| 1. |
- Nilsson, Kerstin, 1947, et al.
(författare)
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Experiences from implementing valuebased healthcare at a Swedish University Hospital – a longitudinal interview study
- 2017
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 17:169, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- Background Implementing the value-based healthcare concept (VBHC) is a growing management trend in Swedish healthcare organizations. The aim of this study is to explore how representatives of four pilot project teams experienced implementing VBHC in a large Swedish University Hospital over a period of 2 years. The project teams started their work in October 2013. Methods An explorative and qualitative design was used, with interviews as the data collection method. All the participants in the four pilot project teams were individually interviewed three times, with interviews starting in March 2014 and ending in November 2015. All the interviews were transcribed and analyzed using qualitative analysis. Results Value for the patients was experienced as the fundamental drive for implementing VBHC. However, multiple understandings of what value for patients’ means existed in parallel. The teams received guidance from consultants during the first 3 months. There were pros and cons to the consultant’s guidance. This period included intensive work identifying outcome measurements based on patients’ and professionals’ perspectives, with less interest devoted to measuring costs. The implementation process, which both gave and took energy, developed over time and included interventions. In due course it provided insights to the teams about the complexity of healthcare. The necessity of coordination, cooperation and working together inter-departmentally was critical. Conclusions Healthcare organizations implementing VBHC will benefit from emphasizing value for patients, in line with the intrinsic drive in healthcare, as well as managing the process of implementation on the basis of understanding the complexities of healthcare. Paying attention to the patients’ voice is a most important concern and is also a key towards increased engagement from physicians and care providers for improvement work.
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| 2. |
- Nilsson, Kerstin, 1947, et al.
(författare)
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The need to succeed - learning experiences resulting from the implementation of value-based healthcare
- 2018
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Ingår i: Leadership in Health Services. - 1751-1879. ; 31:1, s. 2-16
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Tidskriftsartikel (refereegranskat)abstract
- © 2017 Emerald Publishing Limited. Purpose – The aim of this study has been to explore learning experiences from the two first years of the implementation of value-based healthcare (VBHC) at a large Swedish University Hospital. Design/methodology/approach – An explorative design was used in this study. Individual open-ended interviews were carried out with 19 members from four teams implementing VBHC. Qualitative analysis was used to analyse the verbatim transcripts of the interviews. Findings – Three main themes pinpointing learning experiences emerged through the analysis: resource allocation to support implementation, anchoring to create engagement and dedicated, development-oriented leadership with power of decision. Resource allocation included the need to set aside time and administrative resources and also the need to adjust essential IT-systems. The work of anchoring to create engagement involved both patients and staff and was found to be a never-ending task calling for deep commitment. The hospital top management's explicit decision to implement VBHC facilitated the implementation process, but the team leaders' lack of explicit management mandate was experienced as obstructing the process. The development process contributed not only to single-loop learning but also to double-loop learning. Originality/value – Learning experiences drawn from implementing VBHC have not been studied before, and thus the results of this study could be of importance to managers and administrators wanting to implement this concept in their respective organizations.
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| 3. |
- Nilsson, Kerstin, 1947, et al.
(författare)
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Value-based healthcare as a trigger for improvement initiatives.
- 2017
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Ingår i: Leadership in health services (Bradford, England). - 1751-1887. ; 30:4, s. 364-377
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Tidskriftsartikel (refereegranskat)abstract
- Purpose This study explores four pilot teams' experiences of improvements resulting from the implementation of value-based healthcare (VBHC) at a Swedish University Hospital. The aim of this study is to gain a deeper understanding of VBHC when used as a management strategy to improve patients' health outcomes. Design/methodology/approach An exploratory design was used and qualitative interviews were undertaken with 20 team members three times each, during a period of two years. The content of the interviews was qualitatively analysed. Findings VBHC worked as a trigger for initiating improvements related to processes, measurements and patients' health outcomes. An example of improvements related to patients' health outcomes was solving the problem of patients' nausea. Improvement related to processes was developing care planning and increasing the number of contact nurses. Improvement related to measurements was increasing coverage ratio in the National Quality Registers used, and the development of a new coding system for measurements. VBHC contributed a structure for measurement and for identification of the need for improvements, but this structure on its own was not enough. To implement and sustain improvements, it is important to establish awareness of the need for improvements and to motivate changes not just among managers and clinical leaders directly involved in VBHC projects but also engage all other staff providing care. Originality/value This study shows that although the VBHC management strategy may serve as an initiator for improvements, it is not enough for the sustainable implementation of improvement initiatives. Regardless of strategy, managers and clinical leaders need to develop increased competence in change management.
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| 4. |
- Bringedal, B. H., et al.
(författare)
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Guidelines and clinical priority setting during the COVID-19 pandemic - Norwegian doctors' experiences
- 2022
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Ingår i: Bmc Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background In the first phase of the COVID-19 pandemic, strong measures were taken to avoid anticipated pressure on health care, and this involved new priorities between patient groups and changing working conditions for clinical personnel. We studied how doctors experienced this situation. Our focus was their knowledge about and adherence to general and COVID-19 specific guidelines and regulations on priority setting, and whether actual priorities were considered acceptable. Methods In December 2020, 2 316 members of a representative panel of doctors practicing in Norway received a questionnaire. The questions were designed to consider a set of hypotheses about priority setting and guidelines. The focus was on the period between March and December 2020. Responses were analyzed with descriptive statistics and regression analyses. Results In total, 1 617 (70%) responded. A majority were familiar with the priority criteria, though not the legislation on priority setting. A majority had not used guidelines for priority setting in the first period of the pandemic. 60.5% reported that some of their patients were deprioritized for treatment. Of these, 47.5% considered it medically indefensible to some/a large extent. Although general practitioners (GPs) and hospital doctors experienced deprioritizations equally often, more GPs considered it medically indefensible. More doctors in managerial positions were familiar with the guidelines. Conclusions Most doctors did not use priority guidelines in this period. They experienced, however, that some of their patients were deprioritized, which was considered medically indefensible by many. This might be explained by a negative reaction to the externally imposed requirements for rationing, while observing that vulnerable patients were deprioritized. Another interpretation is that they judged the rationing to have gone too far, or that they found it hard to accept rationing of care in general. Priority guidelines can be useful measures for securing fair and reasonable priorities. However, if the priority setting in clinical practice is to proceed in accordance with priority-setting principles and guidelines, the guidelines must be translated into a clinically relevant context and doctors' familiarity with them must improve.
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| 5. |
- Brulin, E., et al.
(författare)
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Healthcare in distress: A survey of mental health problems and the role of gender among nurses and physicians in Sweden
- 2023
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Ingår i: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 339, s. 104-110
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Tidskriftsartikel (refereegranskat)abstract
- Introduction:The present article aimed to investigate 1) if mental health problems (depression and burnout including the dimensions; emotional exhaustion, mental distance and cognitive and emotional impairment) differed between nurses and physicians in Sweden, 2) if any differences were explained by differences in sex compositions, and 3) if any sex differences were larger within either of the two professions. Method:Data were derived from a representative sample of nurses (n = 2903) and physicians (n = 2712) in 2022. Two scales were used to assess burnout (KEDS and BAT) and one to assess depression (SCL-6). The BAT scale has four sub-dimensions. Descriptive statistics and logistic regression were used to analyse each scale and dimension separately. Results:Results showed that 16-28 % of nurses and physicians reported moderate to severe symptoms of burnout. The prevalence differed between occupations across the scales and dimensions used. Nurses reported higher scores on KEDS while physicians reported higher scores on BAT including the four dimensions. Also, 7 % of nurses' and 6 % of physicians' scores were above the cut-off for major depression. The inclusion of sex in the models changed the odds ratios of differences between doctors and nurses in all mental health dimensions except mental distance and cognitive impairment. Limitations: This study was based on cross-sectional survey data which has some limitations. Conclusion:Our study suggests that the prevalence of mental health problems is prominent among nurses and physicians in Sweden. Sex plays an important role in the difference in the prevalence of mental health problems between the two professions.
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| 6. |
- Bååthe, Fredrik, 1968, et al.
(författare)
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Engaging physicians in organisational improvement work.
- 2013
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Ingår i: Journal of health organization and management. - 1477-7266. ; 27:4, s. 479-97
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Tidskriftsartikel (refereegranskat)abstract
- To improve health-care delivery from within, managers need to engage physicians in organisational development work. Physicians and managers have different mindsets/professional identities which hinder effective communication. The aim of this paper is to explore how managers can transform this situation.
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| 7. |
- Bååthe, Fredrik, 1968, et al.
(författare)
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How do doctors experience the interactions among professional fulfilment, organisational factors and quality of patient care? A qualitative study in a Norwegian hospital
- 2019
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Doctors increasingly experience high levels of burnout and loss of engagement. To address this, there is a need to better understand doctors' work situation. This study explores how doctors experience the interactions among professional fulfilment, organisational factors and quality of patient care. Design An exploratory qualitative study design with semistructured individual interviews was chosen. Interviews were transcribed verbatim and analysed by a transdisciplinary research group. Setting The study focused on a surgical department of a mid-sized hospital in Norway. Participants Seven doctors were interviewed. A purposeful sampling was used with gender and seniority as selection criteria. Three senior doctors (two female, one male) and four in training (three male, one female) were interviewed. Results We found that in order to provide quality care to the patients, individual doctors described 'stretching themselves', that is, handling the tensions between quantity and quality, to overcome organisational shortcomings. Experiencing a workplace emphasis on production numbers and budget concerns led to feelings of estrangement among the doctors. Participants reported a shift from serving as trustworthy, autonomous professionals to becoming production workers, where professional identity was threatened. They felt less aligned with workplace values, in addition to experiencing limited management recognition for quality of patient care. Management initiatives to include doctors in development of organisational policies, processes and systems were sparse. Conclusion The interviewed doctors described their struggle to balance the inherent tension among professional fulfilment, organisational factors and quality of patient care in their everyday work. They communicated how 'stretching themselves', to overcome organisational shortcomings, is no longer a feasible strategy without compromising both professional fulfilment and quality of patient care. Managers need to ensure that doctors are involved when developing organisational policies, processes and systems. This is likely to be beneficial for both professional fulfilment and quality of patient care.
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| 8. |
- Bååthe, Fredrik, 1968, et al.
(författare)
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How hospital top managers reason about the central leadership task of balancing quality of patient care, economy and professionals' engagement: an interview study
- 2023
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Ingår i: Leadership in Health Services. - : Emerald. - 1751-1879 .- 1751-1887. ; 36:2, s. 261-274
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThis study aims to deepen the understanding of how top managers reason about handling the relationships between quality of patient care, economy and professionals' engagement. Design/methodology/approachQualitative design. Individual in-depth interviews with all members of the executive management team at an emergency hospital in Norway were analysed using reflexive thematic method. FindingsThe top managers had the intention to balance between quality of patient care, economy and professionals' engagement. This became increasingly difficult in times of high internal or external pressures. Then top management acted as if economy was the most important focus. Practical implicationsFor health-care top managers to lead the pursuit towards increased sustainability in health care, there is a need to balance between quality of patient care, economy and professionals' engagement. This study shows that this balancing act is not an anomaly top-managers can eradicate. Instead, they need to recognize, accept and deliberately act with that in mind, which can create virtuous development spirals where managers and health-professional communicate and collaborate, benefitting quality of patient care, economy and professionals' engagement. However, this study builds on a limited number of participants. More research is needed. Originality/valueSustainable health care needs to balance quality of patient care and economy while at the same time ensure professionals' engagement. Even though this is a central leadership task for managers at all levels, there is limited knowledge about how top managers reason about this.
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| 9. |
- Bååthe, Fredrik, 1968, et al.
(författare)
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Physician experiences of patient-centered and team-based ward rounding – an interview based case-study
- 2014
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Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 3:6, s. 127-142
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Tidskriftsartikel (refereegranskat)abstract
- Background: Rounding has long traditions within hospital-based healthcare, as a way to organize the ward-based part of the care and cure process. Despite an increased emphasis on patient participation, there has been limited research exploring physician experiences of actually applying these principles to the ward round. Aim: To explore physician experiences after changing to a patient-centered and team-based ward round, in an internal medicine department at a Swedish mid-size hospital. Methods: Qualitative exploratory case-study. Semi-structured interviews with 13 physicians (six consultants, three residents, four interns) have been carried out. All interviews have been transcribed and analyzed by qualitative method. Results: The traditional relationship of superiority and subordination, embodied by the patient lying down in bed and the physician standing over the bed, was one essential change in the new ward round. Physicians experienced that less hierarchical relationships with patients, combined with working in a multi-professional team, contributed to betterinformed clinical decisions, fewer follow-up questions from patients, and increased professional fulfilment. However, physicians also experienced that their autonomy was being reduced, and there was uneasiness about exposing potential knowledge gaps in front of others. Conclusions: This qualitative study of physician experiences finds that patient-centered and team-based ward rounds is a fertile development journey forward. Also important to notice are the seemingly new and paradoxical findings that despite the introduction of the “right” ward round structure, negative experiences emerged as unwanted side effects to the positive experiences reported. It could be beneficial for leaders in healthcare (both managers and physicians) to consider these results to facilitate future ward round initiatives.
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| 10. |
- Bååthe, Fredrik, 1968, et al.
(författare)
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Uncovering paradoxes from physicians' experiences of patient-centered ward-round.
- 2016
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Ingår i: Leadership in health services (Bradford, England). - 1751-1887. ; 29:2, s. 168-84
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The purpose of this paper is to uncover paradoxes emerging from physicians' experiences of a patient-centered and team-based ward round, in an internal medicine department. Design/methodology/approach Abductive reasoning relates empirical material to complex responsive processes theory in a dialectical process to further understandings. Findings This paper found the response from physicians, to a patient-centered and team-based ward round, related to whether the new demands challenged or confirmed individual physician's professional identity. Two empirically divergent perspectives on enacting the role of physician during ward round emerged: We-perspective and I-perspective, based on where the physician's professional identity was centered. Physicians with more of a We-perspective experienced challenges with the new round, while physicians with more of an I-perspective experienced alignment with their professional identity and embraced the new round. When identity is challenged, anxiety is aroused, and if anxiety is not catered to, then resistance is likely to follow and changes are likely to be hampered. Practical implications For change processes affecting physicians' professional identity, it is important for managers and change leaders to acknowledge paradox and find a balance between new knowledge that needs to be learnt and who the physician is becoming in this new procedure. Originality/value This paper provides increased understanding about how physicians' professional identity is interacting with a patient-centered ward round. It adds to the knowledge about developing health care in line with recent societal requests and with sustainable physician engagement.
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