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  • 201.
    Ulhassan, Waqar
    et al.
    Medical Management Centre, Karolinska Institutet.
    Schwarz, Ulrica von Thiele
    Medical Management Centre, Karolinska Institutet.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University.
    Sandahl, Christer
    Medical Management Centre, Karolinska Institutet.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Medical Management Centre, Karolinska Institutet.
    How visual management for continuous improvement might guide and affect hospital staff: A case study2015In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 24, no 4, p. 222-228Article in journal (Refereed)
    Abstract [en]

    Visual management (VM) tools such as whiteboards, often employed in Lean thinking applications, are intended to be helpful in improving work processes in different industries including health care. It remains unclear, however, how VM is actually applied in health care Lean interventions and how it might influence the clinical staff. We therefore examined how Lean-inspired VM using whiteboards for continuous improvement efforts related to the hospital staff's work and collaboration. Within a case study design, we combined semistructured interviews, nonparticipant observations, and photography on 2 cardiology wards. The fate of VM differed between the 2 wards; in one, it was well received by the staff and enhanced continuous improvement efforts, whereas in the other ward, it was not perceived to fit in the work flow or to make enough sense in order to be sustained. Visual management may enable the staff and managers to allow communication across time and facilitate teamwork by enabling the inclusion of team members who are not present simultaneously; however, its adoption and value seem contingent on finding a good fit with the local context. A combination of continuous improvement and VM may be helpful in keeping the staff engaged in the change process in the long run.

  • 202.
    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.

  • 203.
    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.

  • 204.
    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.

  • 205.
    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
  • 206.
    Vackerberg, Nicoline
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Levander, Märta Sund
    Department of Medical and Health Sciences, Division of Nursing, Faculty of Medicine and Health Sciences, Linköping University, Sweden.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    What is best for Esther? Building improvement coaching capacity with and for users in health and social Care-A case study2016In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 25, no 1, p. 53-60Article in journal (Refereed)
    Abstract [en]

    While coaching and customer involvement can enhance the improvement of health and social care, many organizations struggle to develop their improvement capability; it is unclear how best to accomplish this. We examined one attempt at training improvement coaches. The program, set in the Esther Network for integrated care in rural Jonkoping County, Sweden, included eight 1-day sessions spanning 7 months in 2011. A senior citizen joined the faculty in all training sessions. Aiming to discern which elements in the program were essential for assuming the role of improvement coach, we used a case-study design with a qualitative approach. Our focus group interviews included 17 informants: 11 coaches, 3 faculty members, and 3 senior citizens. We performed manifest content analysis of the interview data. Creating will, ideas, execution, and sustainability emerged as crucial elements. These elements were promoted by customer focusembodied by the senior citizen trainershared values and a solution-focused approach, by the supportive coach network and by participants' expanded systems understanding. These elements emerged as more important than specific improvement tools and are worth considering also elsewhere when seeking to develop improvement capability in health and social care organizations.

  • 207.
    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)
  • 208.
    Vale, Maria do Carmo
    et al.
    Pediatric Neurodevelopment Unit, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
    Pereira-da-Silva, Luıs
    Woman, Children and Adolescent’s Medicine Teaching and Research Area, NOVA Medical School of Lisbon, Universidade Nova de Lisboa, Lisbon, Portugal.
    Pimentel, Maria João
    Pediatric Neurodevelopment Unit, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
    Marques, Teresa Nunes
    Early Intervention Program Regional Lisbon Area, Ministry of Social Security and Solidarity, Portugal.
    Rodrigues, Helena
    Department of Special Education, Ministry of Education and Science, Portugal.
    Cunha, Gilda
    Department of Exact Science, Lisbon School of Health Technology, Lisbon, Portugal.
    Machado, Maria do Céu
    Department of Pediatrics, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal.
    Sanches-Ferreira, Manuela
    Special Education Department, School of Education, Porto Polytechnic, Porto, Portugal.
    Simeonsson, Rune J.
    Jönköping University, School of Education and Communication, HLK, CHILD. School of Education, University of North Carolina, Chapel Hill, NC, USA.
    Classifying Functioning of Children and Adolescents with Intellectual Disability: The Utility of the International Classification of Functioning, Disability and Health for Children and Youth2017In: Journal of Policy and Practice in Intellectual Disabilities, ISSN 1741-1122, E-ISSN 1741-1130, Vol. 14, no 4, p. 285-292Article in journal (Refereed)
    Abstract [en]

    Observational cross-sectional study carried out in a pediatric neurodevelopment unit of a tertiary-care hospital. A sample of 355 children with median ((min.–max.) 1.0–17.3) years with intellectual disability (30.4% borderline, 43.1% mild, 19.7% moderate, 5.1% severe, and 1.7% profound disability) was seen over a period of 3 years. Based on clinical observation and psychological evaluation, a neurodevelopmental pediatrician selected ICF-CY body functions codes, and respective qualifiers, to effectively describe functioning of children. Based on evaluation reports, a psychologist and a special educator assigned the previously chosen ICF-CY body functions codes to 139 and 67 children, respectively. Inter-rater agreement was estimated using simple and weighted Cohen's kappa coefficients and Gwet's AC1 statistic and Gwet's weighted kappa coefficient statistic. A set of eight ICF-CY codes was identified as efficiently describing impairments of body functions of children with intellectual disability: global mental functions b117 and b122; specific mental functions b147, b163, b164, and b167; and voice and speech functions b320 and b330. Results indicate a correspondence between the level of severity of qualifiers assigned to ICF-CY codes and the level of intellectual disability. Inter-rater agreement was variable among raters, with the best agreements found for qualifying intellectual functions (b117) and psychomotor functions (b122). A profile of eight ICF-CY codes effectively describes functioning of children with intellectual disability, providing an alternative to medically based classification, based on diagnoses with functionally based classification of children's characteristics. The findings contribute to define a comprehensive set of codes to reliably record individual differences of functioning in this population.

  • 209. Vilaseca, J
    et al.
    Dedeu, T
    de Graaf, P
    Hobbs, R
    Muth, C
    Mårtensson, Jan
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
    López-Alcázar, M
    Scherer, M
    Chronic heart failure: the role of primary care: position paper of the European Forum for Primary Care2008In: Quality in Primary Care, ISSN 1479-1072, E-ISSN 1479-1064, Vol. 16, no 5, p. 351-362Article in journal (Refereed)
  • 210.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, Jönköping International Business School, JIBS, Centre for Information Technology and Information Systems (CenITIS). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Linköping University, Linköping, Sweden.
    E-health two-sided markets: Implementation and business models2016Collection (editor) (Refereed)
    Abstract [en]

    E-health two-side Markets: Implementation and Business Models presents empirical models and suggestions that focus on how to remove barriers to deliver online services across borders and how actual barriers affect business models in a two-sided market with regard to eHealth. Technological innovation and business developments in online trade result in fast-evolving markets with the continuous emergence of new products and services, thus requiring a specific approach. This book discusses how to develop innovative and cost-effective implementation strategies for complex organizations, the importance of barriers and facilitators for two-sided markets when implementing e-health services and/or IT based innovations, which pre-requisites have to be achieved in complex organizations that act in two-sided markets when implementing e-services, the ecosystem for implementation of services and innovations in complex organizations, and its effects for business models. This book is a valuable source for researchers in medical informatics, and is also ideal for stakeholders, consultants, advisors, and product designers involved in eHealth services. Presents guidelines that can be used as examples of pros and cons in two-side markets. Provides knowledge that enables readers to identify the changes that need to be considered in budget proposals for eHealth implementation. Includes examples of business models applied in two-side markets, diminishing external effects and failures.

  • 211.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, Jönköping International Business School, JIBS, Centre for Information Technology and Information Systems (CenITIS). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Linköping University, Linköping, Sweden.
    The future of two-sided e-health markets2016In: E-health two-sided markets: Implementation and business models / [ed] Vivian Vimarlund, Elsevier, 2016, p. 189-195Chapter in book (Refereed)
    Abstract [en]

    The two-sided e-health market is rapidly becoming fundamental for health and social care. Worldwide many different steps have been taken to increase the engagement of consumers with e-health, mainly focusing in the development of novel digital services that increase well-being or tackle some social challenges, such as the lack of qualified personnel, or dwindling resources. At the same time, some effort is also spent on establishing a market in which both sides-e-health consumers and providers-can interact and benefit from with each other (Connell and Young, 2007). In this sideline, there has been a great ambition to introduce "service innovation," "design thinking," and other tenors of the service-dominant logic (Vargo and Lusch, 2008) to open up for new collaborations between private and public actors. Intermediary platforms, provided by regional or national authorities (Aanestad and Jensen, 2011) or private actors such as insurance companies (Scott et al., 2006), become a key coordination infrastructure that allows information to flow within and between the two sides of the market, regulating nontransaction activities and making decisions that determine which group receives support and in which manner, and which kind of price structure will exist to stimulate the two sides to become an active actor of the market.

  • 212.
    Vimarlund, Vivian
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, Jönköping International Business School, JIBS, Centre for Information Technology and Information Systems (CenITIS). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Linköping University, Linköping, Sweden.
    Mettler, T.
    University of Lausanne, Lausanne, Switzerland.
    Business models in two-sided markets (analysis of potential payments and reimbursement models that can be used)2016In: E-health two-sided markets: Implementation and business models / [ed] Vivian Vimarlund, Elsevier, 2016, p. 173-185Chapter in book (Refereed)
    Abstract [en]

    Business models play an important role in establishing sustainable intermediary platforms for e-health services in two-sided markets. In this chapter, we describe different types of business models and potential revenue and reimbursement schemes based on the Swedish HealthForMe platform. In doing so, we also discuss many of today's open questions and challenges to be addressed by intermediaries operating in two-sided e-health markets. We conclude this chapter by providing an overview of key implications and success factors for owners of such intermediary platforms, and offer an outlook to focal research areas within the context of business models for two-sided markets.

  • 213.
    Vimarlund, Vivian
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, Jönköping International Business School, JIBS, Centre for Information Technology and Information Systems (CenITIS). Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Linköping University, Linköping, Sweden.
    Mettler, T.
    University of Lausanne, Lausanne, Switzerland.
    Introduction to the ecosystem for two-sided markets, barriers and facilitators2016In: E-health two-sided markets: Implementation and business models / [ed] Vivian Vimarlund, Elsevier, 2016, p. 3-15Chapter in book (Other academic)
    Abstract [en]

    Two-sided markets arise in situations in which there are externalities and in which transaction costs, broadly considered, prevent the two sides from solving this externality directly. In the e-health market, the expansion of the Internet economy has shown to be significant in stimulating the entry of business organizations, many of which are already in two-sided markets.An e-health two-sided market needs to offer sustainable structures, i.e., an ecosystem to support a flexible model that must meet unexpected demand and at the same time be able to handle high demand peaks and long periods if needed. In this chapter we introduce key concepts and factors that are of relevance in two-sided markets. We further discuss the fundamental role of two-side market ecosystem in enabling parties to realize gains from trade or other interactions by reducing the transactions costs of finding each other and interacting. Hence, e-health market ecosystems first and foremost need to be designed for adaptability and network effects. We discuss issues that influence the sustainability and further development of a two-sided e-health market.

  • 214.
    von Plessen, Christian
    et al.
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Syddansk universitet.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Säkrare vård - från teori till praktik i det kliniska mikrosystemet2017In: Kvalitetsarbete för bättre och säkrare vård / [ed] Anne-Marie Boström, Gun Nordström, Bodil Wilde Larsson, Lund: Studentlitteratur AB, 2017, 2, p. 57-77Chapter in book (Other academic)
  • 215.
    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)
  • 216.
    Wagman, Petra
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Björklund, Anita
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Johansson, Ann
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Fristedt, Sofi
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Descriptions of health by EU citizens begging abroad2017In: Society, health and vulnerability, E-ISSN 2002-1518, Vol. 8, no 1, article id 1389586Article in journal (Refereed)
    Abstract [en]

    Poor citizens from European Union (EU) member countries begging to support themselves are now common in affluent EU countries. Their lack of basic amenities, such as access to a shelter and sanitation is not in line with human rights and also implies a risk for health issues. Despite this, we know little about how these vulnerable EU citizens, themselves, perceive their health situation. The aim of this study was to explore vulnerable EU citizens’ descriptions of their health. Eight females and 12 males from Romania, 19–64 years of age, participated in individual interviews that included health issues. Qualitative content analysis was used, identifying the main category “Begging abroad and health - for better and for worse” together with two categories and five subcategories. It is concluded that EU citizens begging abroad risk poorer health as a consequence of their attempts to improve their situation, both their own health and that of their relatives. Therefore, they need access to affordable health care as this may decrease the need for unwanted travelling abroad to beg.

  • 217.
    Wahl, Karina
    Jönköping University, The Jönköping Academy for Improvement of Health and Welfare.
    Förbättringsförslag identifierade efter tvärprofessionell teamträning av urakut kejsarsnitt.: En empirisk, kvalitativ studie2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Förlossningssituationen är ett prioriterat område när det gäller patientsäkerhet, där fel kan få stora konsekvenser. Jönköpings län har svaga resultat när det gäller dödfödda barn och barn med låga APGAR poäng (en bedömning av barnets vitalitet). Vid urakuta kejsarsnitt finns det minst två patienter och oftast en partner. Medarbetare från tre kliniker med olika fokus ska samarbeta i en miljö där flera inte har sin ordinarie arbetsplats. Tvärprofessionell teamträning kan vara en möjlighet för att öka patientsäkerheten.

     

    Syftet med förbättringsarbetet var att förbättra medarbetarnas förmåga att hantera urakut kejsarsnitt, samt att testa användbarheten av simulerad tvärprofessionell teamträning.

     

    Syftet med studien var att beskriva vårdpersonalens samtal om förbättringar efter tvärprofessionell teamträning. Vilka dimensioner av förbättringsmöjligheter, teman, kategorier och underkategorier framträder?

     

    Metod: Tvärprofessionell teamträning enligt CRM (Crew/Crisis Resource Management) genomfördes vid ett tillfälle med 17 deltagare på ett centrum för klinisk träning och medicinsk simulering, Metodikum.

     

    En empirisk studie med kvalitativ ansats genomfördes där datainsamlingsmetoden var fokusgruppsintervjuer med medarbetare som deltagit vid tvärprofessionell teamträning runt urakut kejsarsnitt. En inledande fokusgruppsintervju och tre uppföljande fokusgrupper tillsammans med två enskilda intervjuer ingick i studien. Materialet analyserades med kvalitativ innehållsanalys.

     

    Resultat: Vid sammanställning av resultatet av förbättringsarbetet skattar deltagarna sin trygghet högre efter tvärprofessionell teamträning vilket indikerar att förmågan att hantera urakut kejsarsnitt förbättras.

     

    Resultatet av studien visar att deltagarna samtalar om flera dimensioner av förbättringar. Centrala förbättringsområden är information till mamman, partnern och mellan personalen och förbättrad kommunikation. Ett övergripande team framträder – Att öka patientsäkerheten, och tre kategorier formuleras – Att förmedla ett budskap, - Att samarbeta, – Teamträning en möjlighet. Deltagarna identifierar förbättringsområden som de inte uppmärksammat om de inte träffats och tränat tillsammans.

     

    Diskussion/Slutsats Tvärprofessionell teamträning är användbart till att öka medarbetarnas trygghet och för att uppmärksamma förbättringsområden. Om identifierade förbättringsförslag ska genomföras i verksamheten behöver någon ansvara för genomförandet.

     

     

     

  • 218.
    Wass, Sofie
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    The importance of eHealth innovations: Lessons about patient accessible information2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Access to digital information and communication has an increasing importance in both the work of healthcare professionals and in patients’ everyday life and has transformed what we do and how we carry out activities. It changes the way in which healthcare is delivered, how information is exchanged within and between organizations and how patients and other actors access and manage information. Currently, innovation is imperative in the healthcare sector and today there is a focus on how different eHealth services can improve healthcare. With increased access to various eHealth services, there is a need to know more about the impact of eHealth innovations on healthcare.

    The aim of this thesis is to acquire more knowledge about eHealth innovations in healthcare. The focus is on prerequisites to realize innovative eHealth services and eHealth services that provide patients with access to health information. The theoretical background addresses innovation, services and business models. This thesis is a compilatory work and includes five qualitative research papers. The first study is an interview study, the second is a literature review and the remaining three are case studies. The data collection consisted of interviews, surveys, workshops and secondary data collected from documents. The interview study and the case studies were performed in the Swedish eHealth setting.

    The research contributes to our understanding of eHealth innovations with insights on prerequisites to realize eHealth innovations and knowledge on patient accessible information. The first study provides a classification of prerequisites that need to be considered to realize innovative eHealth services. When dealing with eHealth services, organizational and sematic interoperability are still a challenge, and they transcend organizational boundaries. This thesis provides knowledge on the recent trend of opening up electronic health records to patients. The knowledge derived from the studies on patient accessible electronic health records show that there is a discrepancy between the perceptions of patients and healthcare professionals. The thesis concludes that patients feel more involved and that the patient-professional relationship improves with patient access to electronic health records, whereas healthcare professionals have concerns about how patients will manage access to health information. This thesis also provides empirical insights on how business models can be represented in a public eHealth setting. By viewing public eHealth services as social innovations, the thesis contributes to the research on business models in a public healthcare setting by incorporating societal value into the representation of the business model.

    The research in this thesis contributes to research in health informatics by discussing issues related to eHealth innovations and patient accessible information. Its practical importance lies in identifying issues that are important when discussing eHealth initiatives and the implications of giving patients online access to their electronic health record.

  • 219.
    Wass, Sofie
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Carlsson, Bertil
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Korkmaz, Seher
    E-health and Strategic IT, Public Health Care Administration, Stockholm County Council, Stockholm, Sweden.
    Shemeikka, Tero
    E-health and Strategic IT, Public Health Care Administration, Stockholm County Council, Stockholm, Sweden.
    Vég, Anikó
    Department of Healthcare Development, Stockholm County Council, Stockholm, Sweden.
    Exploring the effects of eHealth service innovation2015In: Health Systems, ISSN 2047-6965, E-ISSN 2047-6973, Vol. 4, no 3, p. 212-223Article in journal (Refereed)
    Abstract [en]

    To analyse the impact of implementation and use of eHealth services is fraught with difficulty, and there is often a gap between expected and identified outcomes. In this paper, we identify innovation effects of an eHealth service by applying a framework that focusses on the expected coherent impacts of implementing an IT innovation and contributes to the body of knowledge on tracking innovation effects of services in eHealth. A case study examines four different care units in a government-funded health-care setting. The results show that the effects in the first two contexts of the framework, the micro level and intra-/interorganisational level, could be clearly identified with regard to the physicians and the organisation. However, effects were lacking in the virtual context when looking beyond the involvement of the stakeholders in the eHealth service. The connections between effects for societal groups and larger societal systems simply could not be made in a satisfactory manner.

  • 220.
    Wass, Sofie
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, Jönköping International Business School, JIBS, Centre for Information Technology and Information Systems (CenITIS). Linköping University, Linköping, Sweden.
    Business models in public eHealth2016In: 24th European Conference on Information Systems, ECIS 2016, 2016Conference paper (Refereed)
    Abstract [en]

    Several countries develop strategies and policies to foster the use of eHealth services and stress the importance of business models to develop and implement digital services. Previous research on business models has however mostly focused on the private setting or a healthcare setting with multi-payer or market-based financial systems. In this paper, we explore the use of business models in eHealth as well as the consistency of such a model in a public healthcare setting. The study is performed through a case study of an eHealth service and to which we apply a business model framework. Data have been collected through interviews, documents and project meetings. The results show that all parts of the business model could be identified and provide an overview of the service but no clear guidance on how to reach a sustainable value in the future. It seems that, in the case of public healthcare, there is a need to add the notion of a societal value as well as issues related to future governance for the diffusion of the service to make the business model and the service sustainable.

  • 221.
    Wass, Sofie
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, Jönköping International Business School, JIBS, Centre for Information Technology and Information Systems (CenITIS). Department of Computer Science, Linköping University, Sweden .
    Healthcare in the age of open innovation – A literature review2016In: Health Information Management Journal, ISSN 1833-3583, E-ISSN 1833-3575, Vol. 45, no 3, p. 121-133Article in journal (Refereed)
    Abstract [en]

    Background: In spite of an increased interest in open innovation and strategies that call for an increased collaboration between different healthcare actors, there is a lack of open innovation research in public contexts.

    Objective: This article presents the results of a review regarding the healthcare sector’s engagement in open innovation as well as constraining factors and positive outcomes of open innovation in healthcare.

    Method: The literature search focused on papers published in English between 2003 and 2014. Based on specified inclusion criteria, 18 articles were included.

    Results: Results reveal that most studies focus on inbound open innovation where external knowledge is integrated with the internal knowledge base at an initial phase of the innovation process. Innovation primarily results in products and services through innovation networks. We also identified constraining factors for open innovation in healthcare, including the complex organizations of healthcare, the need to establish routines for capturing knowledge from patients and clinicians, regulations and healthcare data laws as well as the positive outcome patient empowerment.

    Conclusion: The healthcare sector’s engagement in open innovation is limited, and it is necessary to perform further research with a focus on how open innovation can be managed in healthcare. 

  • 222.
    Wass, Sofie
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Linköping University, Sweden.
    Same, same but different: Perceptions of patients’ online access to electronic health records among healthcare professionals2018In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811Article in journal (Refereed)
    Abstract [en]

    In this study, we explore how healthcare professionals in primary care and outpatient clinics perceive the outcomes of giving patients online access to their electronic health records. The study was carried out as a case study and included a workshop, six interviews and a survey that was answered by 146 healthcare professionals. The results indicate that professionals working in primary care perceive that an increase in information-sharing with patients can increase adherence, clarify important information to the patient and allow the patient to quality-control documented information. Professionals at outpatient clinics seem less convinced about the benefits of patient accessible electronic health records and have concerns about how patients manage the information that they are given access to. However, the patient accessible electronic health record has not led to a change in documentation procedures among the majority of the professionals. While the findings can be connected to the context of outpatient clinics and primary care units, other contextual factors might influence the results and more in-depth studies are therefore needed to clarify the concerns.

  • 223.
    Wass, Sofie
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, Jönköping International Business School, JIBS, Centre for Information Technology and Information Systems (CenITIS). Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Computer and Information Science, Linköping University, Sweden .
    The Role of ICT in Home Care2017In: Context Sensitive Health Informatics: Redesigning Healthcare Work / [ed] Christian Nøhr, Craig E. Kuziemsky, Zoie Shui-Yee Wong, IOS Press, 2017, Vol. 241, p. 153-158Conference paper (Refereed)
    Abstract [en]

    With an ageing population and limited resources, ICT is often mentioned as a solution to support elderly people in maintaining an independent and healthy lifestyle. In this paper, we describe how ICT can support access to information and rationalization of work processes in a home care context. We do this by modelling the workflow and identifying the possible impact of ICT. The results show a complex process and indicate that the available resources are not used in the best possible way. The introduction of ICT could increase patient safety by reducing the risk of misplacing information about the care recipients and at the same time provide real time information about the care recipients’ needs and health at the point of care. However, to rationalize the work processes there is a need to combine ICT with a changed procedure for handling keys.

  • 224.
    Wass, Sofie
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Vimarlund, Vivian
    Jönköping University, Jönköping International Business School, JIBS, Informatics. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Computer and Information Science/Human-Centered Systems, Linköping University, Sweden.
    The Role of PAEHRs in Patient Involvement2018In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 42, no 11, article id 210Article in journal (Refereed)
    Abstract [en]

    With increased patient access to data, healthcare services are experiencing change where patients are moving away from being mere passive actors towards becoming more active and involved participants. In this paper, we explore the role of patient accessible electronic health records (PAEHRs) with respect to this increase in patient involvement. The study was performed as a case study and included nine interviews with patients and a survey that was responded to by 56 patients. Our results show that PAEHRs have a role in the enhancement of patient involvement because PAEHRs (i) foster a more balanced relationship between patients and healthcare professionals and (ii) increase access to information.

  • 225.
    Westergren, Robert
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Nasser, Mehdi
    Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Patient satisfaction and mobility with their assistive device and service2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective: To gather knowledge related to patient satisfaction and mobility with lower limb prosthetic and orthotic devices and to investigate satisfaction with services received. Another purpose of this study is to analyze potential differences between orthotic and prosthetic patients in relation to patient satisfaction and mobility.

    Design: Cross-sectional study

    Subjects: 21 participants with a mean age of 58 (SD 16) with an average duration of use of devices of 10 (SD 10) years. 12 out of the 21 participants were orthotic users and 9 were prosthetic users.

    Methods: Patients were asked to complete two questionnaires, one regarding satisfaction with assistive device and service (QUEST 2.0) and one regarding mobility.

    Results: Patients mean score regarding satisfaction with assistive device and service were 4.0 (SD 0.8) and 4.2 (SD 1.0) respectively. 91% reported that they had the ability to walk at least 100 meters with their assistive device. The areas where participants experienced most difficulties were walking on uneven ground (70%), walking up and down a hill (57%) and walking on stairs (57%).

    Conclusion: Overall this study demonstrates that participants were quite satisfied with their assistive device and the service received by the P&O clinic. No statistically significant differences regarding satisfaction with assistive device and service, or mobility, were found between prosthetic and orthotic participants.

  • 226.
    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.

  • 227.
    Wijma, Barbro
    et al.
    IKE, Linköpings universitet, Linköping - Genus och medicin Linköping, Sweden.
    Persson, Alma
    Linkopings universitet Tema Genus - Linkoping, Sweden Linkopings universitet Tema Genus - Linkoping, Sweden.
    Ockander, Marlene
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Brüggemann, Jelmer
    Linköpings universitet - Institutionen för TEMA - Teknik och social förändring Linköping, Sweden.
    Kränkningar i vården är vanligt förekommande - viktigt med aktivt arbete mot att patienter kränks [Abuse in healthcare - lessons learned during two decades of research]2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, no 3, p. 84-88Article in journal (Refereed)
    Abstract [en]

    Patients' experience of abuse in health care (AHC) is common, and may cause long-lasting suffering. In Sweden, lifetime prevalence is estimated at 20 per cent among female patients and 8 per cent among male patients, and a background of other abuse is a risk factor. Most health care staff have experience of patients who have been abused, but the topic is surrounded by silence from both patients and caregivers. Models for training staff in groups have been evaluated and a more proactive stance can be fostered. Department heads and health care authorities are responsible for providing staff with options to counteract AHC. Caregivers need training in how to carry out consultations with patients who say they have been abused in health care, and this training should be included in efforts to increase quality of care. Changes are within reach but educational efforts are urgent.

  • 228.
    Williamsson, Anna
    et al.
    Department of Biomedical Engineering and Health Systems, KTH - Royal Institute of Technology, Stockholm, Sweden.
    Dellve, Lotta
    Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden.
    Karltun, Anette
    Jönköping University, School of Engineering, JTH, Supply Chain and Operations Management.
    Nurses' use of visual management in hospitals: A longitudinal, quantitative study on its implications on systems performance and working conditions2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 4, p. 760-771Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to examine potential benefits provided by daily visual management tool use and explore its association with systems performance and working conditions among hospital nurses.

    BACKGROUND: Visual management tools used in everyday work and improvement work in health care theoretically contribute to shared understanding of complex work systems and provide certain user benefits. Cognitive load, miscommunication within and between professional groups, and pressure to engage in care process redesign add to nurses' strained working conditions.

    DESIGN: Quantitative longitudinal.

    METHODS: Questionnaires were distributed at T0, (N = 948, 66% response rate), T1 (N = 900, 70% response rate), and T2 (N = 621, 72% response rate) to nurses at five hospitals. Three groups of users (daily users, start users, and non-daily users) were compared by means T1-T2 (significance tested with Wilcoxon signed rank test) and by mixed model repeated measures T0, T1, T2.

    RESULTS: Daily use associated to better overview of work, collaboration, social capital, and clinical engagement. Job resources were rated higher by daily users. Mental stress increased and development opportunities decreased over time among non-daily users. There were associations between use and perceptions of systems performance, though the differences between groups were small.

    CONCLUSION: This study specifically explores visual management tool use in the hospital setting, which contributes to research by broadening the understanding of cognitive, social, and emotional benefits provided by visual management tool use. Daily use was associated to positive working conditions, small but positive differences in systems performance, and indicated a buffering effect on nurses' mental stress.

  • 229.
    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.

  • 230.
    Wranne, Birgitta
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Förbättringsarbete om att öka patientens delaktighet: En fallstudie om att införa personcentrerad vård på en kardiologisk vårdenhet2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Enligt nationella patientenkäten är patienterna nöjda med vården, däremot skattas inte delaktigheten lika högt.  Ett sätt att öka delaktigheten är personcentrerad vård, som dessutom kan ge en mer effektiv vård med högre kvalitet. 

    Syfte: Studiens syfte var att beskriva och analysera ett förbättringsarbete om att öka patientens delaktighet genom införande av personcentrerad vård på en kardiologisk vårdenhet.

    Metod: Förbättringsarbetet genomfördes enligt Nolans förbättringsmodell. Studien var en fallstudie med induktiv ansats. Kvantitativ datainsamling skedde genom enkäter till patienter och medarbetare före och efter fem månaders förbättringsarbete. Kvalitativ datainsamling skedde genom foksugruppsintervjuer med medarbetare.

    Resultat: Enkäterna visade inga tydliga skillnader efter fem månaders förbättringsarbete. Både patienter och medarbetare skattade patientdelaktigheten högt. Det som skattades lägst av båda grupper var hänsynstagande till arbete, levnadsvanor och tidigare erfarenhet av sjukhusvård.

    Fokusgruppsintervjuerna visade att välinformerade patienter i större utsträckning kunde vara mer delaktiga. Medarbetarna fick en bättre förståelse av patienten, samtidigt fanns oro över att missa viktig information. Viljan fanns till personcentrering, men förutsättningarna saknades.

    Slutsats: Förbättringsmodellen är lämplig för införande av personcentrerad vård för att kunna testa vad som fungerar praktiskt. För att lyckas behövs tid och stöd från ledningen. Medarbetarna behöver träning, coaching och få vara delaktiga i förbättringsarbetet.

  • 231.
    Wright, Rebecca J.
    et al.
    Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK.
    Lowton, Karen
    Department of Sociology, University of Sussex, Brighton, UK.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK.
    Grudzen, Corita R
    Ronald O. Perelman Department of Emergency Medicine, School of Medicine, New York University, New York, NY, USA.
    Grocott, Patricia
    Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK.
    Emergency department staff priorities for improving palliative care provision for older people: A qualitative study2018In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 32, no 2, p. 417-425Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Emergency department-based palliative care services are increasing, but research to develop these services rarely includes input from emergency clinicians, jeopardizing the effectiveness of subsequent palliative care interventions.

    AIM: To collaboratively identify with emergency clinicians' improvement priorities for emergency department-based palliative care for older people.

    DESIGN: This was one component of an experience-based co-design project, conducted using semi-structured interviews and feedback sessions.

    SETTING/PARTICIPANTS: In-depth interviews with 15 emergency clinicians (nurses and doctors) at a large teaching hospital emergency department in the United Kingdom exploring experiences of palliative care delivery for older people. A thematic analysis identified core challenges that were presented to 64 clinicians over five feedback sessions, validating interview findings, and identifying shared priorities for improving palliative care delivery.

    RESULTS: Eight challenges emerged: patient age; access to information; communication with patients, family members, and clinicians; understanding of palliative care; role uncertainty; complex systems and processes; time constraints; and limited training and education. Through feedback sessions, clinicians selected four challenges as improvement priorities: time constraints; communication and information; systems and processes; and understanding of palliative care. As resulting improvement plans evolved, "training and education" replaced "time constraints" as a priority.

    CONCLUSION: Clinician priorities for improving emergency department-based palliative care were identified through collaborative, iterative processes. Though generally aware of older palliative patients' needs, clinicians struggled to provide high-quality care due to a range of complex factors. Further research should identify whether priorities are shared across other emergency departments, and develop, implement, and evaluate strategies developed by clinicians.

  • 232.
    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.

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