1.
Kjellström, Sofia, 1970-, et al.
(författare)
Work motivation among healthcare professionals: A study of well-functioning primary healthcare centers in Sweden.
2017
Ingår i: Journal of Health Organization and Management [1477-7266]. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 31:4, s. 487 -502
Tidskriftsartikel (refereegranskat) abstract
Abstract Purpose – The purpose of this paper is to explore work motivation among professionals at well-functioningprimary healthcare centers subject to a national healthcare reform which include financial incentives. Design/methodology/approach – Five primary healthcare centers in Sweden were purposively selectedfor being well-operated and representing public/private and small/large units. In total, 43 interviews werecompleted with different medical professions and qualitative deductive content analysis was conducted. Findings – 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 non-hierarchical collaboration, and systematicquality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. Practical implications – 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. Social implications – The design of the reforms and leadership are essential preconditions for work motivation. Originality/value – The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.
2.
Areskoug Josefsson, Kristina, 1973-, et al.
(författare)
Workers' experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study
2018
Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 36:4, s. 406-414
Tidskriftsartikel (refereegranskat) abstract
Objective: Staff experiences of healthy work environment (HWE) indicators at primary care units can assist in understanding why some primary care units function better than others. The aim of the study was to create increased understanding of how workers experienced HWE indicators at well-functioning primary care units. Design: Fifty in-depth interviews with staff at six primary care units in Sweden were analysed with deductive content analysis, revisiting a systematic review of HWE indicators. Results: The study presents additional perspectives on staff experiences of HWE indicators at well-functioning primary care units. The included primary care units (PCU) shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges. Staff at the included PCUs were encouraged to work to create and sustain a HWE, but each domain (indicator) also provided challenges that the staff and organisation needed to meet. The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work. Conclusions: Both managers and staff are encouraged to actively work not only to create and sustain an HWE but also to promote organisational virtuousness, employee commitment, joy at work and to increase the performance at work, which is of benefit to staff, patients and society.
3.
Kjellström, Sofia, 1970-, et al.
(författare)
A dialogue map of leader and leadership development methods : A communication tool
2020
Ingår i: Cogent Business & Management. - : Cogent OA. - 2331-1975. ; 7:1
Tidskriftsartikel (refereegranskat) abstract
The dialogue map is a new pedagogical framework that provides an overview of leader and leadership development methods and is designed to facilitate dialogues about how to promote leadership development. The aim was to create and test a dialogue map. This was accomplished through an iterative process using the literature, experts on leadership development, 45 interviews, 16 questionnaire responses and 6 workshops in three large organizations with managers, professionals and human resources experts. The dialogue map is designed as a table with five categories: developmental relationships, developmental assignments, feedback-intensive processes, education and self-development activities. Each category consists of individual leader development methods and collective leadership development methods. Thirty three methods are presented. The pilot test showed that the dialogue map increased awareness about available methods and enabled more deliberate choices regarding development activities. The dialogue map contributes by providing a systematic overview of collective leadership development, not only individual leadership development. Leadership development becomes more democratized because it focuses on activities that can be done in daily work, inside and outside work, at both an individual and collective level.
4.
Avby, Gunilla, 1965-, et al.
(författare)
Tending to innovate in Swedish primary health care: a qualitative study
2019
Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 19
Tidskriftsartikel (refereegranskat) abstract
BackgroundPolicymakers in many countries are involved in system reforms that aim to strengthen the primary care sector. Sweden is no exception. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as innovation. The study was performed in relation to the introduction of a national health care reform, and conducted in Jonkoping County Council, as the region's handling of health care reforms has attracted significant national and international interest. This study employed success case method to explore what enables primary care innovations.MethodsFive Primary Health Care Centres (PHCCs) were purposively selected to ensure inclusion of a variety of aspects, such as size, location, ownership and regional success criteria. 48 in-depth interviews with managers and staff at the recruited PHCCs were analysed using content analyses. The COREQ checklist for qualitative studies was used to assure quality standards.ResultsThis study identified three types of innovations, which break with previous ways of organizing work at these PHCCs: (1) service innovation; (2) process innovation; and (3) organizational innovation. A learning-oriented culture and climate, comprising entrepreneurial leadership, cross-boundary collaboration, visible and understandable performance measurements and ability to adapt to external pressure were shown to be advantageous for innovativeness.ConclusionsThis qualitative study highlights critical features in practice that support primary care innovation. Managers need to consistently transform and integrate a policy push with professionals' understanding and values to better support primary care innovation. Ultimately, the key to innovation is the professionals' engagement in the work, that is, their willingness, capability and opportunity to innovate.
5.
Nordin, Annika, et al.
(författare)
Measurement and outcomes of co-production in health and social care : A systematic review of empirical studies
2023
Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:9
Forskningsöversikt (refereegranskat) abstract
Background: Co-production is promoted as an effective way of improving the quality of health and social care but the diversity of measures used in individual studies makes their outcomes difficult to interpret.Objective: The objective is to explore how empirical studies in health and social care have described the outcomes of co-production projects and how those outcomes were measured.Design and methods: A scoping review forms the basis for this systematic review. Search terms for the concepts (co-produc∗ OR coproduc∗ OR co-design∗ OR codesign∗) and contexts (health OR 'public service∗ OR "public sector") were used in: CINAHL with Full Text (EBSCOHost), Cochrane Central Register of Controlled trials (Wiley), MEDLINE (EBSCOHost), PsycINFO (ProQuest), PubMed (legacy) and Scopus (Elsevier). There was no date limit. Papers describing the process, original data and outcomes of co-production were included. Protocols, reviews and theoretical, conceptual and psychometric papers were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The Mixed Methods Appraisal Tool underpinned the quality of included papers.Results: 43 empirical studies were included. They were conducted in 12 countries, with the UK representing >50% of all papers. No paper was excluded due to the Mixed Methods Quality Appraisal screening and 60% of included papers were mixed methods studies. The extensive use of self-developed study-specific measures hampered comparisons and cumulative knowledge-building. Overall, the studies reported positive outcomes. Co-production was reported to be positively experienced and provided important learning.Conclusions: The lack of common approaches to measuring co-production is more problematic than the plurality of measurements itself. Co-production should be measured from three perspectives: outputs of co-production processes, the experiences of participating in co-production processes and outcomes of co-production. Both self-developed study-specific measures and established measures should be used. The maturity of this research field would benefit from the development and use of reporting guidelines.
6.
Gabrielsson-Järhult, Felicia, et al.
(författare)
Telemedicine consultations with physicians in Swedish primary care : a mixed methods study of users' experiences and care patterns
2021
Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 39:2, s. 204-213
Tidskriftsartikel (refereegranskat) abstract
OBJECTIVE: The study aimed to explore users' experiences and care patterns concerning telemedicine consultations with physicians in Swedish primary care from 2017 to 2019.Design and participants: A mixed methods study involving 26 qualitative interviews with users of telemedicine consultations from a national sample, complemented by a quantitative registry study of data from 10,400 users in a Swedish region.RESULTS: Users mainly described telemedicine consultations as a positive experience and perceived that the service met their current health care needs. Users also valued high accessibility, timesaving, and the contribution to ecological sustainability. Users felt competent about choosing when to use telemedicine consultations, most commonly for less severe health care concerns. This was confirmed by the quantitative results; only a few users had other care contacts within physical primary care before, or after, the telemedicine consultation, attended acute care or phoned 1177 Health Care Guidance.CONCLUSIONS: This study provides a rare account of users' experiences of telemedicine consultations. Users expressed satisfaction with this up-to-date use of health care resources for them as individuals, the health care system, and the environment. Telemedicine consultations were perceived as efficient and safe according to users. In addition, the study shows a low degree of further physical contacts in primary care or in acute care related to the telemedicine consultations.Key points Users have positive experiences of telemedicine consultations with physicians and experienced that the service had meet their actual needs for health care.Users were mainly satisfied with the service and highlighted the value of high accessibility.Users experienced that telemedicine consultants provided an alternative care service for mostly minor health problems, perceiving them to save time and resources for themselves, the health care system, and the environment.Most telemedicine consultations did not result in additional contacts with 1177 Health Care Guidance, physical visits to primary care, or acute health care.Telemedicine consultations with physicians were mainly used by persons aged 0-30 years and need to be further developed to suit other age groups.
7.
Suutari, Anne-Marie, et al.
(författare)
Improving Health for People Living With Heart Failure : Focus Group Study of Preconditions for Co-Production of Health and Care
2021
Ingår i: Journal of Participatory Medicine. - : JMIR Publications. - 2152-7202. ; 13:2
Tidskriftsartikel (refereegranskat) abstract
BACKGROUND: Co-production of health and care involving patients, families of patients, and professionals in care processes can create joint learning about how to meet patients' needs. Although barriers and facilitators to co-production have been examined previously in various health care contexts, the preconditions in Swedish chronic cardiac care contexts are yet to be explored. This study is set in the health system of the Swedish region of Jönköping County and is part of system-wide efforts to promote better health for persons with heart failure (HF).OBJECTIVE: The objective of this study was to test the usefulness of the Capability, Opportunity, and Motivation Behavior (COM-B) model when assessing the barriers to and facilitators of co-production of health and care perceived by patients with HF, family members of patients with HF, and professionals in a Swedish chronic cardiac care context as a guide for subsequent initiatives.METHODS: Data collection involved 1 focus group interview (FGI) with patients with HF (n=5), 1 FGI with family members of patients with HF (n=5), 1 FGI with professionals in primary care (n=7), and 1 FGI with professionals in cardiac care (n=4). In addition, patients with HF kept diaries of their thoughts regarding co-production. Using a deductive approach to content analysis, underpinned by the COM-B model, barriers and facilitators were categorized into capabilities, opportunities, and motivations to co-produce health and care.RESULTS: The participants showed limited understanding of co-production as a practice. They appeared to view it as a privilege to be offered to patients on top of traditional care and rarely as an approach for improving health care processes. The interviews revealed the limited health literacy among patients and the struggle of professionals to convey health information to these patients. Co-production was considered to be more resource-intensive than traditional care. Different expectations of stakeholders' roles were revealed: professionals expected older patients not to want to co-produce health and care, and all participants expected professionals to be in charge of health care services. The family members' position involved trying to balance their desire to support their relatives with understanding when, how, and with whom to co-produce. Presumed benefits motivated stakeholders: co-production was recognized to motivate patients to improve self-care. However, the participants recognized that motivation to get involved in health and care decisions varies over time among stakeholders.CONCLUSIONS: Co-production can be facilitated by the stakeholders' motivation. However, varying levels of understanding of co-production, patients' limited health literacy, unease with power sharing between patients and professionals, and resource constraints are barriers that need to be managed to promote co-produced care and better health for persons living with HF. Further research is warranted to explore how to co-produce health care services with patients with HF and how leaders can facilitate the inevitable cultural change it requires and represents.
8.
Avby, Gunilla, 1965-, et al.
(författare)
”Inga bevis för att chefer blir bättre av att gå på kurs”
2020
Ingår i: Dagens Nyheter. - 1101-2447. ; :2021-04-22
Tidskriftsartikel (populärvet., debatt m.m.) abstract
Ingress: Två forskare: Risken är att cheferna efter en kurs får en mer idealiserad bild av sin roll som inte stämmer med vardagens verklighet.En vanligt förekommande uppfattning är att chefer och ledare utvecklas bäst genom att gå på kurs. Men det finns ingen evidens för att det är det bästa sättet att utveckla ledarskapets kompetens.
9.
Kjellström, Sofia, 1970-, et al.
(författare)
Leadership as a driver for work motivation : a study of well-functioning primary healthcare centers in Sweden
2017
Konferensbidrag (refereegranskat) abstract
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.
10.
Kjellström, Sofia, 1970-, et al.
(författare)
Professionals’ experiences of using an improvement programme : applying quality improvement work in preschool contexts
2020
Ingår i: BMJ Open Quality. - : BMJ Publishing Group Ltd. - 2399-6641. ; 9:3
Tidskriftsartikel (refereegranskat) abstract
Background Improvement work can be used in preschools to enrich outdoor environment for children’s better health. Effective improvement work can facilitate the necessary changes, but little is known about professionals’ experiences of participation in improvement interventions. The aim was to evaluate how preschool staff experience quality improvement work, using the Breakthrough Series Collaborative improvement programme, to enhance outdoor environments.Methods An improvement intervention using a breakthrough collaborative was performed at 9 preschools in Sweden and examined with a longitudinal mixed method design. Staff completed questionnaires on 4 occasions (n=45 participants) and interviews took place after the intervention (n=16 participants).Results The intervention was successful in the sense that the staff were content with the learning seminars, and they had triggered physical changes in the outdoor environment. They integrated the quality improvement work with their ordinary work and increasingly involved the children. The staff tested improvement tools but did not find them entirely appropriate for their work, because they preferred existing methods for reflection.Conclusions The challenges in quality improvement work seem to be similar across contexts. Using the Breakthrough Series Collaborative in a public health intervention is promising but needs to be integrated with preunderstandings, current reflections and quality tools and models.
