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  • 51.
    Gashi, Fitnete
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Evidensbaserad praktik i socialt arbete: En fallstudie av ett förbättringsarbete om hur ESL kan bidra till ökat brukarinflytande och delaktighet inom socialpsykiatri2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 52.
    Godfrey, Marjorie M.
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Improvement Capability at the Front Lines of Healthcare: Helping through Leading and Coaching2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    SUMMARY

    This thesis addresses improvement capability at the front lines of healthcare with a focus on interprofessional health care improvement teams who provide care and improve care. The overall aim is to explore high performing clinical microsystems and evaluate interventions to cultivate health care improvement capabilities of frontline interprofessional teams.

    Methods

    Descriptive and evaluative study designs were employed in the five studies which comprise this thesis. A total of 495 interprofessional health care providers from a variety of health care contexts in the United States (Study I, II, III & IV) and Sweden (Study V) participated in the studies. The mixed methods research included qualitative observation, interviews, focus groups and surveys analyzed with qualitative manifest content analysis. The quantitative data were analyzed with statistics appropriate for non-parametric data.

    Findings

    Study I and II describe how leaders who understand health care improvement can create conditions for interprofessional teams to provide care and simultaneously improve care. Study III evaluates adapted clinical microsystem processes and tools successfully adapted in two different hospitals. Frontline staff reported that they needed help to balance providing care and improving care. Study IV and V explored and tested team coaching to help interprofessional teams to increase their improvement capabilities within improvement collaboratives. The participants perceived team coaching mostly positively and identified supportive coaching actions. In Study V an intervention with “The Team Coaching Model” was tested in Sweden and showed increased acquisition of improvement knowledge in the intervention teams compared to teams who did not receive the coaching model.

    Conclusions

    The thesis findings show leaders can help cultivate health care improvement capability by designing structures, processes and outcomes of their organizational systems to support health care improvement activities, setting clear improvement expectations of all staff, developing the knowledge of every staff member in the microsystem to know their operational processes and systems to promote action learning in their daily work, and providing help with team coaching using a Team Coaching Model.

  • 53.
    Godfrey, Marjorie M.
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Nelson, Eugene C.
    Geisel School of Medicine at Dartmouth, Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
    Nilsson, Mats
    Futurum, Jönköping County Council, Jönköping, Sweden.
    Ahlström, Gerd
    The Swedish Institute for Health Sciences and Department of Health Sciences, Lund University, Lund, Sweden.
    Coaching interprofessional health care improvement teams: the coachee, the coach and the leader perspectives2014In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 22, no 4, p. 452-464Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

  • 54.
    Godfrey, Marjorie M.
    et al.
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Thor, J.
    Nilsson, M.
    Andersson-Gäre, Boel
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Testing a Team Coaching Model to develop improvement capability of frontline teams: A comparative intervention and process evaluation pilot studyManuscript (preprint) (Other academic)
  • 55.
    Gäre Arvidsson, Stina
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Tillitsbaserad uppföljningsdialog för primärvård ur ett beställar- och vårdutförarperspektiv: En organisatorisk fallstudie av ett nationellt förbättringsarbete2019Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    Background

    Swedish health care use multiple principles for management, where market and hierarchy are most prominent. Critics mean that these interfere with basic ethical aspects of health care and raise the need for alternative forms of management.

    Purpose

    The quality improvement project develops a method for Audit and feedback in primary health care based on trust. The study describes the participants’ perceptions of influencing factors, development, learning and effects.

    Method

    The quality improvement project used Nolan´s improvement method.

    The study is a qualitative organizational case study that analyzes data from interviews and focus group with content analysis.

    Results

    Important components for building trust are openness, continuity and that principles of trust align with values of the organization. Trust-based Audit and feedback enhances identification of deficiencies, gives a solid ground for quality improvement and is patient centered. No disadvantages were identified. Combining follow-up and support for development legitimize and empower work with quality improvement, results in learning for all participants and gives positive synergies.

    Conclusion

    Development towards trust in Audit and feedback requires increased competencies in quality improvement at all levels, aligned steering signals and a change in culture. The method gives opportunity for reflection and new perspectives. Large-scale introduction is welcomed by the participants.

  • 56.
    Hagiwara, Magnus
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Development and Evaluation of a Computerised Decision Support System for use in pre-hospital care2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of the thesis was to develop and evaluate a Computerised Decision Support System (CDSS) for use in pre-hospital care.

    The thesis was guided by a theoretical framework for developing and evaluating a complex intervention. The four studies used different designs and methods. The first study was a systematic review of randomised controlled trials. The second and the last studies had experimental and quasi-experimental designs, where the CDSS was evaluated in a simulation setting and in a clinical setting. The third study included in the thesis had a qualitative case study design.

    The main findings from the studies in the thesis were that there is a weak evidence base for the use of CDSS in pre-hospital care. No studies have previously evaluated the effect of CDSS in pre-hospital care. Due to the context, pre-hospital care is dependent on protocol-based care to be able to deliver safe, high-quality care. The physical format of the current paper based guidelines and protocols are the main obstacle to their use. There is a request for guidelines and protocols in an electronic format among both clinicians and leaders of the ambulance organisations. The use of CDSS in the pre-hospital setting has a positive effect on compliance with pre-hospital guidelines. The largest effect is in the primary survey and in the anamnesis of the patient. The CDSS also increases the amount of information collected in the basic pre-hospital assessment process. The evaluated CDSS had a limited effect on on-the-scene time.

    The developed and evaluated CDSS has the ability to increase pre-hospital patient safety by reducing the risks of cognitive bias. Standardising the assessment process, enabling explicit decision support in the form of checklists, assessment rules, differential diagnosis lists and rule out worst-case scenario strategies, reduces the risk of premature closure in the assessment of the pre-hospital patient.

  • 57.
    Hagiwara, Magnus
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Sjöqvist, Bengt-Arne
    Department of Signals and Systems, Chalmers University of Technology, Gothenburg, .
    Lundberg, Lars
    School of Health Sciences, University of Borås, Borås, Sweden.
    Suserud, Björn-Ove
    School of Health Sciences, University of Borås, Borås, Sweden.
    Henricson, Maria
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Jonsson, Anders
    School of Health Sciences, University of Borås, Borås, Sweden.
    Decision support system in prehospital care: a randomized controlled simulation study2013In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 31, no 1, p. 145-153Article in journal (Refereed)
    Abstract [en]

    Introduction: Prehospital emergency medicine is a challenging discipline characterized by a high level of acuity, a lack of clinical information and a wide range of clinical conditions. These factors contribute to the fact that prehospital emergency medicine is a high-risk discipline in terms of medical errors. Prehospital use of Computerized Decision Support System (CDSS) may be a way to increase patient safety but very few studies evaluate the effect in prehospital care. The aim of the present study is to evaluate a CDSS.

    Methods: In this non-blind block randomized, controlled trial, 60 ambulance nurses participated, randomized into 2 groups. To compensate for an expected learning effect the groups was further divided in two groups, one started with case A and the other group started with case B. The intervention group had access to and treated the two simulated patient cases with the aid of a CDSS. The control group treated the same cases with the aid of a regional guideline in paper format. The performance that was measured was compliance with regional prehospital guidelines and On Scene Time (OST).

    Results: There was no significant difference in the two group's characteristics. The intervention group had a higher compliance in the both cases, 80% vs. 60% (p < 0.001) but the control group was complete the cases in the half of the time compare to the intervention group (p < 0.001).

    Conclusion: The results indicate that this CDSS increases the ambulance nurses' compliance with regional prehospital guidelines but at the expense of an increase in OST.

  • 58.
    Hagiwara, Magnus
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Suserud, Björn-Ove
    University of Borås, School of Health Sciences, 501 90 Borås, Sweden.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Sjöqvist, Bengt-Arne
    Department of Signals and Systems, Chalmers University of Technology, Gothenburg, Sweden.
    Henricson, Maria
    Jönköping University, School of Health and Welfare.
    Jonsson, Anders
    University of Borås, School of Health Sciences, 501 90 Borås, Sweden.
    The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study2014In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 14, no 70, p. 1-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

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

    METHODS:

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

    RESULTS:

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

    CONCLUSIONS:

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

  • 59.
    Hagiwara, Magnus
    et al.
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Suserud, Björn-Ove
    School of Health Sciences, University of Borås, Borås, Sweden.
    Andersson-Gäre, Boel
    Jönköping University, The Jönköping Academy for Improvement of Health and Welfare.
    Sjöqvist, Bengt-Arne
    Department of Signals and Systems, Chalmers University of Technology, Gothenburg.
    Henricson, Maria
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. ADULT.
    Jonsson, Anders
    School of Health Sciences, University of Borås, Borås, Sweden.
    The effect of a Computerized Decision Support System on prehospital assessment: results of an interrupted time-series studyManuscript (preprint) (Other academic)
  • 60.
    Hagiwara, Magnus
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Suserud, Björn-Ove
    Högskolan i Borås, Insitutionen för vårdvetenskap.
    Jonsson, Anders
    Högskolan i Borås, Insitutionen för vårdvetenskap.
    Henricson, Maria
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Exclusion of context knowledge in the development of prehospital guidelines: results produced by realistic evaluation2013In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, no 46Article in journal (Refereed)
    Abstract [en]

    Background

    Prehospital work is accomplished using guidelines and protocols, but there is evidence suggesting that compliance with guidelines is sometimes low in the prehospital setting. The reason for the poor compliance is not known. The objective of this study was to describe how guidelines and protocols are used in the prehospital context.

    Methods

    This was a single-case study with realistic evaluation as a methodological framework. The study took place in an ambulance organization in Sweden. The data collection was divided into four phases, where phase one consisted of a literature screening and selection of a theoretical framework. In phase two, semi-structured interviews with the ambulance organization's stakeholders, responsible for the development and implementation of guidelines, were performed. The third phase, observations, comprised 30 participants from both a rural and an urban ambulance station. In the last phase, two focus group interviews were performed. A template analysis style of documents, interviews and observation protocols was used.

    Results

    The development of guidelines took place using an informal consensus approach, where no party from the end users was represented. The development process resulted in guidelines with an insufficiently adapted format for the prehospital context. At local level, there was a conscious implementation strategy with lectures and manikin simulation. The physical format of the guidelines was the main obstacle to explicit use. Due to the format, the ambulance personnel feel they have to learn the content of the guidelines by heart. Explicit use of the guidelines in the assessment of patients was uncommon. Many ambulance personnel developed homemade guidelines in both electronic and paper format. The ambulance personnel in the study generally took a positive view of working with guidelines and protocols and they regarded them as indispensable in prehospital care, but an improved format was requested by both representatives of the organization and the ambulance personnel.

    Conclusions

    The personnel take a positive view of the use of guidelines and protocols in prehospital work. The main obstacle to the use of guidelines and protocols in this organization is the format, due to the exclusion of context knowledge in the development process.

  • 61.
    Hammar, Madeleine
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Rehabilitering - En självklarhet för patienter i rättspsykiatrisk slutenvård: Ett förbättringsarbetet och en kvalitativ studie av ett förbättringsarbete2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Purposes: The purpose of this work was to describe a quality improvement project that aimed on improving rehabilitation in forensic psychiatric care. The study also identified facilitators and barriers for systematic quality improvement in this setting.

    Methods: Nolan’s improvement model has been used. Process and result measurements conducted in order to determine whether the change was an improvement. The qualitative study was based on two focus group interviews; one group was from the forensic care unit and the other group was an external development unit with experience of quality improvement. The data from the interviews were analysed by content analysis.

    Results: The results of the improvement project indicated process improvements within planning, cooperation and logistics. However, more interventions are needed to reach the goal of increasing rehabilitation for the patients. The research study found nine categories of critical facilitators and barriers: motivation, methods, participation, leadership, safety, resistance, “Rågårdtänket”, system understanding and culture. The clear differences between the focus groups were that the external group highlighted the importance of sustainability as a success factor, and the group of forensic psychiatry brought up the security issue as a barrier in the improvement work.

    Conclusions: The study identifies experiences that there were specific barriers in conducting improvement in forensic psychiatric inpatient care. Security has impact on ideas, plan and do in the improvement model.

  • 62.
    Hasahya, Olivia Topister
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Karolinska Universitetssjukhus .Stockholm..
    A case study of Patient Involvement in Improving care flow of Prostate cancer Brachytherapy (HDR) while moving services from inpatient to outpatient.2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

  • 63.
    Hassel, Per-Magnus
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Uppstart av ett team med multimodal ansats på rehabiliteringen för patienter med långvarig smärta: Ett förbättringsarbete med blandad studiedesign2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Smärta från rörelseorganen ligger bakom många sjukskrivningar. För att stärka den medicinska rehabiliteringen gjorde Socialdepartementet en överenskommelse med Sveriges kommuner och landsting 2008; Rehabgarantin. Den insats som skulle få prestationsersättning var multimodal rehabilitering. I Landstinget Dalarna har man startat multimodala team med resurser från Rehabgarantin i primärvården. Denna uppsats beskriver ett sådant teams uppbyggnad och faktorer som personal uppfattar som viktiga för teamets uppbyggnad och arbete.

    Syfte: Syftet med förändringsarbetet är att patienter med långvarig värk ska få ett snabbt och adekvat omhändertagande av ett team som har kunskaper och erfarenhet av att jobba tillsammans.

    Studiefrågor: Vilka effekter för patienterna kan kopplas till ansatsen att skapa multimodal rehabilitering på en primärvårdspraktik? Vilka faktorer, upplever personal på vårdcentralen, har påver-kat skapandet av ett smärtteam på vårdcentralen?

    Metod: En blandad studie med flera metoder för datainsamling. Öppen intervju med personal, strukturerad telefonintervju med patienter och journalgranskning.

    Resultat: Smärtteamet har lyckats påverka arbetsåtergången och patienterna har en positiv upp-levelse av genomförandet av rehabiliteringen där de varit med och skapat en rehabiliteringsplan. De faktorer som personal upplever har påverkat smärtteamets uppbyggnad är: syfte, mätningar, patientcentrering, samarbete, miljö, engagemang, information, stöd från ledning och tid.

    Diskussion: Oavsett om man fokuserar på ett teams uppbyggnad eller generellt på ett förbättringsarbete återkommer vissa faktorer som viktiga. Här ingår en tydlig plan för arbetet där deltagarna ställer sig bakom syftet med det arbete som man i teamet ska utföra och kontinuerliga mätningar för att öka engagemanget för deltagarna i arbetet och de som direkt eller indirekt berörs av arbetet. Vidare finns det en vinst att skapa sig en gemensam bild av vad vi tillsammans ska uppnå.

    Vidare forskning behövs av effekterna av teamarbete med smärtpatienter. Patientnytta och ekonomiska konsekvenser behöver kartläggas. Är multimodal rehabilitering det bästa alternativet eller kan intermediär rehabilitering vara ett alternativ för små enheter?

  • 64.
    Hedegaard, Joel
    et al.
    Jönköping University, School of Education and Communication, HLK, Lifelong learning/Encell.
    Ahl, Helene
    Jönköping University, School of Education and Communication, HLK, Lifelong learning/Encell.
    Rovio-Johansson, Airi
    Gothenburg Research Institute, School of Business, Economics and Law, University of Gothenburg, Gothenburg, Sweden.
    Siouta, Eleni
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Karolinska Institute/Sofiahemmet University, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
    Gendered communicative construction of patients in consultation settings2014In: Women & health, ISSN 0363-0242, E-ISSN 1541-0331, Vol. 54, no 6, p. 513-529Article in journal (Refereed)
    Abstract [en]

    This study aimed to explore the communication in consultations between patients and health care staff from a gender perspective. We used 23 tape-recorded consultations between patients with Atrial Fibrillation and 5 nurses and 5 physicians at cardiac outpatient clinics at 6 different hospitals in southern Sweden during autumn 2009 to explore the verbal gendered constructions of patients. Through critical discourse analysis, we revealed that the male patients tended to describe their ailments with performance-oriented statements, whereas the female patients usually used emotional-oriented statements. The staff downplayed the male patients' questions and statements, while they acknowledged concern toward the female patients. Both the patients and the staff made conclusions according to a mutual construction. Male patients were constructed as competent, and female patients as fragile through gender-stereotypical communication. Open-ended statements and questions enabled consultations to be less limited by gender stereotypes.

  • 65.
    Hedegaard, Joel
    et al.
    Jönköping University, School of Education and Communication, HLK, Lifelong learning/Encell.
    Rovio-Johansson, Airi
    Gothenburg Research Institute (GRI), School of Business, Economics and Law, Universi-ty of Gothenburg .
    Siouta, Eleni
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Sophiahemmet University.
    Communicative construction of native versus non-native Swedish speaking patients in consultation settings2013In: Offentlig Förvaltning. Scandinavian Journal of Public Administration, ISSN 2000-8058, E-ISSN 2001-3310, Vol. 17, no 4, p. 21-49Article in journal (Refereed)
    Abstract [en]

    In this paper, we examine patient-centered care through analyzing communicative constructions of patients, on the basis of their native language, in consultations with physicians. Whereas patient-centered care is of current interest in health care, research has not addressed its implications in this dimension. Previous studies indicate that non-native Swedish speaking patients, experience substandard interpersonal treatment far more than native Swedish speaking patients. Our findings show that the non-native Swedish speaking patients presented themselves as participating, whereas the native Swedish speaking patients presented themselves as amenable. The physicians responded in two different ways, argumentatively towards the non-native Swedish speaking patients and acknowledging vis-à-vis the native Swedish speaking patients. When decisions and conclusions were made by the patients and physicians, this resulted in preservation of the status quo in the consultations with the non-native Swedish speaking patients, while the corresponding result with the native Swedish speaking patients was monitoring of their health status. So, whereas the non-native Swedish speaking patients actually were model patient-centered care patients, physicians were more amenable towards the native Swedish speaking patients. We suggest that patient-centered care is desirable, but its practical application must be more thoroughly scrutinized from both a patient and a health care worker perspective.

  • 66.
    Hegen, Malin
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hur ser planeringen ut för min rehabilitering?: Orgainsatorisk fallstudie av förändringsprocessen vid ett förbättringsarbete med målsättningen att korta väntetider och tydliggöra nästa steg för patienten2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Input from patients on waiting times to outpatient rehabilitation and poor information became the start of QI at Rehabilitation Medicine. Studies are available on conditions that affect change, but research is needed on what and why it works in the local context.Aim: QI aimed to shorten waiting times and provide the right information at the right time. The study aimed to explore facilitators and barriers for QI.Method: An improvement team performed QI together with former patients. A case study was made and analyzed by using the Consolidated Framework for Implementation Research (CFIR).Result: Goal attainment was reached for shorter waiting times. Information was given more in advance. Patient´s experience of information was difficult to evaluate because of limited study material. Facilitators were patient perspective, co-production, team spirit as culture and systematic QI. Barriers were complexity with many persons involved and several steps in the process.Conclusions: Production planning can shorten waiting times. New ways of working with information is complex and takes time. Using a patient perspective and co-production can facilitate QI.

  • 67.
    Hjorth, Yngve
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Användarvänligt beslutsstöd för mer tidseffektiv prehospital sjukvårdsledning: Patientbefrämjande förbättringsarbete inom ambulanssjukvården i Sverige2017Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [sv]

    Insatstiden vid prehospital sjukvårdsledning mellan 2010–2016 visar på att tid mellan händelsens inträffande och första avtransporterade patient på olycksplats, är för lång i jämförelse med rekommendationer inom traumaforskning. Författaren identifierade flera orsaker. Fokus i aktuell förbättringsansats kom att ligga på den prehospitala sjukvårdsledarens beslutsfattande förmåga. Ett beslutsstöd utvecklades från en kvalitetssäkrad bedömningsmall och provades via intervention i utbildning. Här rapporteras den vetenskapliga utvärderingen av deltagarnas självskattade förmågor före och efter utbildningen.

    Syftet med förbättringsarbetet var att utveckla och förbättra ett beslutsstöd och utbildningen av det, för snabbare initial insats vid prehospital sjukvårdsledning. Studiens syfte var att belysa om beslutsstödet upplevdes göra någon skillnad mellan deltagarna som använde beslutsstöd och de som ej använde beslutsstöd.

    Förbättringsarbetet bestod av ett test i befintlig prehospital sjukvårdsledarutbildning. Sjukvårdsledarens användning av beslutsstödet studerades via en mellangruppsdesign i befintlig utbildningsverksamhet genom observationsstudie som analyserades via styrdiagram. Studien innehöll en kvantitativ enkätstudie med egenskattad förmåga där svaren genomgick en statistisk analys via SPSS och MANOVA samt en fokusgruppsintervju som genomgick en kvalitativ analys med deduktiv-induktiv ansats.

    Prehospitala sjukvårdsledarens tid till beslut noterades bli kortare i flera fall vid användning av beslutsstöd. Positiva upplevelser av beslutsstödet förmedlades av deltagarna. Ingen signifikant skillnad mellan gruppernas egenskattade förmågor konstaterades efter analysen av enkätsvaren.

    Beslutsstödet kan tidseffektivisera insatsen vid prehospital sjukvårdsledning, vilket leder till att drabbade får ett snabbare omhändertagande. Bättre förutsättningar skapas för drabbade att få inhospital vård inom traumaforskning rekommenderad tid.

  • 68.
    Holm Löv, Marita
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Effektivare resursanvändning vid återbesök inom psykiatrisk öppenvård: Utveckling, test och erfarenheter av digitala vårdmöten2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund

    Hög andel sena återbud och uteblivna besök, är ett problem vid psykiatriska kliniker och orsakar effektivitetsbrister då tillgängliga resurser inte används optimalt. Fysiska besök och telefonkontakter behöver kompletteras med fler mötesformer för att bättre möta patientens behov och öka tillgängligheten.

    Syfte

    Syfte och övergripande mål med förbättringsarbetet var att öka tillgängligheten till psykiatrisk öppenvård genom att erbjuda digitala vårdmöten. Syftet med studien av förbättringsarbetet var att identifiera erfarenheter från förbättringsarbetet som kan användas som lärdomar i fortsatt verksamhetsutveckling.

    Metod

    Nolans förbättringsmodell har används i förbättringsarbetet. Studien är en fallstudie, inspirerad av interaktiv ansats med kvalitativ metod.

    Resultat

    Genom utveckling och genomförande av 20 digitala vårdmöten är lärdomarna att digitala vårdmöten är ett komplement till besök på mottagning och att digital teknik stödjer arbetsprocessen. Studiens resultat visar att ledningen, strukturer och medarbetares delaktighet är centrala vid kvalitetsförbättringar.

    Slutsatser

    Inställning till patientens kapacitet och digital teknik är central för att erbjuda mötesformen. Tekniska lösningar måste vara lättillgängliga. För att dela kunskap, öka tryggheten i det nya sättet att mötas och undanröja hinder som uppstår är arbetsmöten viktiga. Ledningen utgör en central roll för att påverka förbättringskulturen och de värderingar och mönster som finns i verksamheten.

  • 69.
    Häglund, Lina
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Likvärdig, lättillgänglig föräldrautbildning om autism: En fallstudie av föräldringsprocess, hinder och framgångsfaktorer i ett förbättringsarbete2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Equivalent and Accessible Parental Education Programs for Autism

    A Case study on the developmental process, obstacle and factors that promote success in working with improvement

  • 70.
    Idvall, Ewa
    et al.
    Malmö Högskola.
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Kvalitetsutveckling inom omvårdnad2014In: Omvårdnadens grunder: Ansvar och utveckling / [ed] Anna Ehrenberg och Lars Wallin, Lund: Studentlitteratur AB, 2014, 2, p. 331-357Chapter in book (Other academic)
  • 71.
    Jansson, Charlotte
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Tidig understödd utskrivning från strokeenhet: En fallstudie av ett förbättringsarbete inom rehabilitering2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Sammanfattning

    Bakgrund Rehabilitering efter ett strokeinsjuknande ska påbörjas tidigt och vara målinriktad. För patienter som drabbats av mild till måttlig stroke rekommenderas i Socialstyrelsens riktlinjer vård på strokeenhet i kombination med tidig understödd utskrivning. Uppsatsen beskriver, analyserar och utvärderar ett förbättringsarbete där tidig understödd utskrivning med stöd av ett stroketeam prövades som arbetsmodell på en strokeenhet.

    Syfte Syftet med förbättringsarbetet var att patienterna skulle uppleva ett tryggt omhändertagande i samband med utskrivningen, samtidigt som strokeprocessen effektiviserades genom kortare vårdtid på sjukhus. Syftet med studien var att beskriva erfarenheter hos patienter, närstående och personal vid införandet av tidig understödd utskrivning från sjukhus med stöd av ett stroketeam för patienter med mild till måttlig stroke.

    Metod Förbättringsarbetet utvärderades genom mätning av vårdtider och mätning av patienternas upplevelse av trygghet i samband med utskrivningen. I studien av förbättringsarbetet insamlades data genom semistrukturerade intervjuer med patienter och deras närstående, samt i en fokusgruppsintervju med involverad personal. Nio patienter och sex närstående intervjuades. Vid fokusgruppsintervjun deltog två arbetsterapeuter, två sjukgymnaster och en sjuksköterska. Intervjuerna analyserades med kvalitativ innehållsanalys.

    Resultat Arbetssättet med tidig understödd utskrivning testades på tio patienter. Vårdtiden var något kortare, men osäkerhet finns i mätningarna och i den kvalitativa analysen framkom tveksamhet om vårdtiderna påverkades. Upplevelsen av trygghet i samband med hemgång var något högre bland deltagarna i projektet jämfört med baslinjemätningen. Vid intervjuerna med patienter framkom värdet av att erhålla rehabilitering i sin hemmiljö. Både patienter och närstående beskrev att teamet bidrog med kunskaper om stroke, rehabilitering och säkerhetsaspekter i hemmet, samt att kontinuiteten med samma personal var värdefull. Närstående beskrev också att de fått stöd av teamet i närståenderollen. Personalen framhöll vid fokusgruppsintervjun förbättrad kvalitet för patienterna, tidsbrist och svårigheter med prioriteringar samt en arbetstillfredställelse i nöjda patienter och att arbeta med förbättringar.

    Slutsats Tidig understödd hemgång med stöd av ett stroketeam upplevdes positivt av patienter, närstående och personal. Arbetssättet var engagerande men tidskrävande. Förhoppningen är att lärdomarna från detta projekt kan bidra till fortsatt utveckling av rehabiliteringsprocessen i samband med utskrivning.

     

     

     

  • 72.
    Johansson, Karoline
    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. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Hygienobservatörer i fokus: - en fallstudie för säkrare vård och ökat antal mätande enheter till de basala hygienrutinerna och klädreglerna i Region Jönköpings län.2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Healthcare associated infections (HAIs) are one of the greatest threats to patient safety. Hand hygiene is the most important component in the prevention efforts. Measurements to standard precautions are important for adherence to the basic rules of hygiene and clothing.  An improvement work focused on hygiene observers in Region Jönköping County, was implemented in which three hall gatherings was replaced by 17 meetings with fewer participants.  

    The aim of the improvement work is to increase the number of measuring devices. 

    The purpose of the study of the improvement work is to describe the hygiene observers experiences concerning deficiencies in the basic hygiene practices and the new meeting structure and to identify factors that influence the extent to which measurements will be carried out. 

    Method: PDSA, Nolan's improvement model, survey, qualitative data analysis in the form of focus group interviews.

    The result of the improvement work indicates more units performing measurements.

    Results of the study of the improvement work shows lack of management support and inadequate knowledge among staff about how infections spread. Other factors are lack of disinfection before patient care, overuse of gloves and poor adherence to dress rules.

    Conclusions: Management support is crucial for adherence to measurement. Improvements in number of HAI, costs and patients ' suffering increases as hygiene measurements are carried out.

     

  • 73.
    Johansson, Pernilla
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Beteendemedicinsk prevention och behandling inom tandvård - utformning av ett individanpassat behandlingsprogram kring tobaksavvänjning/rökning.2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Rökning är en riskfaktor för tandlossningssjukdom, parodontit, och inflammationssjukdomar kring tänder leder till att stödjevävnad bryts ner. En konsekvens av detta är tandlossning, men genom att eliminera rökning ökar möjligheten för en god utläkning.  Syfte: Utforma ett individuellt behandlingsprogram kring rökavvänjning inom tandvård för individer med diagnosticerad parodontit.  Metod: Genom en studiedesign baserad på en systematisk litteraturöversikt utformades ett behandlingsprogram, baserat på beteende medicinsk prevention och behandling för att förändra ett beteende. Randomiserade kontrollerade studier är de studier som främst är inkluderade som underlag med fokus på cigarett-rökning. Avgränsning är andra former av rökning, medicinska produkter samt nikotinersättningsmedel.  Resultat: Det finns ett gap i forskningen kring individanpassade behandlingsprogram men den forskning som existerar föreslår ett förhållningssätt där motiverande samtal ingår tillsammans med social kognitiva behandlingsstrategier. En möjlig behandlingsmodell i 7 steg presenteras. Slutsats: Mer forskning krävs kring individanpassade behandlingsstrategier, där syftet är att förändra ett beteende, för att kunna implementera en evidensbaserad vård. 

  • 74.
    Johansson, Pernilla
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Förebyggande arbete med munhälsa inom äldreomsorg.: Ett förbättringsarbete och fallstudie kring preventivt arbete inom kommunal hälso- och sjukvård.2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 75.
    Johansson, Rose-Marie
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Malmvall, Bo-Eric
    Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University.
    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.
    Larsson, Bruno
    Unit of Urology, County Hospital Ryhov, Jönköping.
    Erlandsson, Ingrid
    Unit of Urology, County Council Ryhov, Jönköping.
    Sund-Levander, Märtha
    Unit of Research and Development, Hoegland Hospital, Eksjö.
    Rensfelt, Gunhild
    Infection Control, County Hospital Ryhov, Jönköping.
    Mölstad, Sigvard
    Unit of R&D in Primary Care, Futurum, Jönköping.
    Christensson, Lennart
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Guidelines for preventing urinary retention and bladder damage during hospital care2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 3/4, p. 347-355Article in journal (Refereed)
    Abstract [en]

    Aims and objectives.  To develop evidence-based guidelines for adult patients in order to prevent urinary retention and to minimise bladder damage and urinary tract infection.

    Background.  Urinary retention causing bladder damage is a well known complication in patients during hospital care. The most common treatment for urinary retention is an indwelling urinary catheter, which causes 80% of hospital-acquired urinary tract infections. Appropriate use of bladder ultrasonography can reduce the rate of bladder damage as well as the need to use an indwelling urinary catheter. It can also lead to a decrease in the rate of urinary tract infections, a lower risk of spread of multiresistant Gram-negative bacteria, and lower hospital costs.

    Design.  An expert group was established, and a literature review was performed.

    Methods.  On the basis of literature findings and consensus in the expert group, guidelines for clinical situations were constructed.

    Results.  The main points of the guidelines are the following: identification of risk factors for urinary retention, managing patients at risk of urinary retention, strategies for patients with urinary retention and patient documentation and information.

    Conclusion.  Using literature review and consensus technique based on a multiprofessional group of experts, evidence-based guidelines have been developed. Although consensus was reached, there are parts of the guidelines where the knowledge is weak.

    Relevance to clinical practice.  These guidelines are designed to be easy to use in clinical work and could be an important step towards minimising bladder damage and hospital-acquired urinary tract infections and their serious consequences, such as bacteraemia and the spread of multidrug-resistant bacteria in hospitals.

  • 76.
    Jonasson, Lise-Lotte
    et al.
    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.
    Berterö, Carina
    The importance of approaching older people: a grounded theory2012In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 7, no 1, p. 29-36Article in journal (Refereed)
    Abstract [en]

    Aims and Objectives:  The aim of this study was to identify and describe the ethical values in caring encounters as experienced by older patients in their daily interaction with nurses in wards for older people.Background: Ethical values and morals are important aspects that influence the quality of care.

    Methods: Empirical observational study including follow-up interviews. Twenty-two older patients participated voluntarily in this study. Constant comparative analysis, the core foundation of grounded theory was used. Results: Five categories; Being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the bases for the core category:

    Approaching: Approaching concerns how people become closer to each other in a physical space .It also includes how people become closer to each other in a dialogue, involving verbal or bodily communication.

    Conclusions and Relevance to Clinical Practice: Approaching indicates the ethical values that guide nurses in their caring encounters with older patients. These values are noted by the patient and have an individual value as well as leading to improved quality of their care. The older patient will be confident and satisfied with the caring encounter if the desired components in the nurse’s approaching are exhibited.

  • 77.
    Josephson, Iréne
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    In what ways do physiotherapists utilize patient resources inintervention?: A qualitative analysis of the interaction in the context of non-specific low back pain2013Conference paper (Refereed)
    Abstract [en]

    This paper reports on an empirical study of how patient resources are explicitly utilized in intervention. A qualitative analysis of five videorecorded and observed first encounters between patients with nonspecific low back pain (NSLBP) and physiotherapists in primary care was conducted in southern Sweden. The analysis focuses on physiotherapists’ various ways of explicitly utilizing patient resources in intervention. The findings illuminate a gap between the number of occurring patient resources and the explicit utilization of these resources in intervention. Resources like objects, condition, personal characteristics and energies were identified and followed during the first encounter with physiotherapists. These resources were checked by the therapists or initiated by the patients. Resources concerning personal characteristics (such as optimism and motivation) and energies (such as experience-based knowledge) seem to be the underutilized. The findings raise questions about professional challenges beyond professional skill, indicating a need for clinical improvement regarding interaction, with potential implication for back pain recovery. The findings are discussed in relation to patient participation and professional ethics.

  • 78.
    Josephson, Iréne
    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 Behavioural Science and Social Work.
    Utrymme för deltagande: Beslutsprocesser i möten mellan patienter med ospecifika ländryggsbesvär och sjukgymnaster i primärvård2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [sv]

    Hälso- och sjukvårdsmöten som föranleds av medicinskt ospecifika symptom innebär utmaningar för både patient och vårdprofessionell. Samtidigt erbjuder det ospecifika ett mer flexibelt utrymme för patienters aktiva deltagande i beslutsprocesser än vad som är fallet vid specifika hälsoproblem med ett begränsat antal vedertagna behandlingsalternativ. Syftet med forskningsprojektet var att undersöka utmaningar relaterade till utrymmet för patienters deltagande i beslutsprocesser avseende intervention. Avhandlingen baseras på fyra artiklar som undersöker erfarna sjukgymnasters föreställningar om, och interagerande i möten med patienter med ospecifika ländryggsbesvär.

    Forskningsprojektet genomfördes med explorativ empirisk ansats kombinerat med fokuserad etnografi. Det betyder att forskningen grundas på erfarenhetsbaserad kunskap som samlas in i naturligt förekommande verksamhet. Data samlades in via fokusgrupper med sjukgymnaster, samt via deltagande observationer av det första mötet mellan sjukgymnast och patient. Samtliga sammankomster videofilmades och transkriberades, och analyserades med fokus på beslutsprocesser avseende intervention.

    Forskningsprojektet resulterade i tre mönster: i) kontrasten mellan sjukgymnasternas förställningar om helhetsperspektiv i förhållande till det biomedicinska intresse som de utövade, ii) omvandlingen av patienternas resursorientering till biomedicinskt hälsoproblem, samt iii) överensstämmelse mellan sjukgymnasternas inställning till, och deras hantering av andra aktörer. Resultatet tyder på att sjukgymnasterna resonerade om element från flera systemnivåer men fattade beslut på sin egen systemnivå, det vill säga utifrån professionell metodik och teori. Det innebär att utrymmet för patienters aktiva deltagande i beslutsprocesser avseende intervention inte togs tillvara i den omfattning som var möjlig. Genom att vårdprofessionella utvecklar kommunikativa och interaktiva förmågor kan patienters resurser bättre tas tillvara i intervention, vilket indirekt kan leda till ökad nöjdhet och bättre funktionsförmåga.

  • 79.
    Josephson, Iréne
    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, HHJ, Dep. of Social Work.
    Bülow, Pia H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work.
    In what ways do physiotherapists utilize patient resources in intervention?: A qualitative analysis of the interaction in the context of non-specific low back painManuscript (preprint) (Other academic)
  • 80.
    Josephson, Iréne
    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, HHJ, Dep. of Behavioural Science and Social Work.
    Hedberg, Berit
    ’Not physically present actors’ in encounters between physiotherapists in primary care and patients with nonspecific low back painManuscript (preprint) (Other academic)
  • 81.
    Josephson, Iréne
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Bülow, Pia H.
    Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work.
    Problem-solving in physiotherapy - physiotherapists' talk about encounters with patients with non-specific low back pain2013In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 35, no 8, p. 668-677Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate how physiotherapists talk about the choice of intervention for patients with NSLBP, particularly how professionals manage clinical encounters that may be experienced as challenging.

    Method: Discourse analysis was performed of four focus groups’ talk. Twenty-one experienced physiotherapists working in primary health care in southern Sweden participated.

    Results: Four focal themes appeared: Responsibility for health and health-related problems; Normalization – what counts as a normal back pain problem in relation to living an ordinary life; Change process – how to lead one’s life; and Individualization of the intervention in relation to the individual patient but also from the physiotherapists’ point of view. The themes shape an over-arching pattern of Problem-solving – which concerned both the professional task and the back pain problem, and was related to varying case complexity. This may have implications for the intervention the individual patient will be offered and on outcome.

    Conclusions: Physiotherapists’ attitudes and approaches seem to entail components of professional and personal values which may influence patients’ access to health care, with a risk for unequal assessment and intervention as a consequence. We argue that enhanced physiotherapist-patient collaboration, including patient-led problem-investigation, is a prerequisite for improved outcome in terms of patient satisfaction, and for physiotherapy development. Future investigations of patients’ roles in specific face-to-face encounters are needed.

  • 82.
    Karlsson Leksell, Lena
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Autistiska barns ökade möjlighet till alternativ och kompletterande kommunikation: Fallstudie av ett förbättringsarbete enligt OD metodiken2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Children with autism often suffer from severe social and lingual difficulties. Frequent change in behavior creates problems for the affected families. When these obstacles are too difficult to handle, some families make the decision to leave their children to shelter home for children vid disabilities.

    Purpose: The purpose of intervention is to make sure that every child on the shelter home grants functioning communications and possibilities for participation in the activities performed in the shelter home.The purpose is to describe how the staffs on the shelter home for children with autism experience the effect of improvement on the matter of communication and participation regarding the children.

    Method: The improvement has been performed by the use of the Organization Development (OD) methodology. The study is a case study in which the OD-methodology is described as well as the staff's perceptions of improvement and the development of the children’s communication. Empirical materials were collected through interviews of focus groups. The interviews have been analysed using qualitative content analysis.

    Result: The results showed that children’s participation increased due to the use of augmentative and alternative communication. Different methods of communication were adapted to various children’s specific needs. Staff experienced greater consensus on the work with the children’s communication. Opportunities for reflection and exchanges of experience were provided. Their thoughts were made clear by getting written down in an action plan. Collaboration with parents was simplified and some parents became more interested in the children’s communication.

    Conclusion: The results showed that quality improvement such as OD methodology gave autistic children opportunity to develop their communication in the child’s current context.

  • 83.
    Keller, Christina
    et al.
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Stevenson, Katherine
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Participation in blended learning: Settings and intersections of a master programme in healthcare2012In: International Journal of Web Based Communities, ISSN 1477-8394, E-ISSN 1741-8216, Vol. 8, no 4, p. 504-520Article in journal (Refereed)
    Abstract [en]

    This article examines educational settings, intersections and participation in a master programme in healthcare given as blended learning. Regarding communication between learners and teachers dialogical intersections were found between campus and home as well as between campus and work. Furthermore, not only learners but also teachers worked from other physical locations than campus. In communication between learners, dialogical intersections were found between home and campus, work and campus, and between home settings. Discussion and assignment tools were used in other settings than campus and were found to enhance learning and reflection by learners. Communication patterns in synchronous and asynchronous online seminars were characterised by a high share of communication between learners. However, the share of teachers’ postings increased in online seminars devoted to support on course content from expert teachers. The article is concluded with implications of the findings for planning and structuring of blended learning.

  • 84.
    Khatami, Annelie
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Förändrat omhändertagande av patienter med uretärsten: - Lärdomar från ett förbättringsarbete2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: About 10-15% of the population, mostly at working age, has the risk that at some point be affected by kidney stones. There is a lack of national guidelines for kidney stone treatment, but several studies suggest treatment to start within 48 hours for rapid symptom relief and reduced discomfort for the patient. Within the studied context, the time from diagnosis to final treatment was too long, and the readmission rate was high, why a quality improvement project was initiated.

    Purpose: The aim of the Quality Improvement project was to halve the time from diagnosis to final treatment for the patients suffering from urethral calculi, and to reduce negative impacts related to an untreated urethral stone. Furthermore the aim of the study was to describe a multi-professional teams’ experiences of actual Quality improvement project.

    Method: Nolans model for Improvement was used by the team. The effects of the quality improvement were evaluated with Statistical Process Control (SPC). A case study with inductive approach was used. The teams’ experiences was studied through group interviews, and written stories and the data were conducted through qualitative content analysis

    Results: The goal considering time to final treatment was not achieved, but positive effects for the patients were noted. Extracorporeal Shock Wave Lithotripsy (ESWL) treatment within 48 hours reduced the time from diagnosis to final treatment. Planning, cooperation and communication was the key factors for success for quality improvement. Several barriers was identified in the context, such as; high work load and indistinct routines, which complicated their work. Furthermore a lack of holistic view, considering patients with kidney stone was described, which led to a variation in the driving forces among the employees.

    Conclusions: ESWL in 48 hours shortened the time from diagnose to final treatment, even if a retreatment was necessary. In a complex organization, the challenges conducting a quality improvement project is on several levels. Well known guidelines and a shared goal for the entire process are important to be able to offer patients appropriate care at the right time.  Communication is fundamental to achieve success.

  • 85.
    Kihlberg, Karin
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Sjuksköterskors dokumentation av patienters riskbedömning: En kvalitativ intervjustudie som grund för kvalitetsförbättring2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 86.
    Kilström, David
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Mot en rättssäker bedömning: Kvalitetsförbättringar av klinisk träning inom sjuksköterskeutbildningen utifrån en programteoretisk ansats med studie av samsyn mellan lärare2019Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    Nurses' practical knowledge is crucial for safe care. Within the nursing program skills are checked through clinical examinations. Based on identified deficiencies in terms of legal validity and working environment related to clinical examinations improvement work was initiated.

    The purpose of the improvement work was to improve the process of clinical training within the nursing program by developing the clinical examination.

    A study of the improvement work was conducted with the purpose of:

    • Exploring teachers shared interpretations with clinical examinations as an educational activity.
    • Analysing and developing initial program theory based on interview data.

    Improvement work was designed according to the model for improvement, improvement ramp, and a program theory approach. The study includes qualitative interviews with content analysis based on an interactive and abductive approach.

    The improvement work led to improved consensus between teachers and a better work environment. A reduction in variation between teachers’ assessments of clinical examinations was reached. The program theory was revised based on interview data.

    Reduced variation shows increased legal validity. Revised program theory has increased the possibility of learning from the improvement work both locally and in general.

    The work has developed the nursing education and its contribution to good and safe healthcare.

  • 87.
    Kinsman, Leigh
    et al.
    Monash University, Victoria, Australia.
    Rotter, Thomas
    University of Saskatchewan.
    Stevenson, Katherine
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. University of Saskatchewan.
    Bath, Brenna
    University of Saskatchewan.
    Goodridge, Donna
    University of Saskatchewan.
    Harrison, Liz
    University of Saskatchewan.
    Dobson, Roy
    University of Saskatchewan.
    Sari, Nazmi
    University of Saskatchewan.
    Jeffery, Cathy
    University of Saskatchewan.
    Bourassa, Carrie
    First Nations University of Canada.
    Westhorp, Gill
    Community Matters, Unley, South Australia.
    "The largest Lean transformation in the world": the implementation and evaluation of lean in Saskatchewan healthcare2014In: Healthcare Quarterly, ISSN 1710-2774, Vol. 17, no 2, p. 29-32Article in journal (Refereed)
    Abstract [en]

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

  • 88.
    Korszunowa, Alicja
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Implementering av SBAR- vägen till gemensamt lärande: Studie av implementering av SBAR på en kardiologisk vårdavdelning2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Poor professional communication and information transfer are main causes for medical error in the health care systems. The complexity in health care organisations in combina-tion with human factors issues raises a demand for structured and standardised communication. One challenge is to implement standardised communication models and study its effect on pa-tient safety and working conditions. SBAR (Situation, Background, Assessment and Recommen-dation) is a knowledge based communication model, developed to transfer critical information in complex work environments, both in normal and stressful conditions. Aim: To study implementation of SBAR on a Cardiology ward with focus on strategies that could facilitate the process. Method: Ten qualitative interviews with members of staff during the implementation process and quantitative data (130 anonymous questionnaires among staff, Safety Attitude Questionnaire, SAQ, during the implementation of SBAR have been collected (March- December 2011) Results: 95 % of the nurses and 70 % of the physicians have received SBAR education. In the interviews, the nurses describe an improved intra-professional communication after the imple-mentation of SBAR. The nurses also describe the communication to be more focused on the patients’ care, follow the SBAR process. However, only a few physicians explain that they are using SBAR in the intra- and/or inter professional communication. Strategies (leadership, role definitions within the team, structure for multi-professional cooperation, identification and prevention of hierarchical structures and introduc-tion of improvement knowledge) and hinders (limited clinical analyses before the project, unclear assignment, limited resources e.g. time and methodology, handling critical voices, limited input from physicians and external impact factors) for implementation of the SBAR model were identi-fied. The response rate for the baseline SAQ questionnaire was 94 % among nurses and 69% among physicians. No differences were found in nurses and physicians’ attitudes on safety climate and teamwork within their own groups. Some significant differences however were found concerning cooperation and communication between the two groups; nurses were less satisfied with cooperation and communication compared to the level of satisfaction in the group of physi-cians. Discussion: The implementation process has been meaningful in regards to an increase in knowledge trough the analytic outlook of the study. The result indicates that the actual imple-menting of SBAR requires further steps to create optimal conditions to achieve better results in communication and collaboration in cross-professional teams. The study confirms the communi-cation gap that exist between doctors and nurses and highlights the need for a better understand-ing of each other`s roles and responsibilities, in order to achieve an integral patient-centred ap-proach. It is crucial to identify and to prevent existing structures of hierarchy and to clarify the meaning of leadership within the team. The process of implementing SBAR is an effort to ad-dress one of the most important issues in patient safety and requires firm and committed leader-ship.

  • 89.
    Kvarnström, Susanne
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Cedersund, Elisabet
    Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work.
    The dual faces of service user participation: Implications for empowerment processes in interprofessional practice2013In: Journal of Social Work, ISSN 1468-0173, E-ISSN 1741-296X, Vol. 13, no 3, p. 287-307Article in journal (Refereed)
    Abstract [en]

    Summary: This article reports on an empirical research study exploring and describing variations in how front-line practitioners perceive service user participation (SUP), specifically in interprofessional practice. The settings comprised three Swedish health and social care organizations where the professionals worked in interprofessional teams: a program for chronic pain rehabilitation, a program for surgical treatment of obesity, and a short-term municipal home for older adults. The qualitative study design was informed by a phenomenographic approach and conducted as semi-structured individual interviews with 15 professionals representing nine professions, including social work.

    Findings: The main findings show seven qualitative variations in understanding of SUP: 1) inclusion in activities and social events, 2) obtaining guidance, 3) having self-determination and choice, 4) getting confirmation from and contact with professionals, 5) negotiating for adjustment, 6) personal responsibility through insight, and 7) circumstance surrounding SUP.

    Applications: The interprofessional dimensions discerned in the meaning attributed to SUP are mainly described in terms of amplified opportunities for participation. An interesting aspect of the findings is that in all the variations of perceptions of SUP, there are potentials to reverse to their opposites, that is, paradoxes that can be termed ‘the dual faces of service user participation’. These aspects stress the need for continuing reflection on practices among both front-line practitioners and managers in empowering and paternalistic processes and on constantly improving organizational and policy conditions to facilitate SUP.

  • 90.
    Kvarnström, Susanne
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Willumsen, Elisabeth
    Department of Social Studies, University of Stavanger, Norway.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Hedberg, Berith
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    How Service Users Perceive the Concept of Participation, Specifically in interprofessional practice2012In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, Vol. 42, no 1, p. 129-146Article in journal (Refereed)
    Abstract [en]

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

  • 91.
    Källvant, Jonas
    et al.
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Lundh, Theres
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Värdeskapande användning av radiologi: - Utbildning och mätning för förbättring2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction

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

    Purpose

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

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

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

    Method

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

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

    Results

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

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

    Discussion / Conclusion

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

  • 92.
    Lagerqvist, Lise-Lotte
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Bästa möjliga förutsättningar för lärande runt den vårdpreventiva processen - med utgångspunkt i det nationella kvalitetsregistret Senior alert2018Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    Summary

    Best possible learning conditions around the health preventive process - based on the national Quality Registry Senior Alert  

    Background

    Today, it is up to each institution to determine how knowledge of health prevention is implemented theoretically and practically in the nurses undergraduate education. There is no common structure for implementation. This means that nursing students are not adequately involved when doing the practical education. 

    Aim The overall aim was to create good conditions for learning around the preventative process of care during the practical education for nursing students. The aim of the study was to clarify how learning activities around preventive care based on Senior alert can provide nursing students with sufficient knowledge and skills.  

    Method

    In the improvement work, Nolan's improvement model was used as well as Kirkpatrick's learning evaluation model. The study received inspiration from interactive research effort. Focus group interviews were analysed through qualitative content analysis.  

    Results

    The result of the study that nursing students have the opportunity to develop sufficient knowledge and skills increased successfully through the education-based education. Partly through theoretical knowledge, but also through practical application. The cross-sectoral exchange also gave an increased understanding, which also contributed to the development. By working person-centered, an overall thinking was created which contributed to learning.  Conclusions Learning activities around health-preventive work methods based on Senior Alert are a way to increase the ability of nursing students to carry out risk assessments and to put in action when needed.  

    Keywords: improvement knowledge, preventative care, nursing students, practical education   

  • 93.
    Larsson, Ingrid
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Person-centred care in rheumatology nursing in patients undergoing biological therapy: An explorative and interventional study2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The overall aim was to explore and evaluate rheumatology nursing from a person-centred care perspective in patients undergoing biological therapy.

    Methods: This thesis focuses on patients with chronic inflammatory arthritis (CIA) who were undergoing biological therapy at a rheumatology clinic in Sweden. Papers I and II had an explorative descriptive design with a phenomenographic approach. The 40 participants were interviewed about their dependence on or independence of a nurse for the administration of their infusions or injections. Paper III had a randomized controlled design involving 107 patients in the trial. The objective of the intervention was to replace every second monitoring visit at a rheumatologist-led clinic by a visit to a nurse-led rheumatology clinic, based on person-centred care. Paper IV had an explorative descriptive design with a qualitative content analysis approach. Interviews were conducted with 20 participants who attended the nurse-led rheumatology clinic.

    Findings: Dependence on a rheumatology nurse for administration of intravenous infusions was described as invigorating due to the regular contact with the nurse, which provided security and involvement (paper I). Independence of a nurse for subcutaneous injections was understood by the patients in different ways and was achieved by struggling to cope with injecting themselves, learning about and participating in drug treatment (paper II). Patients with stable CIA receiving biological therapy were monitored by a nurse-led rheumatology clinic without any difference in outcome when compared to monitoring carried out at a rheumatologist-led clinic, as measured by the Disease Activity Score 28. Replacing one of the two annual rheumatologist outpatient follow-up visits by a visit to a nurse-led clinic for the monitoring of biological therapy was found to be safe and effective (paper III). A nurse-led rheumatology clinic, based on person-centred care, added value to the follow-up care of patients with stable CIA undergoing biological therapy by providing a sense of security, familiarity and participation (paper IV).

    Conclusions: This thesis contributes a valuable insight into person-centred care as the core of rheumatology nursing in the area of biological therapy. The rheumatology nurse adds value to patient care when she/he gives patients an opportunity to talk about themselves as a person and allow their illness narrative to constitute a starting point for building collaboration, which encourages and empowers patients to be an active part in their biological therapy and become autonomous. A nurse who provides person-centred care and keeps the patients’ resources and needs in focus serves as an important guide during their healthcare journey.

  • 94.
    Larsson, Ingrid
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Bergman, Stefan
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Arvidsson, Barbro
    Patients' experiences of a nurse-led rheumatology clinic in Sweden: a qualitative study2012In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 14, no 4, p. 501-507Article in journal (Refereed)
    Abstract [en]

    In this study, patients' experiences of a nurse-led rheumatology clinic for those undergoing biological therapy are discussed. The study had an explorative design, based on a qualitative content analysis with an inductive approach. Strategic sampling was used in order to achieve variations in experiences of a nurse-led clinic. Interviews were conducted with 20 participants, and the analysis resulted in the theme "the nurse-led rheumatology clinic provided added value to patient care". The participants' experiences of the encounter with the nurse led to a sense of security (due to competence and accessibility), familiarity (due to confirmation and sensitivity), and participation (due to exchange of information and involvement). Replacing every second visit to a rheumatologist with one to a nurse added value to the rheumatology care, making it more complete. Nurses and rheumatologists complemented each other, as they approached patients from different perspectives. This study suggests that a nurse-led rheumatology clinic adds value to the quality of care for patients in rheumatology units.

  • 95.
    Larsson, Ingrid
    et al.
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Arvidsson, Barbro
    Teleman, A
    Bergman, S
    A nurse-led rheumatology clinic for monitoring biological therapy: A randomized controlled trialManuscript (preprint) (Other academic)
  • 96.
    Lempiäinen, Niina
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Ökat välbefinnande för patienter efter intensivvård med hjälp av dagbok och post-IVA mottagning: Ett förbättringsarbete på en intensivvårdsavdelning i Södertälje sjukhus AB2017Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
  • 97.
    Lenrick, Raymond
    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.
    A potential for further enhancing obstetrical safety: Patient harm measurement with the global trigger tool in the south-east health-care region of Sweden2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    A decade of heightened awareness concerning safety issues in healthcare since the Institute of Medicine’s awakening call has resulted in a string of counteroffensive measures. The pace of improvement has been slow and not altogether clear. Rates of patient harm are in general now measured by voluntary reporting and indicator measurements. The use of triggers or clues in random nurse-based reviews to enable identification of patient harm is a more effective method for measuring the overall rate of harm in a health care organisation. Measured actual overall rates of patient harm, their variations and patterns during delivery in the south-east health-care region of Sweden are not previously known. Measurement is important to patient safety improvement, as a foundation for accountability, effort selection and keeping track of results. The patient’s voice must also be much clearer in quality and safety improvement efforts in healthcare. The Institute of Healthcare Improvements Global Trigger Tool for measuring adverse events was used to review 1137 deliveries during 2011 in the seven departments (10% of all cases). Mother and new-born were both evaluated. Thirty eight patient harm events per 1000 patient days were identified, correlating to 13% of admissions. Presupposed rates among staff were double this value. Current patient safety indicators are half this value. One third of patient harm events at birth affected the new-born. Twenty different categories of harm were found. This study shows significantly higher rates of patient harm than previously reported. The nurse reviewers defined the method as valuable and a useful method for measuring harm at delivery. Limitations at this stage are no observed changes in health care delivery or clinical outcomes and that value assessment is based entirely on the judgement of the data-abstractors.

     

  • 98.
    Lindberg, Susanne
    Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare. Hälsohögskolan Jönköping.
    Ett kommunikationsverktyg utvecklat för och med nyblivna föräldrar: – en fallstudie inom postpartum vården2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 99.
    Ljungberg, Maria
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Telemedicin inom barnsjukvård: Familjers och professionellas upplevelser och medverkan vid pilotinförandet av videokonsultationer2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

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

  • 100.
    Ljunggren, Eva
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    "Deras behov och våra önskningar" Sjuksköterskemottagning för att öka tillgängligheten till vården: En studie av att införa sjuksköterskemottagningar vid en hudklinik2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    “Our wishes and their needs”

    Nurse-led clinics to increase access to healthcare

    A study of implementing nurse-led clinics at a Dermatology Department

     

    Background: The demand for timely access to healthcare service encourage task shifting from physicians to nurses. Previous studies of task-shifting evaluated quality, delivery and efficiency. Including the work environment in the evaluation can make it more balanced. In order to improve access and the working environment, the Department of Dermatology in Östergötland Region introduced nurse-led clinics for some groups of patients.

     

    Purpose: The purpose of the improvement work was to introduce nurse-led clinics to increase access and improve quality, delivery, efficiency and working environment. The purpose of the study of the improvement work was to identify the experience of the change process.

     

    Methods: Working groups developed and tested nurse-led clinics on a small scale, using common improvement methodology. Measures of quality, delivery, efficiency and the working environment were defined. A case study of the improvement work was conducted. Interviews, individual and focus group, were used to gather data. The data was analyzed via qualitative content analysis.

     

    Results: Access to return visits was partly improved and patients were partly offered appointments right when they needed them. The increased contact between nurses and patients was seen as an improvement to the work environment although the number of tasks also increased nurses stress levels. The simultaneous implementation of several nurse-led clinics affected the clinic as a whole.

     

    Conclusion: Nurse-led clinics can improve patient access. As a result of the improvement work, the tasks and organization within the clinic require additional review. Measures of quality, delivery, efficiency and working environment were useful for performance evaluation.

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