| 240411. |
- Norman, Ann-Charlott, 1965-
(författare)
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The Implicit or Explicit Character of Negotiation: how Quality Improvements are discussed in Communities of Practicein Health Care.
- 2013
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundClinical Microsystem theory underlines the importance of doing improvements both in and between communities. The design and improvements of each clinical microsystem is as important as the pathway between microsystems. But how are uniform or differentiated standards negotiated in a community of practice compared to a network of practices?AimThe aim was to analyze discursive differences in the negotiation depending on whether practices were shared or differentiated. The study analyzed the interactive negotiation in a tightly coupled Community of practice compared with a loosely coupled Network of practices, with an interest of investigating what kind of pedagogical support different improvement groups need.MethodObservations of quality improvement conversations were made at an orthopedic- and rheumatology clinic in Sweden. A clinical ward meeting represents a tightly coupled Community of practice and a process team represents a loosely coupled network of practices. Critical discourse analysis was used and the social learning theory Communities of practice was the theoretical framework that explained the findings.FindingsThe analysis showed that the most important difference between a tightly coupled community of practice and loosely coupled network of practices is the explicit character of the negotiation. At the clinical ward meeting standards and traditional hierarchy were taken for granted and not explicitly negotiated. Initiatives of change had no impact because new standards were not discursively valued compared with old ones. In contrast to the ward meeting, the team had to negotiate and explain old standards as well as new ones because of the unfamiliar relation to each other. As they argued they mutually found out new meanings, and new solutions that could be more valuable for patients.DiscussionGiven the discursive perspective, the study shows that in the interface between adaptation and change the negotiation needs to be explicit if change is going to happen. This explicit improvement negotiation was more easily done in a differentiated practice which contradicts other research of Communities of practice in health care. Anglo-Saxon research has shown the difficulties of learning and change in networked practices because of rivalry between professionals or specialties. One explanation could be differences in culture between Swedish and Anglo-Saxon hierarchies in health care which has to be considered in future Community of practice analyzes.Practical implicationsThe study indicates that external coaches of improvement work could be useful in tightly coupled communities of practice. An external coach can help the community create awareness of taken for granted issues and support an explicit negotiation.
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| 240412. |
- Norman, Ann-Charlott, 1965-, et al.
(författare)
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The role of professional logics in quality register use: a realist evaluation
- 2020
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Background Clinical practice improvements based on quality-register data are influenced by multiple factors. Although there is agreement that information from quality registers is valuable for quality improvement, practical ways of organising register use have been notoriously difficult to realise. The present study sought to investigate the mechanisms that lead various clinicians to use quality registers for improvement. Methods This research involves studying individuals’ decisions in response to a Swedish programme focusing on increasing the use of quality registers. Through a case study, we focused on heart failure care and its corresponding register: the Swedish Heart Failure Register. The empirical data consisted of a purposive sample collected longitudinally by qualitative methods between 2013 and 2015. In total, 18 semi-structured interviews were carried out. We used realist evaluation to identify contexts, mechanisms, and outcomes. Results We identified four contexts – registration, use of output data, governance, and improvement projects – that provide conditions for the initiation of specific mechanisms. Given a professional theoretical perspective, we further showed that mechanisms are based on the logics of either organisational improvement or clinical practice. The two logics offer insights into the ways in which clinicians choose to embrace or reject certain registers’ initiatives. Conclusions We identified a strong path dependence, as registers have historically been tightly linked to the medical profession’s competence. Few new initiatives in the studied programme reach the clinical context. We explain this through the lack of an organisational improvement logic and its corresponding mechanisms in the context of the medical profession. Implementation programmes must understand the logic of clinical practice; that is, be integrated with the ways in which work is carried out in everyday practice. Programmes need to be better at helping core health professionals to reach the highest standards of patient care.
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| 240413. |
- Norman, Ann-Charlott, 1965-
(författare)
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To go beyond knowledge transfer problems – a participatory research effort
- 2010
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundIn healthcare numerous implementation efforts are made to integrate new knowledge in practice. Some even say that future medical breakthroughs are more dependent on how fortunate these integrating processes are than of the medical research itself (Calltorp et al, 2006). Bridging the Gap is a Vinnvård-financed researchproject which is contributing with deeper understanding about how healthcare systems can acquire new knowledge in practice. The project intends to do the knowledgeproduction and the application at the same time in a participatory research effort to go beyond knowledge transfer problems. Pedagogical and sociological communicative theories support that application interests are constitutive of the knowledge production process and not just related to subsequent forms of the same (Fritzell, 2006).AimThe purpose of an ongoing subproject of Bridging the Gap is to study learning processes in daily activities that aims for increased value for patients in terms of quality improvement.MethodsThe subproject is interdisciplinary conducted with researchers from both a pedagogical and a technical research field. Observations were made to collect data of how the personnel discussed findings and interventions from their registered measurements. The participatory actions with the clinic were planned as three learning seminars building on the model of Ellström (2008) and Fritzell (2003).ResultsThe first seminar led to fruitful discussion about the problematization of the study and it pointed out the research questions more distinctively. At the second seminar reflections from the data collection were discussed without having it analysed yet just to make sure we were on track together. The researchers benefitted from having the data validated and the practitioners from reflecting about how they can do immediate changes to improve in practice. At the conference in the beginning of may the results from the study and an evaluation of the methodological participatory effort can be presented.ReferencesCalltorp, J., Johansson, A. och Maathz, G. (2006). Kunskapsbaserad ledning, styrning och utveckling inom hälso- och sjukvården. Stockholm: Sveriges kommuner och landsting.Ellström, P-E. (2008). Knowledge Creation Through Interactive Research: A Learning Approach. Paper presented at the ECER Conference, September 10-12 2008, Göteborg.Fritzell, C. (2003). Towards deliberative relationships between pedagogic theory and practice. Nordisk pedagogik, nr 2 (2003), s. 93-103.Fritzell, C. 2006. On the Reconstruction of Educational Science. Educational Philosophy and Theory, vol 28, no 2, 2006.
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| 240414. |
- Norman, Ann-Charlott, 1965-
(författare)
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To go beyond knowledge transfer problems - an evaluation of a participatory research effort
- 2010
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- IntroductionIn healthcare numerous implementation efforts are made to integrate new knowledge in practice. Some even say that future medical breakthroughs are more dependent on how fortunate these integrating processes are than of the medical research itself. Bridging the Gap is a Vinnvård-financed research project which is contributing with deeper understanding about how healthcare systems can acquire new knowledge in practice. The project intends to do the knowledge production and the application at the same time in a participatory research effort to go beyond knowledge transfer problems. Pedagogical and sociological communicative theories support that application interests are constitutive of the knowledge production process and not just related to subsequent forms of the same. The purpose is to evaluate the participatory research effort of an ongoing subproject of Bridging the Gap which studies learning processes in daily activities that aims for increased value for patients in terms of quality improvement.MethodObservations were made to collect data of how the personnel discussed findings and interventions from their registered measurements. The participatory actions were planned as three learning seminars.ResultsThe first seminar pointed out the research questions more distinctively. At the second seminar the researchers benefitted from having the data validated and the practitioners from reflecting about how they can do immediate changes to improve practice. At the third seminar a contextual interpretation and conceptualization was made of the analysed data. The research process went beyond validating the data to a collaborative knowledge production of the same.ConclusionWith a participatory research effort the researcher can take advantage of the masseducated professionals in healthcare in the knowledge production. There is a win-win situation by using learning seminars in the research process; the practice make use of the researchers’ observations at the same time as the researchers validate their data. But what is actually happening is not just a mutual consultation but also a constitutive knowledge production process between researchers and practitioners.
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| 240415. |
- Norman, Ann-Charlott, 1965-
(författare)
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Towards the creation of learning improvement practices : Studies of pedagogical conditions when change is negotiated in contemporary healthcare practices
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the early 2010s, competitive market logic was introduced into healthcare systems so as to achieve rapid improvements. This took place as improvement policies began to emphasize the notion of collaboration as a method of ensuring patient safety across organizational boundaries. This thesis addresses how staff, in their practical improvement work, balance economic values, on the one hand, against meaningful solutions for the patient, on the other. The research interest focuses on the particular interpretations about improvements that emerge in negotiations about change. These interpretations are foundational to the learning that simultaneously takes place. The aim of the thesis is to analyse and explain the pedagogical conditions that take place in improvement practices in a healthcare system in the 2010s.The thesis takes its theoretical point of departure in a pedagogical theory that describes how contextual conditions influence learning processes in a specific practice where communication is foundational for learning. The thesis uses critical discourse analysis as a methodological point of departure and builds on a model of improvement work, namely, the clinical microsystem. The first study consists of a literature review of the microsystem framework. Subsequently, three case studies were conducted at Jönköping county council, Sweden. Discussions of improvements at clinical meetings and improvement coaches’ reflections over their pedagogical approaches provide the empirical data for the case studies.The findings show that market logic gives rise to a number of displacement effects with respect to learning processes. Short-term profits are shown to supersede goals of a more profound development of knowledge. The composition of an improvement practice is of critical importance to the nature of the negotiation that takes place, and thus how the practice comes to successfully challenge things that are taken for granted and the power structures that exist within the practice. Improvement coaches themselves become pedagogical prerequisites under the influence of the prevailing conditions, as they promote different learning organizations. This thesis develops the conceptual framework that is instantiated by the clinical microsystem, and it also contributes to the social constructionist field of improvement science by establishing pedagogical and discursive perspectives on improvement and change.
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| 240416. |
- Norman, Armando H., et al.
(författare)
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The Quality and Outcomes Framework : Body commodification in UK General Practice
- 2016
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 170, s. 77-86
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Tidskriftsartikel (refereegranskat)abstract
- The UK's Quality and Outcomes Framework (QOF) is the largest pay-for-performance scheme in the world. This ethnographic study explored how QOF's monetary logic influences the approach to healthcare in UK general practice. From August 2013 to April 2014, we researched two UK general practice surgeries and one general practice training programme. These environments provided the opportunity for studying various spaces such as QOF meetings, consultation rooms, QOF recoding sessions, and the collection of computer-screen images depicting how patients' biomarkers are evaluated and costed through software systems. QOF as a biomedical technology has led to the commodification of patients and their bodies. This complex phenomenon breaks down into three main themes: commodification of patients, QOF as currency, and valuing commodities. Despite the ostensible aim of QOF being to improve healthcare in general practice, it is accompanied by a body commodification process. The interface between patients and care providers has been commodified, with QOF's pricing mechanism and fragmentation of care provision performing an important role in animating the UK economy.
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| 240417. |
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| 240418. |
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| 240419. |
- Norman, Johan, et al.
(författare)
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Influence of outdoor recreation on self-rated human health: comparing three categories of Swedish recreationists
- 2010
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Ingår i: Scandinavian Journal of Forest Research. - : Informa UK Limited. - 0282-7581 .- 1651-1891. ; 25, s. 234-244
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated the relationship between self-rated human health and outdoor recreation, comparing three categories of Swedish outdoor recreationists. Data were obtained from three different surveys, concerning outdoor recreation in all of Sweden, outdoor recreation in southern Swedish forests and hunting in all of Sweden. The influence of outdoor recreation on health was measured by comparing self-rated health in the current situation with a hypothetical situation where the possibility for outdoor recreation was suggested to be removed. The removal resulted in a reduction of average self-rated health in all three samples. The average reduction was significantly different between the samples. The results in this paper suggest that methods usually used in medical research can also be useful in the context of measuring the influence of outdoor recreation on human health.
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| 240420. |
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