| 1. |
- Marcusson, Jan, et al.
(författare)
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Proactive healthcare for frail elderly persons : study protocol for a prospective controlled primary care intervention in Sweden
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.
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| 2. |
- Cronemyr, Peter, et al.
(författare)
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Assessing the Quality of Elderly Care – Can Survey Incomparability be Solved by Vignettes?
- 2014
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Ingår i: Proceedings of the 21st EurOMA conference, Palermo, Italy. - Palermo, Italy..
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Konferensbidrag (refereegranskat)abstract
- User and customer surveys are the most commonly used instruments to evaluate the efficiency and quality of public services, but an important question is whether the data collected by the surveys are of sufficient quality to support decision making and improvements of public services. One of the mentioned problems is the interpersonal incomparability of survey responses, which may be biased if individuals interpret the questions in different ways and use response scales in systematically different ways. The purpose of the present study is therefore to investigate how the use of anchoring vignettes could improve the quality of survey results. Our results show that anchoring vignettes remove some noise from survey results and allow the correction of otherwise interpersonally incomparable survey responses. The suggested methodology has the potential to contribute to better evaluations of the quality of elderly care and, thereby, to better decisions on how to improve elderly care services.
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| 3. |
- Dannapfel, Petra, et al.
(författare)
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Dissemination strategy for Lean thinking in health care
- 2014
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Ingår i: International Journal of Health Care Quality Assurance. - 0952-6862 .- 1758-6542. ; 27:5, s. 391-404
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare organisations.Design/methodology/approach – The Östergötland county council, Sweden (CCÖ ) was chosenas a case study for an healthcare Lean-thinking dissemination strategies. Document analysis and interviews were used and results were compared with similar strategies employed by staff at the National Health Service Institute for Innovation (NHSI) and improvement in Great Britain and the Odense University Hospital in Denmark.Findings – The Lean improvement programme was introduced to tackle challenges such as anageing society, rising care expectations and budgetary and economic constraints. It was designedas a long-term programme to create added value for patients and employee involvement. The dissemination strategy was: forming clear visions and objectives; piloting; training potential adopters; and formal dissemination. The CCÖ strategy was focused primarily on managers and was not meant to involve all staff until the implementation stage. Staff at the NHS attempted to address nurses’ needs during dissemination, which questioned whether the CCÖ managers’ dissemination strategy is sustainable.Practical implications – This paper inspires healthcare managers and decision makers who aim to disseminate Lean production in their organisations.Originality/value – There are many case studies describing Lean implementation in single healthcare organisations, but little is known about effective dissemination and implementation strategies in large healthcare systems. The authors, therefore, suggest activities for developing and implementing dissemination strategies in multiple healthcare organisations.
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| 4. |
- Drotz, Erik, et al.
(författare)
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Lean in healthcare from employees' perspectives
- 2014
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Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 28:2, s. 177-95
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations.DESIGN/METHODOLOGY/APPROACH: The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data were collected by methods including interviews, observations, and document studies.FINDINGS: The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers.PRACTICAL IMPLICATIONS: Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations' working environment, staff development, and organizational performance.ORIGINALITY/VALUE: In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.
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| 5. |
- Drotz, Erik, 1985-, et al.
(författare)
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Lean in healthcare from the employee perspective
- 2012
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- PurposeSeveral studies may be found on how Lean production is implemented in healthcare. Most articles include single case studies and are often published in medical journals. There is however a different tradition on how research is performed in medical and management sciences. The medical studies describe the state before and after an intervention or improvement program, but rarely pay attention to the implementation process and consider such important issues such as leadership, management processes and employee's role. There is a need for more management studies on Lean healthcare that focus not only on outcomes, but also on the context and factors that influence outcomes.The purpose of the article is to contribute to the knowledge on how Lean production influences the daily work and routines of healthcare staff.What does it mean to employees to work in a Lean healthcare unit?How does a Lean implementation affect the role and responsibilities of the employees?Methodology/Approach:The data described in this paper comes from three case studies performed in healthcare organizations: two district care centres and one hospital unit. The data was collected through interviews, both with managers and employees, observations and document studies. The case organizations were described as successful Lean organizations and had worked with Lean for at least three years.FindingsThe implementation of Lean production often implies increased responsibility of employees for management of daily activities and increased participation in the improvement work. The influence of Lean on the daily work is however to great extent a matter of how the implementation is managed. In one case, Lean had been implemented by discrete projects, mainly conducted by the manager group with little effort on empowering the employees, increasing two-way communication and involvement in improvement work. Therefore, the role of the employees did not change much in conjunction with the Lean implementation. On the contrary, at another case the managers put a lot effort on coaching, developing and empowering the employees, and the improvement work had become an important working task for all employees. This led to a substantial improvement in the social climate, since the former barriers between different professions were weakened and the teamwork had increased.The conclusion is that there are great potential benefits with a Lean implementation for the employees, but this can only be realized if the implementation is managed with a focus on the development of employees and a more open social structure. An important method to facilitate this is improvement groups with employees from different professions and functions within the organization that has an explicit ownership of the improvements, from idea to realization. Originality/Value of paper:Lean Healthcare is relatively a new phenomenon and more research work is needed to determine the full range of implications of the concept. The paper increases the understanding of what Lean production actually means to the healthcare staff. This knowledge is vital for the success and sustainability of Lean improvement programs in healthcare. The paper is also an inspiring source for both researchers and healthcare professional who are interested in the application of lean production in healthcare.
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| 6. |
- Drotz, Erik, et al.
(författare)
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Lean in social services : possibilities and limitations
- 2014
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Purpose – With this paper we aim to explore the opportunities and limitations of implementing Lean production in the social service context.Methodology/approach – This paper is based on an ongoing longitudinal case study performed in the municipal social services. Several data collection methods have been used. First, we performed interviews with employees and managers in January-June 2012. Second, a questionnaire was sent out to all employees (n=303, response rate = 56%) in June - August 2013. Third, we have participated in numerous education events, improvement meetings, feedback seminars and strategic meetings. Fourth, we have studied protocols from project group meetings and other meetings that were relevant for the Lean work, as well as internal and external information about the Lean work.Findings – This paper shows that there are big differences on how Lean can be applied in front-office and back-offices processes. The application of Lean production have a limited value for the improvement of front-office processes that imply a high degree of service characteristics. The limitation of Lean is the absence of principles that can be used to enhance the value creation in the meeting and interaction with users. In back-office processes where service characteristics are less evident, the Lean principles are more suitable and easy to apply. By engaging employees in improvement work Lean helped the social service organization to achieve more coordinated and consistent workflows and thereby shorten handling times and reduce costs.Practical implications – Since Lean production was not intended to assure the functional quality of services it needs to be complemented by other improvement activities to enhance the value co-creation with the user. In respect to the current trend of greater involvement of users, citizens and the wider community in public services an important question for the social service providers is not just how to improve the organization, but how to better work with users and other involved persons.Originality/value – The current research on Lean in public services is limited to a number of case studies describing success stories from implementing some Lean methods and tools. In our study we take different approach and analyze Lean production from the distinctive context and purpose of the social service. We discuss how the service characteristics and the technical and functional dimensions of service quality influenced the choice of Lean principles, methods and tools, and what implications it has for improving municipal social services.
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| 7. |
- Drotz, Erik, 1985-
(författare)
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Lean in the Public Sector : Possibilities and Limitations
- 2014
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The demands on efficiency and quality in the public sector have increased over the past few years, which have raised the need for strategies on how the public sector can be improved (Denhardt and Denhardt, 2000). Consequently, the concept of Lean production, or just Lean, have become increasingly spread, especially in health care, but also in government agencies, police, military and social services. Lean production is an integrated operational and socio-technical system with the aim of creating value and reducing waste in operations. Some research has been conducted on Lean in the public sector, but it has been too focused on the a few operational tools and results of these, and there is lack of a comprehensive critical review of Lean from a holistic perspective.The aim of this thesis is to increase understanding of how Lean production is used in different contexts. The thesis particularly focuses on the public sector, and investigates the possibilities and limitations of Lean production in this context. A total of seven organizations have been studied, including two manufacturing companies, three care units and two local businesses. In particular, qualitative methods have been used, along with some quantitative.The thesis shows several possibilities and limitations of Lean in public sector. One possibility is the improved flow orientation that reduces the lead time and efficiency in back office processes. Moreover, the new roles and responsibilities can lead to improved job characteristics for public sector employees. One limitation is that Lean is more commonly used to improve the technical quality than the functional, which means that the focus has been placed on improving the instrumental performance of the service, rather than how the service is provided. There is also often a focus on efficiency in the back office rather than the front office processes. This means that Lean initiatives may become too focused on internal efficiency and thereby miss important aspects of user perceived quality.
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| 8. |
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| 9. |
- Elg, Mattias, et al.
(författare)
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Co-creation and learning in health-care service development
- 2012
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Ingår i: Journal of Service Management. - : Emerald Group Publishing Limited. - 1757-5818 .- 1757-5826. ; 23:3, s. 328-343
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Tidskriftsartikel (refereegranskat)abstract
- Purpose - The purpose of this study is to develop and evaluate a model for patient co-creation and learning based on diaries for use in health-care service development. In particular, the study aims to investigate the process of patient co-creation and different mechanisms through which health-care service providers can learn from the patient. Design/methodology/approach - The study is based on an action research approach. First, a development phase for patient co-creation and learning leading to a proposed model was conducted. Second, a test phase of the diary-based method was performed on 53 patients in three cases: orthopaedic care, rehabilitation care and gastroenterology care. Findings - The study suggests a model for co-creation and learning in health-care service development through three learning methods. First, the model may be used as a means for generating and collecting patient ideas; second, a single patient's story can be illustrated and can serve as incentive for health-care service development and creation of patient-centred care; finally, a larger number of diaries can be analysed and combined with patient surveys to provide a deeper understanding of how the patient experiences health care services. Originality/value - This study extends the research on diary-based methods as an operationalisation of co-creation in two ways. First, the study offers new and more diverse ways of using the rich material provided by customer diaries in the development of services. Second, the study suggests a co-creation approach of involving patients in health-care service development through patient diaries.
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| 10. |
- Elg, Mattias, 1968-, et al.
(författare)
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Solicited Diaries as a Means of Involving Patients in Development of Healthcare Services
- 2011
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Ingår i: International Journal of Quality and Service Sciences. - : Emerald Group Publishing Limited. - 1756-669X .- 1756-6703. ; 3:2, s. 128-145
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of this paper is to develop an understanding of how patients experience their health problems and how they can generate innovative ideas about health care services. The research questions that guide the present study are: how can solicited diaries be used for capturing patient ideas? What type of data is generated from solicited diaries used for generating patient ideas? And what are the potential benefits and shortcomings of using patient diaries in generating ideas for improvement of health care services? Design/methodology/approach – The paper is based on an exploratory case study using patient diaries to solicit ideas about how health care services in Sweden can be improved. From the methodological viewpoint, the diaries are used as a tool for patient co-creation of health care services. Findings – When analyzing dairies written by patients four different types of diaries emerged from the study: brief, reporting, descriptive and reflective diaries. Furthermore, 102 ideas for improvements within nine areas were identified from the contents of dairies. Research limitations/implications – Adopting patients' diaries as a way to activate and promote co-creation of values is at an embryo stage, and hence more research is needed. Originality/value – One of the strengths of the paper includes its potential for practical implications, either clinical or methodological, by using patients' dairies. It focuses both on the content generated from the diaries for improving health services, as well as the use of the diaries for practicing the idea of patients as co-creators in health care service.
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