1.
Andersson, Réka
(författare)
Gränsdragningar i Vårdens Vardag : Hanteringen av arbetsrelaterad psykisk ohälsa i det svenska välfärdssystemet
2017
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Psykisk ohälsa i arbetslivet är ett stort och växande problem i välfärdssamhället. Problemet har flera bottnar och väcker många frågor om vem som har ansvar, vad det egentligen är för ett slags fenomen och hur det bör hanteras. Den här studien undersöker hur arbetsrelaterad psykisk ohälsa hanteras av yrkesverksamma inom vården, med fokus på företagshälsovård och primärvård. Intresse riktas mot hur yrkesverksamma personerna resonerar kring arbetsrelaterad psykisk ohälsa, vilka dilemman de ställs inför och de strategier de har för att hantera dessa. Den söker också svar på ansvarsfrågan kring detta komplexa problem, inte minst i ljuset av privatiseringen av företagshälsovården.I studien används ett tvärvetenskapligt perspektiv, där begrepp från teknik- och vetenskapsstudier (STS), professionssociologi och organisationsteori kombineras för att analysera olika aspekter av vårdens hantering av arbetsrelaterad psykisk ohälsa. Det empiriska materialet bygger i huvudsak på intervjuer med läkare, psykoterapeuter, kuratorer, arbetsterapeuter, psykologer, rehabiliteringskoordinatorer och beteendevetare, men inkluderar även observationer inom primärvård och företagshälsovård. Hanteringen av arbetsrelaterad psykisk ohälsa i vårdens vardag präglas av att orsaksbilden till problemet är komplext, ansvarsfördelningen otydlig och att psykosociala orsaker till sjukdom är kontroversiellt. I studien diskuteras utmaningarna och möjligheterna kring hanteringen av detta komplexa problem i bred bemärkelse. I analyserna uppmärksammas de yrkesverksammas gränsdragningar kring både ansvar och fenomenet arbetsrelaterad psykisk ohälsa. Begreppet kunskapsinfrastruktur används för att förklara och förstå den kunskapsmässiga och materiella struktur som de yrkesverksamma verkar inom. Analyserna visar att de yrkesverksamma har ett pragmatiskt förhållningssätt och använder olika strategier för att skapa sig handlingsutrymme i hur de hanterar arbetsrelaterad psykisk ohälsa.
2.
Fredriksson, Mio, 1976-, et al.
(författare)
Are data from national quality registries used in quality improvement at Swedish hospital clinics?
2017
Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 29:7, s. 909-915
Tidskriftsartikel (refereegranskat) abstract
To investigate the use of data from national quality registries (NQRs) in local quality improvement as well as purported key factors for effective clinical use in Sweden. Comparative descriptive: a web survey of all Swedish hospitals participating in three NQRs with different levels of development (certification level). Heads of the clinics and physician(s) at clinics participating in the Swedish Stroke Register (Riksstroke), the Swedish National Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Lung Cancer Registry (NLCR). Individual and unit level use of NQRs in local quality improvement, and perceptions on data quality, organizational conditions and user motivation. Riksstroke data were reported as most extensively used at individual and unit levels ((x) over bar 17.97 of 24 and (x) over bar 27.06 of 35). Data quality and usefulness was considered high for the two most developed NQRs ((x) over bar 19.86 for Riksstroke and (x) over bar 19.89 for GallRiks of 25). Organizational conditions were estimated at the same level for Riksstroke and GallRiks ((x) over bar 12.90 and (x) over bar 13.28 of 20) while the least developed registry, the NLCR, had lower estimates (x 10.32). In Riksstroke, the managers requested registry data more often ((x) over bar 15.17 of 20). While there were significant differences between registries in key factors such as management interest, use of NQR data in local quality improvement seems rather prevalent, at least for Riksstroke. The link between the registry's level of development and factors important for routinization of innovations such as NQRs needs investigation.
3.
Kullberg, Linn, et al.
(författare)
Does voluntary health insurance reduce the use of and the willingness to finance public health care in Sweden?
2022
Ingår i: Health Economics, Policy and Law. - : Cambridge University Press. - 1744-1331 .- 1744-134X. ; 17:4, s. 380-397
Tidskriftsartikel (refereegranskat) abstract
Voluntary private health insurance (VHI) has generally been of limited importance in national health service-type health care systems, especially in the Nordic countries. During the last decades however, an increase in VHI uptake has taken place in the region. Critics of this development argue that voluntary health insurance can undermine support for public health care, while proponents contend that increased private funding for health services could relieve strained public health care systems. Using data from Sweden, this study investigates empirically how voluntary health insurance affects the public health care system. The results of the study indicate that the public Swedish health care system is fairly resilient to the impact of voluntary health insurance with regards to support for the tax-based funding. No difference between insurance holders and non-holders was found in willingness to finance public health care through taxes. A slight unburdening effect on public health care use was observed as VHI holders appeared to use public health care to a lesser extent than those without an insurance. However, a majority of the insurance holders continued to use the public health care system, indicating only a modest substitution effect.
4.
Fredriksson, Mio, 1976-, et al.
(författare)
Recentralizing healthcare through evidence-based guidelines – striving for national equity in Sweden
2014
Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 14, s. 509-
Tidskriftsartikel (refereegranskat) abstract
Background: The Swedish government has increasingly begun to rely on so called informative governance when regulating healthcare. The question this article sets out to answer is: considered to be “the backbone” of the Swedish state’s strategy for informative governance in healthcare, what kind of regulatory arrangement is the evidence-based National Guidelines? Together with national medical registries and an extensive system of quality and efficiency indicators, the National Guidelines constitutes Sweden’s quality management system. Methods: A framework for evaluating and comparing regulatory arrangements was used. It asks for instance: what is the purpose of the regulation and are regulation methods oriented towards deterrence or compliance? Results: The Swedish National Guidelines is a regulatory arrangement intended to govern the prioritizations of alldecision makers – politicians and administrators in the self-governing county councils as well as healthcare professionals – through a compliance model backed up by top-down benchmarking and built-in mechanisms for monitoring. It is thus an instrument for the central state to steer local political authorities. The purpose is to achieve equitable and cost-effective healthcare. Conclusions: This article suggests that the use of evidence-based guidelines in Swedish healthcare should be seen in the light of Sweden’s constitutional setting, with several autonomous levels of political authority negotiating the scope for their decision-making power. As decision-making capacity is relocated to the central government – from the democratically elected county councils responsible for financing and provision of healthcare – the Swedish National Guidelines is part of an ongoing process of healthcare recentralization in Sweden, reducing the scope for local decision-making. This represents a new aspect of evidence-based medicine (EBM) and clinical practice guidelines (CPGs).
5.
Kullberg, Linn, et al.
(författare)
Market-orienting reforms in rural health care in Sweden : how can equity in access be preserved?
2018
Ingår i: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 17
Tidskriftsartikel (refereegranskat) abstract
Background: Health care provision in rural and urban areas faces different challenges. In Sweden, health care provision has been predominantly public and equitable access to care has been pursued mainly through public planning and coordination. This is to ensure that health needs are met in the same manner in all parts of the country, including rural or less affluent areas. However, a marketization of the health care system has taken place during recent decades and the publicly planned system has been partially replaced by a new market logic, where private providers guided by financial concerns can decide independently where to establish their practices. In this paper, we explore the effects of marketization policies on rural health care provision by asking how policy makers in rural counties have managed to combine two seemingly contradictory health policy goals: to create conditions for market competition among health care providers and to ensure equal access to health care for all patients, including those living in rural and remote areas. Methods: A qualitative case study within three counties in the northern part of Sweden, characterized by vast rural areas, was carried out. Legal documents, the "accreditation documents" regulating the health care quasi-markets in the three counties were analyzed. In addition, interviews with policy makers in the three county councils, representing the political majority, the opposition, and the political administration were conducted in April and May 2013. Results: The findings demonstrate the difficulties involved in introducing market dynamics in health care provision in rural areas, as these reforms not only undermined existing resource allocation systems based on health needs but also undercut attempts by local policy makers to arrange for care provision in remote locations through planning and coordination. Conclusion: Provision of health care in rural areas is not well suited for market reforms introducing competition, as this may undermine the goal of equity in access to health care, even in a publicly financed health care system.
6.
von Granitz, Heléne, 1969-
(författare)
Enabling disability rights in practise : Understanding how the governance of state-funded personal assistance is fulfilling the Swedish LSS Act
2022
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Personal assistance (PA) is stated in Article 19 of the UNCRPD as an internationally recognised disability right and is operationalised as a measure in the Swedish Act concerning Support and Service for Persons with Certain Functional Impairments (the LSS Act). The Act’s overall policy goal is to promote good living conditions for the eligible persons by enabling participation in society on equal terms with others. The governance of PA is a divided responsibility between the municipality and the Swedish Social Insurance Agency (SSIA), which assesses and grants PA-allowance if the PA applicant exceed 20 hours of certain needs per week. The overall aim of the thesis was to explore how the governance of PA-allowance enables to fulfil the LSS Act policy goals. The main findings of the thesis demonstrate a tilt in PA towards a medical model of disability, marked by a domination and an increase of healthcare activities over time. Less activities representing participation in society were found and unequal access to PA activities across age, gender and groups of persons with disabilities. The findings imply an increased risk to social and financial exclusion of PA users. Further, the LSS Act’s rationale and policy goals were shown to have a weakened impact on the SSIA instruction, the refined policy tool which outlines the PA-allowance granting process. A development towards a medicalised application of PA-allowance was found, characterised by healthcare measures to support medical conditions and a shift towards PA users with less ability to partake in the PA-allowance granting process. Factors shown to have influenced the governance of PA-allowance include: case law, changed policy priorities, weakened PA collaboration structures, inadequate monitoring of PA outcomes, strained working conditions at the SSIA and extensive complexities of the PA-allowance application. This thesis illustrates that the SSIA regime logic has thoroughly influenced the LSS policy outcome with time and emphasises the need for social reform policy tools to be continuously calibrated towards the original policy goals to uphold policy compliance. The regression of PA, by gradually resigning to a medical model of disability, demonstrates weakened conditions for Swedish disability policy through the LSS Act to fulfil Article 19 of the UNCRPD.
7.
Björkman, Annica, et al.
(författare)
Malpractice claimed calls within the Swedish Healthcare Direct: a descriptive – comparative case study
2021
Ingår i: BMC Nursing. - : Springer. - 1472-6955. ; 20
Tidskriftsartikel (refereegranskat) abstract
BackgroundMedical errors are reported as a malpractice claim, and it is of uttermost importance to learn from the errors to enhance patient safety. The Swedish national telephone helpline SHD is staffed by registered nurses; its aim is to provide qualified healthcare advice for all residents of Sweden; it handles normally about 5 million calls annually. The ongoing Covid-19 pandemic have increased call volume with approximate 30%. The aim of the present study was twofold: to describe all malpractice claims and healthcare providers’ reported measures regarding calls to Swedish Healthcare Direct (SHD) during the period January 2011–December 2018 and to compare these findings with results from a previous study covering the period January 2003–December 2010.MethodsThe study used a descriptive, retrospective and comparative design. A total sample of all reported malpractice claims regarding calls to SHD (n = 35) made during the period 2011–2018 was retrieved. Data were analysed and compared with all reported medical errors during the period 2003–2010 (n = 33).ResultsTelephone nurses’ failure to follow the computerized decision support system (CDSS) (n = 18) was identified as the main reason for error during the period 2011–2018, while failure to listen to the caller (n = 12) was the main reason during the period 2003–2010. Staff education (n = 21) and listening to one’s own calls (n = 16) were the most common measures taken within the organization during the period 2011–2018, compared to discussion in work groups (n = 13) during the period 2003–2010.ConclusionThe proportion of malpractice claims in relation to all patient contacts to SHD is still very low; it seems that only the most severe patient injuries are reported. The fact that telephone nurses’ failure to follow the CDSS is the most common reason for error is notable, as SHD and healthcare organizations stress the importance of using the CDSS to enhance patient safety. The healthcare organizations seem to have adopted a more systematic approach to handling malpractice claims regarding calls, e.g., allowing telephone nurses to listen to their own calls instead of having discussions in work groups in response to events. This enables nurses to understand the latent factors contributing to error and provides a learning opportunity.
8.
Fredriksson, Mio, et al.
(författare)
Local politico-administrative perspectives on quality improvement based on national registry data in Sweden : a qualitative study using the Consolidated Framework for Implementation Research.
2014
Ingår i: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 9
Tidskriftsartikel (refereegranskat) abstract
Background. Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement¿s intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data.Methods. Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed.Results. The politicians and administrators perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians¿ role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations.Conclusions. The Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.
9.
Eldh, Ann Catrine, 1965-, et al.
(författare)
Factors facilitating a national quality registry to aid clinical quality improvement : findings of a national survey
2016
Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 6:11
Tidskriftsartikel (refereegranskat) abstract
Objectives: While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement.Methods: Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression.Results: A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R2=0.76) with ‘Colleagues’ call for local results’ (p=<0.001), ‘Management Request of Registry data’ (p=<0.001), and it was said to be ‘Simple to explain the results to colleagues’ (p=0.02). Using stepwise regression, ‘Colleagues’ call for local results’ was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results.Conclusions: While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.
10.
Fredriksson, Mio, 1976-
(författare)
Between Equity and Local Autonomy : A Governance Dilemma in Swedish Healthcare
2012
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Both national equity in healthcare and the county councils’ local autonomy are important values supported by Swedish law. Politically it is a balancing act; how much freedom should the county councils have and to what extent should healthcare be equal throughout the country? The general aim of this dissertation, concerning political governance in Swedish healthcare, is to investigate the tensional values of national equity and local autonomy in the light of current trends in healthcare governance in Sweden. How is this tension manifested? Four studies are included in the dissertation. These studies show that the Swedish state is becoming more active in governing and regulating healthcare, for example by the use of informative governance and legislation, which increasingly rely on monitoring and evaluation of results that are made public. The findings show that the tension between national equity and local autonomy is manifested in increasing emphasis on national equity – or rather national equivalence – which is interpreted in terms of Swedish healthcare being recentralized. Delivery and financing of healthcare are still the responsibilities of the county councils. Planning and arranging – the setting of the regulatory framework – is increasingly taken over by the central state. Although power seems to be transferred from local level to central level, the county councils’ autonomy is only partially restricted, which means Swedish healthcare is still decentralized. However, if the recentralization process proceeds further, the county councils´ autonomy may be seriously challenged. Another challenge is to maintain or strengthen the procedures for democratic legitimacy through citizen participation at the local level. When local autonomy looses ground, it becomes more difficult to tailor healthcare according to local needs and conditions in the county councils, and decisions are taken at greater distance from the citizens.
