utgörs av fokusgruppsinterjuver.

    Resultat: Samordnat processflöde medförde att 93 % av patienterna utreddes inom regionala riktlinjers rekommenderade 120 dagar. Väntetiden reducerades från 9 till 4 månader efter utgången vårdgaranti. Utredningslängd minskade från bakgrundsmätnings 236 dagar till 48 dagar. Studien visar att samordnat utredningsschema kräver tvärprofessionell samordning, delaktiga medarbetare, lärande organisation, styrande, stödjande och delegerat ledarskap samt att omkringliggande system är effektiva. Systemet är sårbart och arbetsmiljön belastas.

     

    Slutsats: Samordnat tvärprofessionellt processflöde ökade tillgänglighet till barnpsykiatriska utredningar samt sammanhållen utredningstid. Tvärprofessionell samordning, implementering av förbättringskunskap, lärande organisation, involverade och delaktiga medarbetare, effektiv organisation samt ett styrande, stödjande och delegerat ledarskap är avgörande faktorer för processens görlighet. Processflödet var sårbart för yttre faktorer. Upplevelsen var att arbetsmiljön belastas.

  • 197.
    Öhrn, Mona
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hemsjukvård för barn ‒ föräldrars upplevelser med fokus på delaktighet2014Independent thesis Advanced level (degree of Master (Two Years)), 180 HE creditsStudent thesis
    Abstract [en]

    Home care services for children

    ‒ parents experiences focusing on participation in care

     

    Background

    Previous studies about hospital- and community-based home care for children shows that it is safe, cost efficient and preferable by parents. Studies have been done about parent´s participation in care at hospitals but not in the home care setting. In Sweden not all children have access to home care services. The quality improvement intervention, to increase access to home care services took place at a children´s clinic at a county hospital in southern Sweden.

     

    Aim

    The purpose of the improvement effort was to enhance home care for children by the means of identifying children at the hospital who were suitable for offering the service.

    The purpose of the study was to investigate how parents experiences home care service for children in terms of participation in the child´s care and decision-making regarding it.

     

    Methods

    Eight interviews were carried out with ten parents of children that had received home care during the period from March 2013 to February 2014. The interviews focused on experiences primarily regarding parents participation in the child´s care and decision-making, and were semi-structured. The content was transcribed verbatim and analyzed by using qualitative content analysis with an inductive approach.

     

    Results

    During November 2013 to April 2014 seventeen children were identified as suitable for home care and eleven of them actually received home care service. This was an increase from the previous 6 month, when four children received the service.

    The three themes and nine subthemes that emerged, describing parent´s experiences, showed that they felt they had good communication with doctors and staff, they experienced involvement in care and decision-making, and that the best of the whole family was prioritized.

     

    Conclusions

    Parents felt that home care was invaluable in terms of being able to live a normal life, for the family as a hole. The result supports a person-centered care approach and emphasizes the equal dialogue as a tool. Further studies are needed to enlighten children´s own experiences about home care, participation in their own treatment and decision-making regarding care form.

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