| 1. |
- Andersson, Ann-Christine
(författare)
-
Practice-based Improvements in Healthcare
- 2010
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A central problem for the healthcare sector today is how to manage change and improvements. In recent decades the county councils in Sweden have started various improvement initiatives and programs in order to improve their healthcare services. The improvement program of the Kalmar county council, which constitutes the empirical context for this thesis, is one of those initiatives.The purpose of this thesis is to contribute to a broader understanding of large-scale improvement program in a healthcare setting. This is done by analyzing practitioner’s improvement ideas, describing participants in the improvement projects, revising and testing a survey to measure the development of improvement ideas and describing the improvement program from a theoretical perspective. The theoretical change model used looks at change from two opposing directions in six dimensions; Goals, Leadership, Focus, Process, Reward system and Use of consultants.The aims of the county council improvement program are to become a learning organization, disseminate improvement methodologies and implement continuous quality improvements in the organization. All healthcare administrations and departments in the county council were invited to apply for funds to accomplish improvement projects. Another initiative invited staff teams to work with improvement ideas in a program with support from facilitators, using the breakthrough methodology. Now almost all ongoing developments, improvements, patient safety projects, manager and leader development initiatives are put together under the county council improvement program umbrella.In the appended papers both qualitative and quantitative research approach were used. The first study (paper I) analyzed which types of improvement projects practitioners are engaged in using qualitative content analysis. Five main categories were identified: Organizational Process; Evidence and Quality; Competence Development; Process Technology; and Proactive Patient Work. Most common was a focus on organizational changes and process, while least frequent was proactive patient work. Besides these areas of focus, almost all aimed to increase patient safety and increase effectiveness and availability.Paper II described the participants in two of the initiatives, the categorized improvement projects in paper I and the team members in the methodology guided improvement programs. Strong professions like physicians and nurses were well represented, but other staff groups were not as active. Managers were responsible for a majority of the projects. The gender perspective reflected the overall mix of employees in the county council.Paper III described a revision and test of a Minnesota Innovation Survey (MIS) that will be used to follow and measure how quality improvement ideas develop and improve over time. Descriptive statistics were presented. The respondents were satisfied with their work and what they had accomplished. The most common comment was about time, not having enough time to work with the improvement idea and the difficulty of finding time because of regular tasks. This was the first test of the revised survey and the high use of the answer alternative “Do not know” showed that the survey did not fit the context very well in its present version.Trying to connect the county council improvement program and the initiatives studied in papers I and II with the change model gave rise to some considerations. The county council improvement program has an effort to combine organizational changes and a culture that encourages continuous improvements. Top-down and bottom-up management approaches are used, through setting out strategies from above and at the same time encouraging practitioners to improve their day-to-day work. Whether this will be a successful way to implement and achieve a continuous improvement culture in the whole organization is one of the main issues remaining to find out in further studies.
|
|
| 2. |
- Rejler, Martin
(författare)
-
Quality improvement in the care of patients with inflammatory bowel disease
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A range of studies have supported the existence of a gap between what medicine could possibly deliver and what it actually does deliver. This is also true for the delivery of care to patients with inflammatory bowel disease (IBD) and several international stakeholders have called for action. The aim of this thesis was to describe, study and evaluate a quality improvement intervention (QII) in the care for patients with IBD in a population-based setting, with special reference to clinical redesign, performance measurement and patient experience.The patient population on which this thesis is based was recruited from the gastroenterological unit at the Department of Internal Medicine, Highland Hospital, in Eksjö, Sweden. The QII was implemented through iterative improvement cycles in the early years of the 21st century. Data from yearly check-ups of patients including identification, gender, disease duration, medication, four questions about quality of life (QoL) and laboratory results were entered into a local register created as part of the QII. In addition, data on admittances to hospital were retrieved. The interactions between staff and patients as well as the elements of the delivered care were analysed by applying the model of clinical microsystems (CMS) and the Chronic Care Model (CCM). The QII was studied using a retrospective, descriptive analysis with quantitative elements. A multidimensional quality tool, the Clinical Value Compass (CVC), was applied to assess the quality of care. Later, the CVC and the quality model by Donabedian (Df) were merged to create a quality framework for IBD, which was tested on already existing data in the local IBD register. In a study of patients’ experiences of living with IBD, a content analysis was applied to interviews with 20 purposefully sampled patients.The main components of the redesign, described as a “patient- and demand-directed care”, were: - A specialist nurse staffed the outpatient clinic full time and could offer patients who contacted the clinic an acute visit at the outpatient clinic within two days. - Yearly checkups to either the nurse or physician were offered, either as telephone calls or as traditional visits to the clinic. A letter preceded the contact and included a QoL questionnaire and instructions for laboratory testing of haemoglobin (Hb). The QII led to decreasing numbers of hospitalizations compared to national data and better access to care. The prevalence of anaemia in the population was 6% and was correlated to a risk of being admitted to hospital during the year. The analysis of the interviews showed several parallels to the experiences of people who live with other chronic diseases than IBD. Consequences of living with IBD were associated with everyday life and the adaptations needed to restore one’s life. It was always shadowed by the person’s worry that he or she might potentially need a toilet.The main contribution of this thesis is the overall example of how a quality improvement intervention including continuous performance measures and frameworks, as well as the study of patients’ experiences, can be applied in a local population-based setting. The understanding of the interactions between patients, staff and the healthcare system was described and analysed through the application of CMS and the CCM. As a whole, this thesis contributes to the international quest for quality improvement efforts to bridge the quality gap in the delivery of IBD care today.
|
|
| 3. |
- Sjödin, Carina, 1964-
(författare)
-
User-involved service innovation : Three participating perspectives on co-creation
- 2015
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The involvement of customers and other stakeholders in the innovation process is proposed to be a key success factor and something that makes companies more competitive. As a consequence, more and more organizations alter their innovation strategy accordingly. In order for a company to open up innovation processes, it is vital to foster a practice where there is openness for external ideas and knowledge. However, when external ideas meet internal innovation practices complex organizational situations appear. Creativity, for example, involves co-dependence of other persons’ strategies and actions. New roles for those involved affect hierarchies and knowledge sharing opportunities.This thesis involves three different perspectives of the same process provides an opportunity to study both individual and structural challenges. This research aims to identify on-going challenges for an organization during the transformational processes that adjustment from a traditional product innovation structure to an open service innovation culture implies. This qualitative case study involves two main cases and three supporting cases and aims to understand how users and other external parties, top management and middle managers experience open innovation processes. The results describe interactions between organizations and users or external stakeholders as well as internal interactions within the organization. Top management were dedicated to the idea of increased openness, but detected structural issues to deal with in order to implement user involved innovation. Among middle management, some individual aspects such as attitudes and relational issues matter, as well as organizational structures and practices. Users had mixed opinions about their participation in the process. Favorable experiences, such as benevolence and deepened relationships, were balanced by un-favorable experiences such as incapability and intrusion. Different dimensions of openness regarding open innovation practice are discussed. In this work a relational focus is emphasized. The findings assist managers in their work to create conditions for open innovation. Managers can benefit from this research by getting a better understanding of how different stakeholders’ experience co-creation of value. This is relevant for innovation managers in the process of redesigning innovation processes to understand different aspects of the interactions involved.
|
|
| 4. |
- Andersson, Ann-Christine
(författare)
-
Quality Improvement in Healthcare : Experiences from a Swedish County Council Initiative
- 2013
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Quality improvement (QI) has become an important issue in healthcare settings. A central question for many healthcare systems is how to manage improvement initiatives adequately. All county councils and regions managing healthcare in Sweden have started to work with QI at an organizational system level, to varied extents. The Kalmar county council improvement initiative constitutes the empirical basis of this thesis. The aim of the thesis is to provide knowledge about different aspects of a county-wide improvement initiative, and a broader understanding of factors and strategies that affect participation, management and outcomes. The overall study design is based on a case study.The first two studies illuminate the practice-based (micro level), bottom-up perspective. Inductively five different areas (categories) were identified. Factors influencing participation in improvement initiatives provided the basis for the next study. The result showed that different staff categories were attracted by different initiatives. The next two studies illuminate the top-down (macro/meso) management perspective. Managers’ views of how patients can participate were investigated and a content analysis of the written answers was made. Four main areas (categories) were identified. A survey study investigated all of the county council managers’ experiences of the whole improvement initiative. Overall the managers thought that the improvement work was worth the effort. To evaluate the Breakthrough Collaborative program, a survey was developed and tested. This survey was used to investigate process and outcome of the BC program. The majority of the respondents were satisfied with their work, but wanted more time for teams to meet and work. To find out if an improvement program can affect outcome and contribute to sustainable changes, interviews were made with project applicants (n=202). Almost half (48%) of the projects were funded, and of those 51% were sustained. Of the rejected (not funded) projects, 28% were accomplished and sustained anyway. The results in this thesis cannot show that the “golden mean” exists, or that a single best way to manage changes and improvements in a healthcare organization has been found, but the way QI initiatives are organized does affect participation and outcomes. The intention, from the management topdown system level, encouraging staff and units and letting practice-based ideas develop at all system levels, can stimulate and facilitate improvement work.
|
|
| 5. |
- Pettersen, Jostein, 1977-
(författare)
-
Translating Lean Production : From Managerial Discourse to Organizational Practice
- 2009
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The majority of organizational change efforts end in failure. These failures can often be ascribed to lack of understanding of the translation processes that accompany the implementation of management concepts. Translation becomes evident when the initial ambitions of an implementation process are changed as they are communicated through the organization, often leading to unwanted results.This thesis deals with the translation of management concepts. The ambition is to contribute to the body of knowledge that is concerned with this theoretical direction through demonstrating how the currently dominating management concept Lean Production is translated as it is passed between contexts.The thesis is based on three studies of management concepts at various levels of abstraction. The first study is based on a review of the major literature on Lean Production. The second study is based on a survey among Swedish production managers on their application of management methods and concepts. The third study comprises a series of interviews within a large Swedish industrial organization, focusing on how Lean Production has been translated during the implementation process.The results show that Lean Production is far from well defined or unequivocal. There is always room for translation as the concept is passed between actors within an organization. It is therefore unreasonable to expect the concept to provide certain results. The results are determined by the way the concept is interpreted and translated within the organization that seeks to implement it. It is argued that insufficient translation competence will increase the risk of an uncontrolled and potentially ineffective translation process, leading to unexpected and undesirable results.Through combining these results with existing theories within the management field, the author presents a tentative model for analyzing the translation of management concepts all the way from the general managerial discourse to the practice that can be observed at the factory floor of a company. It is proposed that this model may be used as a conceptual framework for further studies of the translation of management concepts.
|
|
| 6. |
- Snyder, Hannah
(författare)
-
Patient Involvement : A Service Perspective
- 2014
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- For a long time, patients were seen as weak and passive recipients of care, whose only role was to provide information and comply with doctors’ orders. This is beginning to change, and patients are more seen as autonomous, active, and involved collaborators in care, co-creating value with service providers and others. In parallel, the healthcare sector is changing due to an aging population, advances in technology, medical knowhow, and the prevalence of chronic diseases, which all call for a more involved patient. During the last decade, patient involvement in healthcare has been recognized as important to provide more efficient, integrated, patient-focused healthcare. Despite this recent gain in attention, there is a gap between rhetoric’s and practice, since the meaning and benefits of patient involvement are unclear both in theory and practice. This thesis takes an alternate perspective on patient involvement, departing from service theory on value creation and customer involvement. It aims to understand and explore patient involvement and how patients can be involved in both the use, and development, of healthcare services.This thesis is based on three different studies using both qualitative and quantitative research methods. The first study is a systematic literature review of healthcare research, addressing the topic of patient involvement and related concepts. Based on a total of 125 reviewed empirical articles, this study serves as an introduction and orientation to the diverse field. It aims to contribute to the knowledge base in the growing research field of patient involvement. The second study addresses and explores lead-user theory as a method to identify highly innovative patients who can be suitable for involvement in healthcare development. The third study explores how patients, depending on disease, care process and context, can take different roles in healthcare development.The results indicate that patient involvement is not an isolated activity but influences the whole healthcare system. This extends the view of patient involvement from just decision-making and isolated encounters to patients potentially being substantially involved in all aspects of healthcare. This is also important in involvement in use. The patient’s individual experiences, context, and type of illness play an important role in development initiatives. Patients should be selected carefully, for involvement in healthcare development, depending on the goal of the initiative. The type of illness and the patient’s context are key factors to the kind of contributions patients can make. Depending on the type of illness, and if it shows up mostly at home or at the care provider’s, patients develop different contributions.This thesis contributes to understanding patient involvement by taking a service perspective on co-creation and customer involvement. This approach to patient involvement extends the traditional view by proposing that patients should be involved in all stages of healthcare. Understanding how individuals create value and manage their health is important for individuals, healthcare providers, and government. Much of a patient’s value creation takes place outside the patientprovider sphere, and is therefore unknown to the healthcare provider. By actively involving patients in both use and development, healthcare providers can apply a whole-person perceptive.
|
|
