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  • 51. Ekberg, J.
    et al.
    Timpka, T.
    Angbratt, M.
    Frank, L.
    Norén, A. -M
    Hedin, L.
    Andersen, E.
    Gursky, E. A.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Futurum, Jönköping County Council, Jönköping, Sweden.
    Design of an online health-promoting community: Negotiating user community needs with public health goals and service capabilities2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 1, article id 258Article in journal (Refereed)
    Abstract [en]

    Background: An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities.

    Methods: Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified.

    Results: The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions.

    Conclusions: OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users' needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations.

  • 52.
    Engström, Karl
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Snabbare och säkrare övergång för patienter från primärvård till specialistpsykiatri: En empirisk fallstudie av antagandens betydelse för ett förbättringsarbete kring remisser och samverkan2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background

    In Sandviken, the adult psychiatric care is divided between Primary Health Centers and Psychiatry. The transferral of patients was unsafe and meant prolonged time before psychiatric treatment was started as 50 % of the referrals were declined.

    Purpose

    The improvement project aimed to reduce the proportion of declined referrals and to reduce time between referral and psychiatric treatment.

    The study aimed to find out beliefs existing among stakeholders and the effect of these on the improvement work.

    Methods

    The idea to test, a referral template, was chosen in advance of the project start. Several improvement tools were used and one primary focus was to base decisions upon facts.

    The study was an empirical case study with qualitative analysis made on documents and interviews.

    Results

    The improvement project didn’t achieve the set aims. The study showed that beliefs about what was needed and possible to do, contributed to the results of the improvement work.

    Conclusions

    The improvement project showed the importance of testing new ideas. The referral template wasn’t a working solution. Stakeholders beliefs about what was needed and possible to do, and how to do it, was shown to contribute to the results of the improvement work.

  • 53.
    Engvall, Charlotte
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Förbättrade förutsättningar för resiliens inom specialiserad barnsjukvård: tillämplighet av ”Resilience Assessment Grid”2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    This master´s thesis explores how an improvement work of developing and using the “Resilience Assessment Grid”, RAG, can support the potential for resilient performance on a paediatric ward, in light of the need for new safety strategies developed for complex adaptive systems. A qualitative case study of the improvement work was conducted. The improvement work was done according to the Model for Improvement.

    The work of developing and using RAG for measuring and managing resilient performance, supported the employees' potential for resilient performance by helping them in implementing strategic improvement interventions. The awareness and knowledge of patient safety and resilience increased, which led to increased understanding of the system and the needs of the system in terms of patient safety. We have not been able to show that the potential for resilient performance has improved by using RAG for measurement. We can neither demonstrate nor exclude that the potential will improve before further measurements have been made.

    Experience from the present study can be used in future interventions of improving the potential for resilient performance and patient safety in a complex adaptive system in the health care setting.

  • 54.
    Eriksson, Nomie
    et al.
    University of Skövde, Sweden.
    Müllern, Tomas
    Jönköping University, Jönköping International Business School, JIBS, Business Administration.
    Interprofessional barriers: A study of quality improvement work among nurses and physicians2017In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 26, no 2, p. 63-69Article in journal (Refereed)
    Abstract [en]

    This article studies interprofessional barriers between nurses and physicians in the context of quality improvement work. A total of 17 nurses and 10 physicians were interviewed at 2 hospitals in Sweden. The study uncovered a number of barriers relating to both the relative status of each group and their defined areas of responsibility.

  • 55.
    Eriksson, Sören
    Jönköping University, Jönköping International Business School, JIBS, Economics.
    Snakebites in a rural area in northern Vietnam: a southeast Asian context2008In: Herpetological Bulletin, ISSN 1473-0928, Vol. 104, p. 13-21Article in journal (Refereed)
  • 56.
    Ernsth Bavell, Marie
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Avlösningsvård-korttidsvård-växelvård.2001Conference paper (Refereed)
  • 57.
    Ernsth Bravell, Marie
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Care Trajectories in the Oldest Old2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis demonstrates relations among health, social network, ADL and patterns of care in the oldest old guided by a resource theoretical model.

    The analyzed data are based on two studies: the Nona study, a longitudinal study of 157 individuals aged 86 to 94 years, and the H70 study, a longitudinal study of 964 individuals aged 70 at baseline. Data were collected by interviews and to some extent in the H70 study, medical exams and medical records.

    The results demonstrate that perceived resources seem to affect patterns of care to a higher extent than the more objective resources in the sample of the oldest old. On the other hand, sociodemographic variables such as gender, marital status and SES, in addition to the more objective resources of having children nearby and the number of symptoms of illness predicted institutionalization during a subsequent 30-year period from the age of 70. The proportion of elderly persons’ institutionalization was further significantly higher than that generally found in cross-sectional studies. ADL was one of the strongest predictors for both use of formal care and institutionalization in both samples, indicating an effective targeting of the formal care system in Sweden. The care at end of life in the oldest old is challenged by the problems with progressive declines in ADL and health, which makes it hard to fit in the dying oldest old in the palliative care system. There is a need to increase the knowledge and the possibility for care staff to support and encourage social network factors and for decision-making staff to consider factors beyond ADL.

  • 58.
    Ernsth Bravell, Marie
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Changes in Health, ADL and Use of Care in the Oldest Old.2006Conference paper (Refereed)
  • 59.
    Ernsth Bravell, Marie
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Resources and Help Patterns in the Oldest old Swedes.2005Conference paper (Refereed)
  • 60.
    Ernsth Bravell, Marie
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Berg, Stig
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Malmberg, Bo
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Sundström, Gerdt
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Sooner or later?: A study of institutionalization in late life2009In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 21, no 4/5, p. 329-337Article in journal (Refereed)
    Abstract [en]

    Background and aims: Existing information about institutionalization of elderly individuals is mainly based on cross-sectional data and does not address the cumulative risk of institutionalization. The purpose of the present study was to analyze longitudinal data prospectively and estimate the risk of placement in an elder care institution for individuals aged 70 years or older. Methods: The study was based on a longitudinal investigation (the H70 study) of a random sample of 70-year-olds living in Gothenburg, Sweden, in 1971. Individuals were followed from age 70-100 years. Three different analyses were performed: a descriptive prospective analysis, cross-sectional analyses at ages 70, 79 and 85 years, and a longitudinal analysis of predictors for institutionalization. Results: The prospective analysis indicated that 50% of the individuals eventually moved to an elder care institution. Significantly more women than men were institutionalized, although for women the move occurred later in life. Cross-sectional analyses demonstrated that various factors were important to institutionalization at different ages. The Cox regression model with time-varying covariates indicated that gender, socio-economic situation, marital status, number of symptoms, having children living nearby, and activities in daily life were related to institutionalization. Conclusions: The proportion of elderly persons relocating to institutions was significantly higher than that generally found in cross-sectional studies. It was possible to identify variables that predict institutionalization during a subsequent 30-year period, but different analyses revealed different effects from the factors evaluated.

  • 61.
    Ernsth Bravell, Marie
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Larsson, Birgitta
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    En kartläggning av kvälls- och nattpatrullernas arbete i Jönköpings kommun.2000Conference paper (Refereed)
  • 62.
    Ernsth-Bravell, Marie
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Torgé, Cristina Joy
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Delaktighet i hälso- och sjukvård i Jönköpings kommun2019Report (Other academic)
    Abstract [sv]

    Under de senaste decennierna har det skett en rad organisatoriska förändringar inom vård och omsorg. En av de stora konsekvenserna av förändringarna är ett utökat hälso- och sjukvårds-ansvar för kommunerna i landet. Inom hälso- och sjukvården har det också skett lagföränd-ringar, där bland annat delaktighet lyfts fram tydligare nu. Den här studien syftade därför till att undersöka hur personer som erhåller hälso- och sjukvård i kommunen uppfattar sin del-aktighet i planering, genomförande och uppföljning av hälso- och sjukvårdsinsatser.

    Studien omfattar tre olika kontexter; 1) hälso- och sjukvård i ordinärt boende, 2) hälso- och sjukvård i särskilt boende för äldre samt 3) hälso- och sjukvård i boende inom socialpsykiatrin. Olika metoder har använts (enkäter i studie 1 och 3 och intervjuer i studie 2) och rapporten är därför uppbyggd i tre delar.

    Resultaten visar dock att delaktighet är viktigt för personerna i samtliga tre kontexter men att det kan vara svårt att sätta ord på vad delaktighet egentligen betyder. Personer som ingår i studien ger flera goda exempel på när de känt sig delaktiga, men även det motsatta. Delaktighet är således en fråga som ständigt är aktuell och som man ständigt behöver arbeta med.   

  • 63.
    Fabisch, Anna
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping Academy.
    Möte och mätetal – Vad ger vad egentligen?: Lärdomar av att använda Experience Based Co-Design för att utveckla kvalitetsindikatorer för ungdomsmottagningar2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund

    Kvalitetsindikatorer beskrivs underlätta styrning och kvalitetsutveckling av hälso- och sjukvårdsverksamheter. Det finns dock begränsat vetenskapligt stöd för patientinvolvering vid framtagande av kvalitetsindikatorer.

     

    Kontext för studien

    Studien tog utgångspunkt i ett förbättringsarbete på en regions ungdomsmottagningar, som uppvisat omotiverade skillnader avseende tillgänglighet och kompetens. Förbättringsarbetets målsättning var att utveckla kvalitetsindikatorer som ungdomar och personal upplevde speglar en välfungerande ungdomsmottagning. Arbetet genomfördes med Experience Based Co-Design-metodiken (EBCD). Förbättringsarbetets målsättning utvärderades genom 49 oinvigda ungdomars fritextbeskrivningar, samt fokusgrupper med medarbetare. Utvärderingen visade att förbättringsarbetets målsättning hade uppnåtts.

     

    Studien syfte

    Att beskriva lärdomar i organisationen av att utveckla kvalitetsindikatorer genom EBCD, samt jämföra framtagna indikatorer med andra ungdomsmottagningars kvalitetsindikatorsuppsättningar.

     

    Metod

    Fokusgrupper med personal, intervju med processägare och dokumentanalys av kvalitetsindikatorsuppsättningar.

     

    Resultat

    I informanternas beskrivningar vävdes reflektioner om framtagna indikatorer samman med erfarenheter från co-designprocessen. Personbunden förändringsmotivation och bred delaktighet synliggjordes. Dokumentanalysen visade att framtagna indikatorer hade större andel mått med kundperspektiv än jämförda indikatorsuppsättningar.

     

    Diskussion

    EBCD-metodiken integrerade explicit och implicit kunskap om olika kvalitetsaspekter av verksamheten, vilket främjade förändringsmotivation och personligt lärande. Att metodiken inkluderade konkreta förbättringsarbeten stimulerade till formativ användning av kvalitetsindikatorerna, vilket understöddes av bred delaktighet. Det var möten genom co-designprocessen som främjade dessa effekter, snarare än valet av indikatorer.

     

    Nyckelord: kvalitetsindikator, patientinvolvering, ungdomsmottagning, ungdomsvänlig vård

  • 64.
    Garcia-Ptacek, Sara
    et al.
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
    Modéer, Ingrid Nilsson
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Fereshtehnejad, Seyed-Mohammad
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
    Farahmand, Bahman
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
    Religa, Dorota
    Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Eriksdotter, Maria
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
    Differences in diagnostic process, treatment and social support for Alzheimer's dementia between primary and specialist care: results from the Swedish Dementia Registry2017In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 46, no 2, p. 314-319Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: the increasing prevalence of Alzheimer's dementia (AD) has shifted the burden of management towards primary care (PC). Our aim is to compare diagnostic process and management of AD in PC and specialist care (SC).

    DESIGN: cross-sectional study.

    SUBJECTS: a total of, 9,625 patients diagnosed with AD registered 2011-14 in SveDem, the Swedish Dementia Registry.

    METHODS: descriptive statistics are shown. Odds ratios are presented for test performance and treatment in PC compared to SC, adjusted for age, sex, Mini-Mental State Examination (MMSE) and number of medication.

    RESULTS: a total of, 5,734 (60%) AD patients from SC and 3,891 (40%) from PC. In both, 64% of patients were women. PC patients were older (mean age 81 vs. 76; P < 0.001), had lower MMSE (median 21 vs. 22; P < 0.001) and more likely to receive home care (31% vs. 20%; P < 0.001) or day care (5% vs. 3%; P < 0.001). Fewer diagnostic tests were performed in PC and diagnostic time was shorter. Basic testing was less likely to be complete in PC. The greatest differences were found for neuroimaging (82% in PC vs. 98% in SC) and clock tests (84% vs. 93%). These differences remained statistically significant after adjusting for MMSE and demographic characteristics. PC patients received less antipsychotic medication and more anxiolytics and hypnotics, but there were no significant differences in use of cholinesterase inhibitors between PC and SC.

    CONCLUSION: primary and specialist AD patients differ in background characteristics, and this can influence diagnostic work-up and treatment. PC excels in restriction of antipsychotic use. Use of head CT and clock test in PC are areas for improvement in Sweden.

  • 65.
    Goodman, Daisy
    et al.
    Dartmouth Hitchcock Medical Center, USA.
    Ogrinc, Greg
    Veterans Health Administration, USA.
    Davies, Louise
    Veterans Health Administration, USA.
    Baker, G. Ross
    University of Toronto, Canada.
    Barnsteiner, Jane
    University of Pennsylvania, USA.
    Gali, Kari
    Cleveland Clinic Children’s Hospital, USA.
    Hilden, Joanne
    Colorado Children’s Hospital, USA.
    Horwitz, Leora
    New York University, USA.
    Kaplan, Heather C.
    Cincinnati Children’s Hospital Medical Center, USA.
    Leis, Jerome
    University of Toronto, Canada.
    Matulis, John C.
    Dartmouth Hitchcock Medical Center, USA.
    Michie, Susan
    University College, UK.
    Miltner, Rebecca
    University of Alabama, USA.
    Neily, Julia
    Veterans Health Administration, USA.
    Nelson, William A.
    Geisel School of Medicine, USA.
    Niedner, Matthew
    University of Michigan Medical Center, USA.
    Oliver, Brant
    MGH Institute of Health Professions, USA.
    Rutman, Lori
    Seattle Children’s Hospital, USA.
    Thomson, Richard
    Newcastle University, UK.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: Examples of SQUIRE elements in the healthcare improvement literature2016In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 25, no 12, article id e7Article in journal (Refereed)
    Abstract [en]

    Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of the theoretical basis for improvement work; the impact of contextual factors on outcomes; and the development of methodologies for studying improvement work. Consequently, there is now a need to revise the original publication guidelines. To reflect the breadth of knowledge and experience in the field, we solicited input from a wide variety of authors, editors and improvement professionals during the guideline revision process. This Explanation and Elaboration document (E&E) is a companion to the revised SQUIRE guidelines, SQUIRE 2.0. The product of collaboration by an international and interprofessional group of authors, this document provides examples from the published literature, and an explanation of how each reflects the intent of a specific item in SQUIRE. The purpose of the guidelines is to assist authors in writing clearly, precisely and completely about systematic efforts to improve the quality, safety and value of healthcare services. Authors can explore the SQUIRE statement, this E&E and related documents in detail at http://www.squire-statement.org.

  • 66.
    Gremyr, Andreas
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Tracking Change: Usefulness of Statistical Process Control in Improving Psychiatric Care2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Healthcare is facing great challenges and psychiatric care is no exception. Extensive attempts to improve quality are made. It is essential to use methods that enable learning from experience, to improve performance. The core feature of Statistical Process Control (SPC), the control charts, are in use in various settings to enable learning and to support quality improvement work, but its use in psychiatric settings are scarce. This master´s thesis explores the usefulness of control charts, in quality improvement work. This was done in a case study at a department of psychosis by addressing two questions related to: a) control chart’s contribution to knowledge on if, when, where and how changes occur, and 2) how usefulness of control charts is perceived at the department. Control charts were applied to important variables and development officer’s and manager’s thoughts on usefulness were analysed using pattern matching. The use of charts shows shifts and differences between wards related to ongoing improvement projects. There is a readiness to start using control charts. The perceived usefulness matches the benefits and challenges identified in literature. Control charts as a tool supporting continuous improvement work in a psychiatric context, has a great potential still awaiting its use.

  • 67.
    Hanson, Veronica
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Går det att ändra läkares beställningsmönster?: En retrospektiv studie av förbättringsinsatser för en mer värdeskapande användning av diagnostisk service2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Swedish healthcare is facing the challenge of an increasing and aging population making cost reductions necessary. Some of the challenges are based around the over diagnosis and the misutilisation of laboratory analysis. Utilisation management could contribute to proper use. A quality improvement project was performed as a collaboration between a primary care centre and the Council of Value-creating use of Medical Diagnosis. The aim was to reduce the number of analyses and misuse of laboratory analysis. A mixed method study was conducted with the aim to evaluate five interventions made by the Council. Because the improvement project never really started, results are limited. Interviews with physicians revealed that the studied units are open for dialogue with the diagnostic specialties and willing to change ordering patterns but few changes were detected. The literature supports the interventions made so far but few results are shown. One reason might be that previous efforts have been isolated events. By using the knowledge of quality improvement and bringing the questions closer to the units’, change might be easier to embrace. The combination of quality improvement in the microsystems with support and improvements in mesosystems will probably contribute to success.

  • 68.
    Harlock, Jenny
    et al.
    Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
    Williams, Iestyn
    Health Services Management Centre, University of Birmingham, Birmingham, UK.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK.
    Hall, Kelly
    Department of Social Policy and Social Work, University of Birmingham, UK.
    Mannion, Russell
    Health Services Management Centre, University of Birmingham, UK.
    Brearley, Sally
    The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK.
    Doing more with less in health care: Findings from a multi-method study of decommissioning in the English National Health Service2018In: Journal of Social Policy, ISSN 0047-2794, E-ISSN 1469-7823, Vol. 47, no 3, p. 543-564Article in journal (Refereed)
    Abstract [en]

    In the context of an austere financial climate, local health care budget holders are increasingly expected to make and enact decisions to decommission (reduce or stop providing) services. However, little is currently known about the experiences of those seeking to decommission. This paper presents the first national study of decommissioning in the English National Health Service drawing on multiple methods, including: an interview-based review of the contemporary policy landscape of health care decommissioning; a national online survey of commissioners of health care services responsible for managing and enacting budget allocation decisions locally; and illustrative vignettes provided by those who have led decommissioning activities. Findings are presented and discussed in relation to four themes: national-local relationships; organisational capacity and resources for decommissioning; the extent and nature of decommissioning; and intended outcomes of decommissioning. Whilst it is unlikely that local commissioners will be able to ‘successfully’ implement decommissioning decisions unless aspects of engagement, local context and outcomes are addressed, it remains unclear what ‘success’ looks like in terms of a decommissioning process. 

  • 69. Headrick, L. A.
    et al.
    Ogrinc, G.
    Hoffman, K. G.
    Stevenson, Katherine
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Shalaby, M.
    Beard, A. S.
    Thörne, K. E.
    Coleman, M. T.
    Baum, K. D.
    Exemplary Care and Learning Sites: A Model for Achieving Continual Improvement in Care and Learning in the Clinical Setting2016In: Academic Medicine, ISSN 1040-2446, E-ISSN 1938-808X, Vol. 91, no 3, p. 354-359Article in journal (Refereed)
    Abstract [en]

    Problem Current models of health care quality improvement do not explicitly describe the role of health professions education. The authors propose the Exemplary Care and Learning Site (ECLS) model as an approach to achieving continual improvement in care and learning in the clinical setting. Approach From 2008-2012, an iterative, interactive process was used to develop the ECLS model and its core elements-patients and families informing process changes; trainees engaging both in care and the improvement of care; leaders knowing, valuing, and practicing improvement; data transforming into useful information; and health professionals competently engaging both in care improvement and teaching about care improvement. In 2012-2013, a three-part feasibility test of the model, including a site self-assessment, an independent review of each site's ratings, and implementation case stories, was conducted at six clinical teaching sites (in the United States and Sweden). Outcomes Site leaders reported the ECLS model provided a systematic approach toward improving patient (and population) outcomes, system performance, and professional development. Most sites found it challenging to incorporate the patients and families element. The trainee element was strong at four sites. The leadership and data elements were self-assessed as the most fully developed. The health professionals element exhibited the greatest variability across sites. Next Steps The next test of the model should be prospective, linked to clinical and educa tional outcomes, to evaluate whether it helps care delivery teams, educators, and patients and families take action to achieve better patient (and population) outcomes, system performance, and professional development. © 2016 Association of American Medical Colleges.

  • 70.
    Headrick, L. A.
    et al.
    University of Missouri School of Medicine, Columbia, MO, United States.
    Shalaby, M.
    Department of Medicine, Lehigh Valley Health Network, Allentown, PA, United States.
    Baum, K. D.
    University of Minnesota, Minneapolis, MN, United States.
    Fitzsimmons, A. B.
    Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO, United States.
    Hoffman, K. G.
    Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO, United States.
    Höglund, P. J.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Ogrinc, G.
    Dartmouth Medical School, Hanover, NH, United States.
    Thörne, K.
    Jönköping County Council.
    Exemplary care and learning sites: Linking the continual improvement of learning and the continual improvement of care2011In: Academic Medicine, ISSN 1040-2446, E-ISSN 1938-808X, Vol. 86, no 11, p. E6-E7Article in journal (Other (popular science, discussion, etc.))
  • 71.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Nordström, Erik
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Kjellström, Sofia
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Josephson, Iréne
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    "We found a solution, sort of”: qualitative interview study with children and parents on their experiences of the coordinated individual plan (CIP) in Sweden2018In: Cogent Medicine, ISSN 2331-205X, Vol. 5, no 1, article id 1428033Article in journal (Refereed)
    Abstract [en]

    Children and adolescents receiving services from two professional parties may obtain support with a coordinated individual plan (CIP). The Swedish law prescribes that CIP must incorporate service user participation. This study aims to explore children and parents’ experiences of participating in CIP-process to generate knowledge with practical implications of how children and parents may be involved in the CIP-process. A descriptive qualitative interview study with 13 service users was conducted during November 2014 to March 2016. Data were audio-recorded and transcribed, and further subjected to qualitative content analysis. Three main descriptive categories with six subcategories emerged. The category “Struggle for coordination” includes service users’ need for participation which are limited by professionals’ lack of consensus. The category “Alliance for coordination” points out the importance of relationship and personal support to accomplish functional coordination. The category “Structure for coordination” shows how the structure facilitate service user involvement on a high level. Service user involvement seemed limited by professionals’ actions, but could be facilitated by support of professionals working in the child’s daily life. Structured coordination seems to relieve the pressure on parents, as well as children, but CIP needs to be individually tailored to reach its full potential.

  • 72.
    Hedegaard, Joel
    Jönköping University, School of Education and Communication, HLK, Lifelong learning/Encell.
    The role of interactive and action research in developing and improvement oriented projects2009In: Vägval och dilemman i interaktiv forskning: Kurspaper från Bridging the gaps doktorandkurs Interaktiv forskning 2008 / [ed] Mattias Elg och Boel Andersson Gäre, Linköping: Helix , 2009, p. 111-122Chapter in book (Other academic)
  • 73.
    Hvitfeldt-Forsberg, Helena
    et al.
    Medical Management Centre, Karolinska Institutet.
    Mazzocato, Pamela
    Medical Management Centre, Karolinska Institutet.
    Glaser, Daniel
    Medical Management Centre, Karolinska Institutet.
    Keller, Christina
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Unbeck, Maria
    Danderyds sjukhus.
    Staffs' and managers' perceptions of how and when discrete event simulation modelling can be used as a decision support in quality improvement: A focus group discussion study at two hospital settings in Sweden2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 5, article id e013869Article in journal (Refereed)
    Abstract [en]

    Objective: To explore healthcare staffs' and managers' perceptions of how and when discrete event simulation modelling can be used as a decision support in improvement efforts.

    Design: Two focus group discussions were performed.

    Settings: Two settings were included: a rheumatology department and an orthopaedic section both situated in Sweden.

    Participants: Healthcare staff and managers (n=13) from the two settings.

    Interventions: Two workshops were performed, one at each setting. Workshops were initiated by a short introduction to simulation modelling. Results from the respective simulation model were then presented and discussed in the following focus group discussion.

    Results: Categories from the content analysis are presented according to the following research questions: how and when simulation modelling can assist healthcare improvement? Regarding how, the participants mentioned that simulation modelling could act as a tool for support and a way to visualise problems, potential solutions and their effects. Regarding when, simulation modelling could be used both locally and by management, as well as a pedagogical tool to develop and test innovative ideas and to involve everyone in improvement work.

    Conclusions: Its potential as an information and communication tool and as an instrument for pedagogic work with healthcare improvement render a broader application and value of simulation modelling than previously reported.

  • 74.
    Jakobsson, Ulrika
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Slutet gott, allting gott?: Ett förbättringsarbete och en fallstudie om smärtskattning av patienter i livets slutskede på en akutsjukvårdsavdelning2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: En utmaning inom akutsjukvården är att uppmärksamma svårt sjuka patienter med allvarliga sjukdomar, framförallt när det huvudsakliga målet med vården ändras från att vara livsförlängande till att vara lindrande. Smärta är vanligt hos patienter med långvariga sjukdomar särskilt i livets slutskede.  Att inte uppmärksamma patientens symtom kan innebära att risk att utsättas för onödigt lidande. Systematiska bedömningar och skattningar är enkla åtgärder för att uppmärksamma patientens behov.

    Syfte med förbättringsarbetet: att förbättra omhändertagandet av patienter i livets slutskede genom att förbättra upptäckten av och förebygga smärta.

    Syftet med studie av förbättringsarbetet: att beskriva och analysera medarbetares gemensamma erfarenheter av förbättringsarbetet.

    Metod: Förbättringsarbetet genomfördes med stöd av Nolans förbättringsmodell. För att studera förbättringsarbetet genomfördes en fallstudie med fokusgruppsintervjuer som analyserades.

    Resultat: Förbättringsarbetet resulterade i en ökning av patienter som smärtskattades med validerad smärtskattningsskala under sin sista tid i livet. Studien av förbättringsarbetet sammanfattades i temat ”Att balansera vardagens villkor för att skapa lärande och utveckling”.

    Diskussion: Vardagens villkor har stor betydelse för hur medarbetare upplever möjligheten att genomföra ett förbättringsarbete på avdelningen. Att ta vara på medarbetare vilja att förbättra vården och skapa förutsättningar för delaktighet kan bidra till mätbara resultat.

  • 75.
    Janlöv, Ann-Christin
    et al.
    Kristianstad University, Sweden.
    Ainalem, Ingrid
    Center for Innovation and Improvement (CII), Region Skåne, Malmö, Sweden.
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Berg, Agneta
    Kristianstad University, Sweden.
    An improvement program as a way to intensify inter-professional collaboration in the community for people with mental disabilities: a follow-up2016In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 37, no 12, p. 885-893Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to follow up inter-professional experiences of improvement work one year after a completed CII improvement program aiming at improve health care and social services for people with mental disabilities living in ordinary housing. This study was performed with a qualitative descriptive approach which employed six focus group interviews followed by a thematic analysis. The results revealed four themes; Self-awareness and insights; Behavior and actions in daily practice; Organizational cultures and subcultures; and Organizational practices, using Ken Wilbers' integral theory of four quadrants of realities as a holistic frame in the discussion.

  • 76.
    Jegermalm, Magnus
    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). Department of Social Science, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
    Wilińska, Monika
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Ernsth-Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Bülow, Pia H.
    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. ADULT. Department of Social Work, University of the Free State, Bloemfontein, South Africa.
    Bülow, Per
    Jönköping University, School of Health and Welfare. Ryhov County Hospital, Region Jönköping County, Sweden.
    Torgé, Cristina Joy
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Filling the gaps? The role of voluntary organizations in supporting older people with severe mental illnesses2018In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588Article in journal (Refereed)
    Abstract [en]

    Older people ageing with severe mental illness (SMI) usually fall in between mental health care and old age care services. The role of informal care in filling this gap is recognized. The role of other welfare providers, such as voluntary organizations, is unclear. The aim of this article is to analyze and discuss local voluntary organizations' ability to recognize and respond to the needs of older people with SMI in the community.

    11 local organizations focusing on mental illness, social care or old age were identified in a mid-sized Swedish city. Seven voluntary organizations participated in the study.

    Our analysis revealed three overarching themes: 'Age as a non-issue?', 'Public and voluntary sector (non)links' and 'organizational vulnerabilities'. Our results show that older people with SMI are to some extent also invisible in the voluntary sector. We were also able to discern differences in the 'we-for-us' organizations that provide support for their own members with SMI, and 'we-for-them' organizations that provide help to a broader group.

    Overall, older people with SMI remain a relatively invisible as a group for the voluntary organizations. We discuss these findings in relation to the specificity of the group and welfare contexts of voluntary work in communities.

  • 77.
    Johansson, Linda
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Wijk, Helle
    University of Gothenburg, Sweden.
    Christensson, Lennart
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Health Care Professionals' Usage and Documentation of a Swedish Quality Registry Regarding Preventive Nutritional Care2017In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 26, no 1, p. 15-21Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe health care staff members' usage and documentation in a Swedish quality registry focusing on a preventive care process regarding the risk area of malnutrition among persons with dementia. The preventive care process includes risk assessment, analysis of underlying causes, planning and performing interventions, as well as evaluating effects.

    Methods: Data were collected from 2 Swedish quality registries, Senior Alert and the Swedish Dementia Register (Svedem). In total, 1929 people with dementia were assessed and 1432 registered as being at risk of malnutrition or malnourished.

    Results: Performed nutritional interventions were registered in approximately 65% of cases. In more than 80% of registrations, the analyses of underlying causes were missing. Those who had registered underlying causes had significantly more interventions and the evaluation of the performed intervention was registered. The time between assessment and evaluation depended on care setting and ranged from 0 to 702 days.

    Conclusions: Limitations in registration were noted; however, the register allows staff to focus on nutritional care and has resulted in many risk assessments. Rarely people were registered in all steps of the preventive care process. Large variances in when the performed interventions were evaluated makes it difficult to measure improvements.

  • 78.
    Johansson, Lotta
    et al.
    Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Lindahl, Berit
    Faculty of Caring Science, Work Life and Social Welfare, Borås University College, Sweden.
    Knutsson, Susanne
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Ögren, Mikael
    Department of Occupational and Environmental Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Persson Waye, Kerstin
    Department of Occupational and Environmental Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Ringdal, Mona
    Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Evaluation of a sound environment intervention in an ICU: A feasibility study2018In: Australian Critical Care, ISSN 1036-7314, E-ISSN 1878-1721, Vol. 31, no 2, p. 59-70Article in journal (Refereed)
    Abstract [en]

    Background: Currently, it is well known that the sound environment in intensive care units (ICU) is substandard. Therefore, there is a need of interventions investigating possible improvements. Unfortunately, there are many challenges to consider in the design and performance of clinical intervention studies including sound measurements and clinical outcomes.

    Objectives: (1) explore whether it is possible to implement a full-scale intervention study in the ICU concerning sound levels and their impact on the development of ICU delirium; (2) discuss methodological challenges and solutions for the forthcoming study; (3) conduct an analysis of the presence of ICU delirium in the study group; and (4) describe the sound pattern in the intervention rooms.

    Methods: A quasi-randomized clinical trial design was chosen. The intervention consisted of a refurbished two-bed ICU patient room (experimental) with a new suspended wall-to-wall ceiling and a low frequency absorber. An identical two-bed room (control) remained unchanged.

    Inclusion criteria: Patients >18 years old with ICU lengths of stay (LoS) >48. h. The final study group consisted of 31 patients: six from the rebuilt experimental room and 25 from the control room. Methodological problems and possible solutions were continuously identified and documented.

    Results: Undertaking a full-scale intervention study with continuous measurements of acoustic data in an ICU is possible. However, this feasibility study demonstrated some aspects to consider before start. The randomization process and the sound measurement procedure must be developed. Furthermore, proper education and training are needed for determining ICU delirium.

    Conclusion: This study raises a number of points that may be helpful for future complex interventions in an ICU. For a full-scale study to be completed a continuously updated cost calculation is necessary. Furthermore, representatives from the clinic need to be involved in all stages during the project. 

  • 79.
    Jonasson, Emelie
    et al.
    Jönköping University, School of Engineering, JTH, Product Development.
    Petras, Caitlin
    Jönköping University, School of Engineering, JTH, Product Development.
    Visuellt tillfredställande ljusmiljöer vid nyplanerad belysning på utvalda sjukhusavdelningar2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    The purpose with the report is to contribute with information around how to shape a lighting environment that support well-being. The goal is to show builders that the Swedish lighting standard SS-EN 12464-1 ​Ljus och belysning ​can be fulfilled in a more visually satisfactory manner. ​The study includes general areas of newly built and reconstructed hospitals. Observations at the hospitals take place during the day and do not take the weather into account. ​Builders for different types of projects are interviewed to get an understanding of how lighting design is handled in the construction process.

    The thesis has qualitative methodology where previous research forms the basis for the work, supplemented with observations and interviews. Collection of research on well-being and light environment is the first step in the work. Thereafter two hospitals are observed. Conclusions drawn from previous research and observations are used to make interview questions to the builders.

    Research shows that a satisfactory light environment that promotes well-being is an interplay that forms an ensemble of several factors where light is one of the factors together with architecture, air, sound, furnishing, color, and opportunity for outlook from windows as well as daylight. The two hospitals that have been observed follow to some extent what research shows how light environments should be designed after well-being. Builders think that lighting is an important part of a building and should come in at an early stage. Generally, the builder's does not possess any expertise in the area, thus taking expert assistance for best results. The builders who responded to the interviews in the projects had a basic requirement following the Swedish lighting standard SS-EN 12464-1. ​It is shown that visually satisfactory light environments that promote well-being can partly be created with Swedish lighting standard SS-EN 12464-1. Provided that a lighting designer comes in early in the construction process and may depart from the standard if necessary to create interaction with the other factors in the room that are adapted to human perception.

  • 80. Jones, L.
    et al.
    Pomeroy, L.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, United Kingdom.
    Burnett, S.
    Anderson, J. E.
    Fulop, N. J.
    How do hospital boards govern for quality improvement?: A mixed methods study of 15 organisations in England2017In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 26, no 12, p. 978-986Article in journal (Refereed)
    Abstract [en]

    Background

    Health systems worldwide are increasingly holding boards of healthcare organisations accountable for the quality of care that they provide. Previous empirical research has found associations between certain board practices and higher quality patient care; however, little is known about how boards govern for quality improvement (QI).

    Methods

    We conducted fieldwork over a 30-month period in 15 healthcare provider organisations in England as part of a wider evaluation of a board-level organisational development intervention. Our data comprised board member interviews (n=65), board meeting observations (60 hours) and documents (30 sets of board meeting papers, 15 board minutes and 15 Quality Accounts). We analysed the data using a framework developed from existing evidence of links between board practices and quality of care. We mapped the variation in how boards enacted governance of QI and constructed a measure of QI governance maturity. We then compared organisations to identify the characteristics of those with mature QI governance.

    Results

    We found that boards with higher levels of maturity in relation to governing for QI had the following characteristics: explicitly prioritising QI; balancing short-term (external) priorities with long-term (internal) investment in QI; using data for QI, not just quality assurance; engaging staff and patients in QI; and encouraging a culture of continuous improvement. These characteristics appeared to be particularly enabled and facilitated by board-level clinical leaders.

    Conclusions

    This study contributes to a deeper understanding of how boards govern for QI. The identified characteristics of organisations with mature QI governance seemed to be enabled by active clinical leadership. Future research should explore the biographies, identities and work practices of board-level clinical leaders and their role in organisation-wide QI. 

  • 81.
    Jones, Lorelei
    et al.
    School of Health Sciences, Bangor University, G-Bangor, United Kingdom.
    Pomeroy, Linda
    Department of Applied Health Research, University College London, London, United Kingdom.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
    Burnett, Susan
    Centre for Patient Safety and Service Quality, Imperial College London, London, United Kingdom.
    Anderson, Janet E.
    Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
    Morris, Stephen
    Department of Applied Health Research, University College London, London, United Kingdom.
    Capelas Barbosa, Estela
    Department of Applied Health Research, University College London, London, United Kingdom.
    Fulop, Naomi J.
    Department of Applied Health Research, University College London, London, United Kingdom.
    Explaining organisational responses to a board-level quality improvement intervention: Findings from an evaluation in six providers in the English National Health Service2019In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 28, no 3, p. 198-204Article in journal (Refereed)
    Abstract [en]

    Background: Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis' typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.

    Methods: We conducted fieldwork over a 30-month period as part of an evaluation in six healthcare provider organisations in England. Our data comprised board member interviews (n=54), board meeting observations (24 hours) and relevant documents.

    Results: Two organisations transformed their processes in a way that was consistent with the objectives of the intervention, and one customised the intervention with positive effects. In two further organisations, the intervention was only loosely coupled with organisational processes, and participation in the intervention stopped when it competed with other initiatives. In the final case, the intervention was corrupted to reinforce existing organisational processes (a focus on external regulatory requirements). The organisational response was contingent on the availability of 'slack' - expressed by participants as the 'space to think' and 'someone to do the doing' - and the presence of a functioning board.

    Conclusions: Underperforming organisations, under pressure to improve, have little time or resources to devote to organisation-wide quality improvement initiatives. Our research highlights the need for policy-makers and regulators to extend their focus beyond the choice of intervention, to consider how the chosen intervention will be implemented in public sector hospitals, how this will vary between contexts and with what effects. We provide useful information on the necessary conditions for a board-level quality improvement intervention to have positive effects.

  • 82.
    Karlsson, Henrik
    et al.
    Research and Development Northwest (FoU Nordväst), Sollentuna, Sweden.
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Svendsen, Tore
    Department of Social Work, Stockholm University, Stockholm, Sweden.
    QUAT—a Tool for Evaluating the Quality of Core Assessments in Child-Protection Investigations2018In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263XArticle in journal (Refereed)
    Abstract [en]

    This article presents a quantitative tool for evaluating the documentation quality of core assessments in child-protection investigations called the Quality Assessment of the Triangle (QUAT). QUAT measures compliance with a set of quality standards for working with the Swedish adaptation of the British Integrated Children’s System (ICS), and should be viewed as an attempt to further the UK-led efforts to improve child-protection investigations by promoting research-based documentation systems. This article describes how QUAT was developed and later applied to a random sample of case files provided by the social services in Stockholm City, Sweden, to demonstrate its usability in practice. The contribution of QUAT is two-fold: first, it offers a way for managers to stimulate workplace learning by providing continuous feedback on the documentation and, second, it may help researchers to evaluate the effectiveness of interventions aiming to improve professional performance in terms of documenting child-protection investigations.

  • 83.
    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.

  • 84.
    Karlsson, Susanne
    et al.
    Ear Nose and Throat Clinic, Ryhov County Hospital, Jönköping, Sweden.
    Elfström, Maria
    Ear Nose and Throat Clinic, Ryhov County Hospital, Jönköping, Sweden.
    Sunnergren, Ola
    Ear Nose and Throat Clinic, Ryhov County Hospital, Jönköping, Sweden.
    Fridlund, Bengt
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. ADULT.
    Broström, Anders
    Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. ADULT.
    Decisive situations influencing continuous positive airway pressure initiation in patients with obstructive sleep apnea syndrome – A critical incident technique analysis from the personnel’s perspective2015In: Journal of Hospital Administration, ISSN 1927-6990, E-ISSN 1927-7008, Vol. 4, no 1, p. 16-26Article in journal (Refereed)
    Abstract [en]

    Background: Continuous positive airway pressure is an effective treatment of obstructive sleep apnea syndrome, but adherence to treatment is low. Interventions such as encouragement, education and cognitive behavioural therapy have affected adherence to continuous positive airway pressure treatment positively. Currently there are no studies regarding the situation for personnel during the initiation process of treatment.

    Purpose: The purpose was to describe situations influencing the initiation of continuous positive airway pressure in patients with obstructive sleep apnea syndrome from a personnel perspective.

    Materials and methods: A qualitative approach using critical incident technique was used. Data were collected through semi structured interviews. Thirty one informants were strategically selected from sixteen centres in Sweden.

    Results: Motivation, a prepared patient, communicational aspects and participation of family were described as pedagogical circumstances. External conditions, practical experience, the patient’s state of health and adaption to the mask were described as practical circumstances. The personnel handled the situations in a theoretical, practical and/or an emotional way.

    Conclusions: A better understanding of situations creating barriers or being facilitators, as well as ways to handle these situations, can be used to develop the role of personnel during the initiation process in order to increase continuous positive airway pressure adherence.

  • 85.
    Karltun, Johan
    et al.
    Jönköping University, School of Engineering, JTH, Industrial Engineering and Management.
    Keller, Christina
    Jönköping University, Jönköping International Business School, JIBS, Informatics.
    Vinnvård metastudie: Lärdomar utifrån ett forskningsprogram2012Report (Other academic)
    Abstract [sv]

    Forskningsprogrammet Vinnvård är en gemensam satsning av Vårdalstiftelsen, VINNOVA, Sveriges kommuner och landsting (SKL) och Socialdepartmentet. Syftet med Vinnvård är att genom forskning på lednings- och verksamhetsfrågor bidra till ett effektivt och långsiktigt hållbart vård- och omsorgssystem i Sverige. Programmet omfattar totalt 150 miljoner kronor under perioden 2007-2012. Hittills har två utlysningar genomförts, 2006 och 2008.

    Denna rapport är en dokumentation av en metastudie av forskningsprojekten i Vinnvård, som erhöll medel i utlysningarna 2006 ooch 2008. Forskningsuppdragets mål var att fånga lärandet i projekten och hitta framgångsrika angreppssätt för att nå de fyra syften eller mål som var utgångpunkter för programmet:

    1. Öka nyttiggörandet av kvalitetssäkrad kunskap i vård och omsorg

    2. Utveckla innovativ arbetsorganisation i vård och omsorg

    3. Stimulera framväxten av institutionella lärandestrukturer kring vård- och omsorgspraktikens lednings- och verksamhetsfrågor

    4. Etablera forskning om vård- och omsorgspraktikens lednings- och verksamhetsfrågor vid svenska universitet och högskolor

    Metoden för datainsamling har varit strukturerade intervjuer enligt den frågeguide som utarbetades för studien (se bilaga 1) kompletterat med skriftliga kommentarer från forskningsledarna.

    Mål 1 och 2 ansågs vara mycket viktiga av samtliga forskningsledare och var det som motiverade att projekten genomfördes. Mål 3 upplevdes som mer oklart och tolkades på flera olika sätt av forskningsledarna. Mål 4 sågs som en naturlig följd av och en förutsättning för att forskningsprojekten skulle kunna genomföras. Sambanden mellan de två första målen upplevdes som starkast men samtliga mål betraktades som väl sammanhållna och kompletterande.

    De studerade forskningsprojekten utgör en provkarta på olika ansatser och angreppssätt. Här finns exempel på aktionsforskning, interaktiv forskning, följeforskning och interventionsforskning. Vissa projekt har genomfört och beforskat interventioner direkt i vård och omsorg, medan andra projekt har fokuserat på att förbättra förutsättningarna för att genomföra interventioner. Samtliga forskningsprojekt har enligt vår bedömning varit framgångsrika. Resultaten spänner över många olika områden och organisatoriska nivåer. Alla projekt har också producerat flera olika typer av resultat uppdelat på produkter, metoder, arbetssätt, styrsystem och lärande. I minst tre fall har nya starka akademiska forskningsmiljöer inom området etablerats som en följd av Vinnvårds satsning. En av de framgångsfaktorer som framträder tydligast är att tidigt etablera eller att vid projektets start ha ett etablerat kontaktnät för att förankra forskningsresultaten i den verksamhet som berörs eller skall förändras.

    Mot bakgund av detta resultat ser vi en potential i fördjupade studier kring forskningsledarens roll och om hur aktörer från dessa verksamheter har upplevt forskningsprojekten och resultaten och en sammanhållen fördjupad dokumentation av forskningsprogrammet i form av en tematisk antologi.

  • 86.
    Karolina, Nord
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Att leva inte bara existera: Att arbeta personcentrerat med sociala aktiviteter på ett äldreboende2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: A quality improvement project was started to provide person-centered care through personalized social activities.

    The specific aim was to systematically offer residients person-centered care through personalized social activities minimum once a week.

    The aim of the study was to describe staff's views on learning and improvements both for the residents an in their work situation.

    Method: The improvement model was used throughout the improvement project. A tool to measure the number of activities in a simple and illustrative way was developed. The case study was conducted through open questions that the staff answered in writing. The material was then analyzed using qualitative content analysis.

    Results: The results have been going up consistently throughout the whole measuring period. All three sections at the nursing home have implemented new routines and structure for planning the day. The instrument to measure the number of social activities called "Blomman" is now also functioning as a planning tool. Boxes for Reminiscence and lockers with items and various tools for social activities have been installed.

    The quality improvement gave improvements in the wellbeing of the residents. The staff describes residents as calmer, less stressed and that they express less loneliness. The staff also desbride that they have gotten to know the residents better. The results also show that staff is more satisfied by providingt person-centered care. They work better as a team and have more order and structure and results show a general improvement in the work environment.

    Conclusion: Implementing routines and structure for planning can be a way of getting more time for the staff to provide more person-centered care. This can be done by individualizing social activities so that they correspond to the residents' needs and interests. To be successful it is essential to have support from the management for a project like this and to be able to support the staff throughout the change process.

  • 87.
    Keller, Christina
    Jönköping University, Jönköping International Business School, JIBS, Business Informatics.
    Vinnvård metastudie2012Conference paper (Other academic)
  • 88.
    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.

  • 89.
    Kilander, Helena
    et al.
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Berterö, Carina
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Brynhildsen, Jan
    Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Alehagen, Siw
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Women's experiences of contraceptive counselling in the context of an abortion – An interview study2018In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 17, p. 103-107Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 90.
    Kilander, Helena
    et al.
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Salomonsson, Birgitta
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden .
    Thor, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Brynhildsen, Jan
    Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden .
    Alehagen, Siw
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden .
    Contraceptive counselling of women seeking abortion – a qualitative interview study of health professionals’ experiences2017In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 22, no 1, p. 3-10Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 91.
    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.

  • 92.
    Kjellström , Sofia
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Idéer om ansvar för hälsa: forskning och metoder utifrån ett vuxenlivsutvecklingsperspektivManuscript (Other scientific)
  • 93.
    Kjellström, Sofia
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Människors olika komplexa förhållningssätt till hälsa och ansvar2008Conference paper (Other academic)
  • 94.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Applying adult development theories to improvement science2017In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 30, no 7, p. 617-627Article in journal (Refereed)
    Abstract [en]

    Purpose

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

    Design/methodology/approach

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

    Findings

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

    Practical implications

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

    Originality/value

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

  • 95.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson Bäck, Monica
    Gothenburg University.
    Financial incentives and motivation: "What we do is the same but how we do it is different"2016Conference paper (Other academic)
    Abstract [en]

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

  • 96.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    University of Gothenburg.
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Leadership as a driver for work motivation: a study of well-functioning primary healthcare centers in Sweden2017Conference paper (Refereed)
    Abstract [en]

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

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

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

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

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

  • 97.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    University of Gothenburg.
    Research on successful and well-functioning organizations: The role of qualitative studies for theoretical and practical use. Workshop.2017Conference paper (Refereed)
    Abstract [en]

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

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

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

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

  • 98.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Areskoug Josefsson, Kristina
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    Department of Social Work, University of Gothenburg, Gothenburg, Sweden.
    De komplexa drivkrafterna inom vård och omsorg - en fallstudie av finansiella incitament och dess konsekvenser ur ett arbetsmiljöperspektiv: Slutrapport2017Report (Other academic)
    Abstract [sv]

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

  • 99.
    Kjellström, Sofia
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Sjölander, Per
    Arctic Research Centre, Umeå University, Umeå, Sweden.
    Almers, Ellen
    Jönköping University, School of Education and Communication, HLK, School Based Research, Sustainable Development and Science education.
    McCall, Mary E.
    Samuel Merritt University, USA.
    Value systems among adolescents: Novel method for assessing level of ego-development2017In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 58, no 2, p. 150-157Article in journal (Refereed)
    Abstract [en]

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

  • 100.
    Knighton, Andrew J.
    et al.
    Intermountain Institute for Health Research, Intermountain Healthcare, Salt Lake City, UT, United Statesthcare Delivery Rese.
    Kristiansson, Robert S.
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Habilitation Services, Uppsala County, Uppsala, Sweden.
    Belnap, Tom
    Intermountain Institute for Health Research, Intermountain Healthcare, Salt Lake City, UT, United States.
    Daneryd, Peter
    Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Intermountain Institute for Health Research, Intermountain Healthcare, Salt Lake City, UT, United States.
    From the Intermountain Institute for Health Care Delivery Research2017In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 26, no 1, p. 51-52Article in journal (Refereed)
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