| 5661. |
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| 5662. |
- Grek, Jenny, 1982-, et al.
(författare)
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The Digital Divide in Sweden
- 2009
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Ingår i: Uddevalla Symposium 2009: The Geography of Innovation and Entrepreneurship. - Trollhättan : University West. - 9789163355714 ; , s. 509-524
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Bokkapitel (refereegranskat)abstract
- A new technology gradually spreads into a population. When only some individuals use a new technology, we have a technological divide. All citizens should be able to perform their duties and exercise their rights. From a policy point of view, it is of clear interest to find out if the introduction of a new technology leaves some persons behind. In this paper, we present information about the internet use in Sweden 2000 and 2006 by category. We find evidence of a digital divide for both years. By comparing the two years, we find that the digital divide got smaller during this period. We present forecasts for the use of internet and the outcome is that the digital divide will be negligible around 2050. The analysis clearly identifies the characteristics related to lagging behind. In that way, the digital divide is an easy policy target.There are two distinctly different ways to handle the digital divide. The first is simply to accept the situation as it is. If some persons pay their bills over the internet and others pay in the traditional way, both systems have to be functional. The second is to close down all traditional systems. Then many persons will not be able to participate in the democracy in a complete way. This could be solved by giving individuals with certain characteristics a computer, internet connections, schooling, and all technical support needed (including getting it all to work). Obviously, it is also an option to choose a midway policy.
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| 5663. |
- Gremyr, Andreas, et al.
(författare)
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A learning health system for people with severe mental illness : a promise for continuous learning, patient coproduction and more effective care
- 2019
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Ingår i: Digital Psychiatry. - : Taylor & Francis. - 2575-517X. ; 2:1, s. 8-13
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Tidskriftsartikel (refereegranskat)abstract
- A Learning Health System (LHS) promotes the patient being at the very center of his or her care. Patient coproduction of care in an LHS is enabled by a focus on improving outcomes through the use of tools and visualizations that use the harnessed knowledge obtained from every previous treatment of similar patients. Interest in the concept of LHS is growing, and there are promising results in real-world applications. Almost no research has focused on LHSs for severe mental illness (LHS4SMI). By using a user-centered system design approach, a persona and use-case scenarios were created to illustrate how schizophrenia care could be co-produced in an LHS compared to standard care in a non-LHS. The illustration highlight increased participation through decisions informed by all treatments for all similar patients through the use of user interfaces that support continuous evaluation, increased understanding, compensation for cognitive impairment and participation of next of kin in the care process. We propose that an LHS4SMIs like schizophrenia has enormous potential in enabling continuous learning, patient coproduction, and more effective care.
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| 5664. |
- Gremyr, Andreas, et al.
(författare)
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How a Point-of-Care Dashboard Facilitates Co-production of Health Care and Health for and with Individuals with Psychotic Disorders : A Mixed-methods Case Study
- 2022
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Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 22
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIndividuals with psychotic disorders experience widespread treatment failures and risk early death. Sweden’s largest department specializing in psychotic disorders sought to improve patients’ health by developing a point-of-care dashboard to support joint planning and co-production of care. The dashboard was tested for 18 months and included more than 400 patients at two outpatient clinics.MethodsThis study evaluates the dashboard by addressing two questions:Can differences in health-related outcome measures be attributed to the use of the dashboard?How did the case managers experience the accessibility, use, and usefulness of the dashboard for co-producing care with individuals with psychotic disorders? This mixed-method case study used both Patient-Reported Outcome Measures (PROM) and data from a focus group interview with case managers. Data collection and analysis were framed by the Clinical Adoption Meta Model (CAMM) phases: i) accessibility, ii) system use, iii) behavior, and iv) clinical outcomes. The PROM used was the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0), which assesses functional impairment and disability. Patients at clinics using the dashboard were matched with patients at clinics not using the dashboard. PROM data were compared using non-parametric statistics due to skewness in distribution. The focus group included five case managers who had experience using the dashboard with patients.ResultsCompared to patients from clinics that did not use the dashboard, patients from clinics that did use the dashboard improved significantly overall (p = 0.045) and in the domain self-care (p = 0.041). Focus group participants reported that the dashboard supported data feedback-informed care and a proactive stance related to changes in patients’ health. The dashboard helped users identify critical changes and enabled joint planning and evaluation.ConclusionDashboard use was related to better patient health (WHODAS scores) when compared with matched patients from clinics that did not use the dashboard. In addition, case managers had a positive experience using the dashboard. Dashboard use might have lowered the risk for missing critical changes in patients’ health while increasing the ability to proactively address needs. Future studies should investigate how to enhance patient co-production through use of supportive technologies.
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| 5665. |
- Gremyr, Andreas, et al.
(författare)
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The role of co-production in Learning Health Systems
- 2021
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 33:Supplement 2, s. ii26-ii32
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Co-production of health is defined as 'the interdependent work of users and professionals who are creating, designing, producing, delivering, assessing, and evaluating the relationships and actions that contribute to the health of individuals and populations'. It can assume many forms and include multiple stakeholders in pursuit of continuous improvement, as in Learning Health Systems (LHSs). There is increasing interest in how the LHS concept allows integration of different knowledge domains to support and achieve better health. Even if definitions of LHSs include engaging users and their family as active participants in aspects of enabling better health for individuals and populations, LHS descriptions emphasize technological solutions, such as the use of information systems. Fewer LHS texts address how interpersonal interactions contribute to the design and improvement of healthcare services.OBJECTIVE: We examined the literature on LHS to clarify the role and contributions of co-production in LHS conceptualizations and applications.METHOD: First, we undertook a scoping review of LHS conceptualizations. Second, we compared those conceptualizations to the characteristics of LHSs first described by the US Institute of Medicine. Third, we examined the LHS conceptualizations to assess how they bring four types of value co-creation in public services into play: co-production, co-design, co-construction and co-innovation. These were used to describe core ideas, as principles, to guide development.RESULT: Among 17 identified LHS conceptualizations, 3 qualified as most comprehensive regarding fidelity to LHS characteristics and their use in multiple settings: (i) the Cincinnati Collaborative LHS Model, (ii) the Dartmouth Coproduction LHS Model and (iii) the Michigan Learning Cycle Model. These conceptualizations exhibit all four types of value co-creation, provide examples of how LHSs can harness co-production and are used to identify principles that can enhance value co-creation: (i) use a shared aim, (ii) navigate towards improved outcomes, (iii) tailor feedback with and for users, (iv) distribute leadership, (v) facilitate interactions, (vi) co-design services and (vii) support self-organization.CONCLUSIONS: The LHS conceptualizations have common features and harness co-production to generate value for individual patients as well as for health systems. They facilitate learning and improvement by integrating supportive technologies into the sociotechnical systems that make up healthcare. Further research on LHS applications in real-world complex settings is needed to unpack how LHSs are grown through coproduction and other types of value co-creation.
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| 5666. |
- Gremyr, Andreas, et al.
(författare)
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Using Complexity Assessment to Inform the Development and Deployment of a Digital Dashboard for Schizophrenia Care: Case Study
- 2020
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 22:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health care is becoming more complex. For an increasing number of individuals, interacting with health care means addressing more than just one illness or disorder, engaging in more than one treatment, and interacting with more than one care provider. Individuals with severe mental illnesses such as schizophrenia are disproportionately affected by this complexity. Characteristic symptoms can make it harder to establish and maintain relationships. Treatment failure is common even where there is access to effective treatments, increasing suicide risk. Knowledge of complex adaptive systems has been increasingly recognized as useful in understanding and developing health care. A complex adaptive system is a collection of interconnected agents with the freedom to act based on their own internalized rules, affecting each other. In a complex health care system, relevant feedback is crucial in enabling continuous learning and improvement on all levels. New technology has potential, but the failure rate of technology projects in health care is high, arguably due to complexity. The Nonadoption, Abandonment, and challenges to Scale-up, Spread, and Sustainability (NASSS) framework and complexity assessment tool (NASSS-CAT) have been developed specifically to help identify and manage complexity in technology-related development projects in health care. Objective: This study aimed to use a pilot version of the NASSS-CAT instrument to inform the development and deployment of a point-of-care dashboard supporting schizophrenia care in west Sweden. Specifically, we report on the complexity profile of the project, stakeholders' experiences with using NASSS-CAT, and practical implications. Methods: We used complexity assessment to structure data collection and feedback sessions with stakeholders, thereby informing an emergent approach to the development and deployment of the point-of-care dashboard. We also performed a thematic analysis, drawing on observations and documents related to stakeholders' use of the NASSS-CAT to describe their views on its usefulness. Results: Application of the NASSS framework revealed different types of complexity across multiple domains, including the condition, technology, value proposition, organizational tasks and pathways, and wider system. Stakeholders perceived the NASSS-CAT tool as useful in gaining perspective and new insights, covering areas that might otherwise have been neglected. Practical implications derived from feedback sessions with managers and developers are described. Conclusions: This case study shows how stakeholders can identify and plan to address complexities during the introduction of a technological solution. Our findings suggest that NASSS-CAT can bring participants a greater understanding of complexities in digitalization projects in general.
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| 5667. |
- Gremyr, Ida, 1975, et al.
(författare)
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Adapting the Robust Design Methodology to support sustainable product development
- 2014
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Ingår i: Journal of Cleaner Production. - : Elsevier. - 0959-6526 .- 1879-1786. ; 79, s. 231-238
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Tidskriftsartikel (refereegranskat)abstract
- Research on product development has pointed to a challenge in integrating sustainability considerations into existing engineering practices rather than adding additional sets of practices and tools. The question is what practices are suitable for consideration? One set of practices and tools, deemed suitable due to its focus on long-term impacts and customer focus, is Quality Management. Within this area, the Robust Design Methodology has a historic connection to sustainability vis-à-vis quality loss caused by a product not only to an individual customer, but to society at large. Hence, there appears to be a neglected connection to the sustainability area. This paper explores how efforts based on the Robust Design Methodology may better contribute to sustainability and, more specifically, to sustainable product development. This paper reviews earlier Robust Design Methodology case studies that reveal how it supports sustainability. However, the reviews also reveal that efforts so far have focused only on the manufacturing and use phases of a product's lifecycle. Hence, adaptations of the methodology are needed, such as more conceptual and qualitative tools and explicit inclusion of eco-design indicators as a response variable in, for example, Design of Experiments. Adapting the Robust Design Methodology enables meeting the key aspects of an eco-design tool: addressing early integration of environmental aspects in development processes, having a lifecycle approach, and being a multi-criteria approach.
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| 5668. |
- Gremyr, Ida, 1975, et al.
(författare)
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Blueprinting construction logistics services for quality improvement
- 2023
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Ingår i: Construction Management and Economics. - : Informa UK Limited. - 1466-433X .- 0144-6193. ; 41:1, s. 60-78
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Tidskriftsartikel (refereegranskat)abstract
- Construction logistics services can, if implemented with high quality, positively impact both efficiency and sustainability of construction projects. However, present quality management frameworks have not been developed for temporary multi-actor contexts, such as construction, which is largely lacking industrialised processes. Still, construction logistics service providers provide service offerings to temporary settings and could thus benefit from a service quality perspective. Applying this perspective, this study supports the quality improvement of construction logistics services by using a service modularity approach to identify the services to prioritise for improvement. Building on interviews, concept mapping, and a service blueprint of a construction logistics setup, a priority matrix for improvements is developed. The first step in using this matrix is to operationalise the construction logistics setup in modules based on blueprinting. Second, the matrix evaluates the modules against nine empirically derived improvement enablers such as practices and forums for learning, and data measurements enabling the comparison and followup of construction logistics services. In conclusion, the priority matrix helps focus the improvements on modules with high likelihood of successful improvements. Improvements that can become sustained over time through the reuse of standardised modules in upcoming projects.
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| 5669. |
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| 5670. |
- Gremyr, Ida, 1975, et al.
(författare)
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Robust Design Methodology for Sustainability
- 2012
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Ingår i: IIE Asia 2012, June 28-30, Singapore.
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Konferensbidrag (refereegranskat)abstract
- A key principle in Quality Management (QM) is customer focus and much research has aimed at techniques supportive of this principle. One example of a research area within QM focused on developing such techniques is Robust Design Methodology (RDM). Taguchi, an early proponent of robust design defined quality in a way that differs from others, i.e. as loss to the society caused by the product, thus not being restricted to an individual customer. Today, this definition seems to be well in line with the sustainability challenges in all disciplines. Thus, it is time to enhance RDM to again focus on preventing losses to the society and thereby contribute to sustainability. The purpose of this paper is to explore how RDM may support Sustainable Product Development (SPD) and thus propose a research agenda for enhancing quality practices towards sustainability. The house of quality is used as a research instrument; identifying linkages between RDM and SPD. Some examples of the findings include the strong relationship between clean manufacturing and all RDM strategies, and the need to broaden the scope of traditional RDM with respect to material use. Finally, a future research agenda towards RDM for sustainability is proposed.
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