| 1. |
- Mattson Molnar, Malin, et al.
(författare)
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Leading for Safety : A Question of Leadership Focus
- 2019
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Ingår i: SH@W Safety and Health at Work. - : Elsevier BV. - 2093-7911 .- 2093-7997. ; 10:2, s. 180-187
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is considerable evidence that leadership influences workplace safety, but less is known about the relative importance of different leadership styles for safety. In addition, a leadership style characterized by an emphasis and a focus on promoting safety has rarely been investigated alongside other more general leadership styles.Methods: Data were collected through a survey to which 269 employees in a paper mill company responded. A regression analysis was conducted to examine the relative roles of transformational, transactional (management-by-exception active; MBEA), and safety-specific leadership for different safety behavioral outcomes (compliance behavior and safety initiative behaviors) and for minor and major injuries.Results: A safety-specific leadership contributed the most to the enhanced safety of the three different kinds of leadership. Transformational leadership did not contribute to any safety outcome over and above that of a safety-specific leadership, whereas a transactional leadership (MBEA) was associated with negative safety outcomes (fewer safety initiatives and increased minor injuries).Conclusion: The most important thing for leaders aiming at improving workplace safety is to continuously emphasize safety, both in their communication and by acting as role models. This highlights the importance for leadership training programs aiming to improve safety to actually focus on safety-promoting communication and behaviors rather than general leadership. Furthermore, an overly monitoring and controlling leadership style can be detrimental to attempts at achieving improved workplace safety.
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| 2. |
- von Thiele Schwarz, Ulrica, 1975-, et al.
(författare)
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Leadership training as an occupational health intervention : improved safety and sustained productivity
- 2016
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Ingår i: Safety Science. - : Elsevier BV. - 0925-7535 .- 1879-1042. ; 81, s. 35-45
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Tidskriftsartikel (refereegranskat)abstract
- The safety climate in an organization is determined by how managers balance the relative importance of safety and productivity. This gives leaders a central role in safety in an organization, and from this follows that leadership training may improve safety. Transformational leadership may be one important component but may need to be combined with positive control leadership behaviors. Leadership training that combines transformational leadership and applied behavior analysis may be a way to achieve this. Purpose: The study evaluates changes in safety climate and productivity among employees whose leaders (n = 76) took part in a leadership training program combining transformational leadership and applied behavior analysis. Changes in managers' ratings of transformational leadership, contingent rewards, Management-by-Exceptions Active (MBEA) and safety self-efficacy were evaluated. Moreover, we compare whether the training has differentiated effects on safety depending on managers' specific focus on improvements in: (1) safety, (2) productivity or (3) general leadership. Result: Safety climate improved over time, while self-rated productivity remained unchanged. As hypothesized, transformational leadership, contingent rewards and safety self-efficacy as proxies for positive control behaviors increased while MBEA, a negative control behavior, decreased. Managers focusing on general leadership skills showed greater improvement in safety climate expectations. Conclusions: Training leaders in both transformational leadership and applied behavior analysis is related to improvements in leadership and safety. There is no added benefit of focusing specifically on safety or productivity.
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| 3. |
- Hasson, Henna, et al.
(författare)
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Fidelity and moderating factors in complex interventions: A case study of a continuum of care program for frail elderly people in health and social care
- 2012
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Ingår i: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background: Prior studies measuring fidelity of complex interventions have mainly evaluated adherence, and not taken factors affecting adherence into consideration. A need for studies that clarify the concept of fidelity and the function of factors moderating fidelity has been emphasized. The aim of the study was to systematically evaluate implementation fidelity and possible factors influencing fidelity of a complex care continuum intervention for frail elderly people. Methods: The intervention was a systematization of the collaboration between a nurse with geriatric expertise situated at the emergency department, the hospital ward staff, and a multi-professional team with a case manager in the municipal care services for older people. Implementation was evaluated between September 2008 and May 2010 with observations of work practices, stakeholder interviews, and document analysis according to a modified version of The Conceptual Framework for Implementation Fidelity. Results: A total of 16 of the 18 intervention components were to a great extent delivered as planned, while some new components were added to the model. No changes in the frequency or duration of the 18 components were observed, but the dose of the added components varied over time. Changes in fidelity were caused in a complex, interrelated fashion by all the moderating factors in the framework, i.e., context, staff and participant responsiveness, facilitation, recruitment, and complexity. Discussion: The Conceptual Framework for Implementation Fidelity was empirically useful and included comprehensive measures of factors affecting fidelity. Future studies should focus on developing the framework with regard to how to investigate relationships between the moderating factors and fidelity over time. Trial registration: ClinicalTrials.gov, NCT01260493.
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| 4. |
- Bäck, Annika, et al.
(författare)
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Aligning Perspectives? : Comparison of Top and Middle-Level Managers’ Views on How Organization Influences Implementation of evidence-based practice
- 2020
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Ingår i: British Journal of Social Work. - : Oxford University Press (OUP). - 0045-3102 .- 1468-263X. ; 50:4, s. 1126-1145
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Tidskriftsartikel (refereegranskat)abstract
- A supportive organizational context is important for successfully implementing evidence-based practice (EBP). Managers have an important role in creating organizational prerequisites for EBP. The present study compared how top- and middle-level managers describe the process of implementing EBP and the factors influencing this process. Data were collected through interviews with twenty-two managers in social services, and analysed with thematic deductive analysis based on the Theoretical Domains Framework (TDF) and the COM-B model. Findings showed that top-level managers focused more on strategic- and system-level issues, e.g. external comparisons, dialogue with authorities and creating support systems, while the middle managers focused on the operative implementation at staff level, i.e. motivating and involving staff. Furthermore, the two groups had different understandings of EBP. To conclude, there needs to be an alignment in the understanding of, and support for, EBP between the different levels of managers. To create a mutual understanding of what EBP entails and to clearly communicate how the organization applies the different steps of the EBP process could be crucial steps in enabling the implementation of EBP, and needs to be done in dialogue between middle- and top-level managers.
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| 5. |
- Bäck, Annika, et al.
(författare)
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Local politicians in action? : The relationship between perceived prerequisites and actions of political committees responsible for social services in supporting the implementation of evidence-based practice
- 2022
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Ingår i: Evidence & Policy. - 1744-2648 .- 1744-2656. ; 18:1, s. 36-60
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Tidskriftsartikel (refereegranskat)abstract
- Background: A supportive context is essential for successful implementation processes. Localpoliticians are delivery system actors who might both enable and hinder the implementation ofhealth and social policies.Aims and objectives: The study examines the relationship betweenperceived prerequisites and the type of actions taken by local political committees to support theimplementation of evidence-based practice in social services.Methods: A cross-sectional web surveytargeting the chair and vice-chair of committees responsible for social services in Sweden (n=181).The data was analysed with regression analysis, cluster analysis and ANOVA.Findings: Three clustersof action were identified (passive, neutral and active), capturing the reported actions taken by thecommittees to support implementation of EBP. The committees’ perceived prerequisites (capability,motivation, and opportunity) were highest in the active cluster and lowest in the passive cluster. Theclusters also differed regarding chair/vice-chair educational level, and type of municipality in whichthe chair/vice-chair were active.Discussions and conclusion: The variation in reported actionsamong the committees to support the implementation of EBP implies that some social serviceorganisations might lack the contextual support they need for implementing EBP. The prerequisitesfor the committees might need to be strengthened with regard to capability, motivation andopportunity. This study is an indication of the relationship between committees’ prerequisites andtheir actions in the implementation of EBP, but further research is needed.
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| 6. |
- Hasson, Henna, et al.
(författare)
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How can evidence-based interventions give the best value for users in social services? Balance between adherence and adaptations : a study protocol
- 2020
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Ingår i: Implementation Science Communications. - : BioMed Central (BMC). - 2662-2211. ; 1:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Using evidence-based interventions (EBIs) is a basic premise of contemporary social services (e.g., child and family social services). However, EBIs seldom fit seamlessly into a specific setting but often need to be adapted. Although some adaptions might be necessary, they can cause interventions to be less effective or even unsafe. The challenge of balancing adherence and adaptations when using EBIs is often referred to as the adherence and adaptation dilemma. Although the current literature identifies professionals’ management of this dilemma as problematic, it offers little practical guidance for professionals. This research aims to investigate how the adherence and adaptation dilemma is handled in social services and to explore how structured decision support can impact the management of the dilemma.Methods: The design is a prospective, longitudinal intervention with a focus on the feasibility and usefulness of the structured decision support. The project is a collaboration between academic researchers, embedded researchers at three research and development units, and social service organizations. A multi-method data collection will be employed. Initially, a scoping review will be performed, and the results will be used in the development of a structured decision support. The decision support will be further developed and tested during a series of workshops with social service professionals. Different forms of data—focus group interviews, questionnaires, and documentation—will be used on several occasions to evaluate the impact of the structured decision support. Qualitative and quantitative analysis will be performed and usefulness for practice prioritized throughout the study.Discussion: The study will contribute with knowledge on how the adherence and adaption dilemma is handled and experienced by social service professionals. Most importantly, the study will generate rich empirical data on how a structured decision support impacts professionals’ management of adherence and adaptions. The goal is to produce more strategic and context-sensitive implementation of EBIs in social service, which will increase value for service users.
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| 7. |
- Ingvarsson, Sara, et al.
(författare)
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Strategies to reduce low-value care – An applied behavior analysis using a single-case design
- 2023
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Ingår i: Frontiers in Health Services. - : Frontiers Media S.A.. - 2813-0146. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Implementation science has traditionally focused on the implementation of evidence-based practices, but the field has increasingly recognized the importance of addressing de-implementation (i.e., the process of reducing low-value care). Most studies on de-implementation strategies have used a combination of strategies without addressing factors that sustain the use of LVC and there is a lack of information about which strategies are most effective and what mechanisms of change might underlie these strategies. Applied behavior analysis is an approach that could be a potential method to gain insights into the mechanisms of de-implementation strategies to reduce LVC. Three research questions are addressed in this study: What contingencies (three-term contingencies or rule-governing behavior) related to the use of LVC can be found in a local context and what strategies can be developed based on an analysis of these contingencies?; Do these strategies change targeted behaviors?; How do the participants describe the strategies' contingencies and the feasibility of the applied behavior analysis approach? Materials and methods: In this study, we used applied behavior analysis to analyze contingencies that maintain behaviors related to a chosen LVC, the unnecessary use of x-rays for knee arthrosis within a primary care center. Based on this analysis, strategies were developed and evaluated using a single-case design and a qualitative analysis of interview data. Results: Two strategies were developed: a lecture and feedback meetings. The results from the single-case data were inconclusive but some of the findings may indicate a behavior change in the expected direction. Such a conclusion is supported by interview data showing that participants perceived an effect in response to both strategies. Conclusion: The findings illustrate how applied behavior analysis can be used to analyze contingencies related to the use of LVC and to design strategies for de-implementation. It also shows an effect of the targeted behaviors even though the quantitative results are inconclusive. The strategies used in this study could be further improved to target the contingencies better by structuring the feedback meetings better and including more precise feedback.
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| 8. |
- Kakeeto, Mikael, et al.
(författare)
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Meeting patient needs trumps adherence. A cross-sectional study of adherence and adaptations when national guidelines are used in practice
- 2017
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Ingår i: Journal of Evaluation In Clinical Practice. - : WILEY. - 1356-1294 .- 1365-2753. ; 23:4, s. 830-838
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives In the evidence-to-practice pathway, guidelines are developed to provide a practical summary of evidence and stimulate change. However, when guidelines are used in practice, adherence to the recommendations in guidelines is limited, and adaptations are common. Thus, we need more detailed knowledge about adherence and adaptations when guidelines are used in practice to understand the end of the evidence-to-practice pathway. Subsequently, the aim is to examine adherence to and adaptations of recommendations in the Swedish National Guidelines for Methods of Preventing Disease. Material and methods A questionnaire was sent to healthcare professionals and managers in Stockholm between January and March 2014. Adherence to the recommendations was compared between practice settings, and the frequency of different adaptations and reasons for adaptations was analysed. Results Partial adherence to the guidelines was found. The adherence was significantly greater within primary care than at the hospitals (P<.001). Modifications formed the most common category of adaptations (55%) and included mainly prioritization of specific patient groups and increased patient customization. The most common reason for adaptations (25%) was to meet the patients' specific needs and capabilities. Conclusions This study provides insight into adherence and adaptation when guidelines are used in practice. Work with lifestyle habits was partially done in accordance with the guidelines. Lack of time and lack of resources were not the most common reasons for adaptations. Rather, the findings suggest that when patient needs and capabilities contrast with guideline recommendations, patient needs trump adherence to guidelines.
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| 9. |
- Lornudd, Caroline, et al.
(författare)
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A piece of the boardroom pie – An interview study exploring what drives Swedish corporate boards’ engagement in occupational health and safety
- 2020
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Ingår i: Journal of Occupational and Environmental Medicine. - 1076-2752 .- 1536-5948. ; 62:6, s. 389-397
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate why boards of directors engage in occupational health and safety (OHS) and what influences their level of engagement.Methods: Thirty-four board members and chief executive officers at large companies from the manufacturing, construction, trade, and health/social care sectors were interviewed. An inductive thematic analysis was conducted.Results: Five drivers organized along a continuum explain why boards engage: legal compliance, untoward events, external expectations/regulations, business drivers, and moral values. Certain factors influence the level of engagement: board's OHS competence, owner's agenda, and competing needs.Conclusions: Boards continuously prioritize among multiple foci. If a board's total engagement is likened to a pie, the size of the OHS slice will depend on the drivers, as well as on the influencing factors. We suggest that even boards with many drivers can down-prioritize OHS under certain conditions.
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| 10. |
- Lundmark, Robert, et al.
(författare)
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Leading for change : line managers' influence on the outcomes of an occupational health intervention
- 2017
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Ingår i: Work & Stress. - : Taylor & Francis. - 0267-8373 .- 1464-5335. ; 31:3, s. 276-296
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Tidskriftsartikel (refereegranskat)abstract
- Line managers may play a central role in the success of occupational health interventions. However, few studies have focussed on the relationship between line managers' behaviours and the outcomes of occupational health interventions. We examined the influence of both line managers' attitudes and actions towards an intervention as well as their transformational leadership on the expected outcomes of the intervention (i.e. employee self-rated health and work ability). The intervention consisted of the implementation and use of a web-based system for occupational health management. A sample of 180 employees provided data for the analysis. Self-rated health and work ability were measured at the baseline (Time 1) and follow-up (Time 3), while employee ratings of line managers' attitudes and actions, and transformational leadership were measured during the intervention process (Time 2). The results revealed that line managers' attitudes and actions positively predicted changes in both self-rated health and work ability. The influence of transformational leadership was indirect and mediated through line managers' attitudes and actions towards the intervention. Based on the results, we suggest using process measures that include aspects of both line managers' attitudes and actions as well as their transformational leadership in future process evaluation.
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