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- 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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- 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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- 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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- Alverén, Ellen, et al.
(författare)
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Seasonal employees' intention to return and do more than expected
- 2012
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Ingår i: Service Industries Journal. - : Informa UK Limited. - 0264-2069 .- 1743-9507. ; 32:12, s. 1957-1972
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Tidskriftsartikel (refereegranskat)abstract
- Seasonal employment is important in the service industries. Having motivated and satisfied employees is fundamental when front-line employees play a key role for the customers' perceived service quality. Seasonal work differs from permanent employment in many aspects and if managed properly, this could be a competitive advantage and contribute to the success of an organization. This study focuses on seasonal employees' intention to return and to do more than expected at work as well as the relationships between certain motivational factors and job satisfaction. A survey was carried out at four ski resorts with 477 respondents. Correlation and regression analyses indicate that job satisfaction influences the intention to return but does not have a strong influence on organizational citizenship behaviour (i.e. doing more than expected at work). The results improve our understanding of seasonal workers' motivation and behaviour. The concluding part discusses managerial implications.
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- Frisk, Sylva, 1964, et al.
(författare)
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Leadership for teaching and learning: Exploring a department-level educational leadership role at a Swedish comprehensive university
- 2023
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Ingår i: Educational Management, Administration & Leadership. - : SAGE Publications. - 1741-1432 .- 1741-1440. ; 51:6, s. 1461-1477
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Tidskriftsartikel (refereegranskat)abstract
- As excellence in teaching and learning, in combination with a focus on student performance rates, are guiding the demands placed on higher education institutions, modern universities are attributing strategic importance to leadership of teaching and learning. Previous studies on educational leadership have, nevertheless, identified significant challenges to such leadership due to lack of clear role descriptions, lack of recognition, and lack of access to professional development and support. Using empirical data from a Swedish comprehensive university, we explore the experiences of an appointed leadership role for teaching and learning, that is, the Education Leader, at the department level. Our findings show that a university-wide policy establishing the role and a support structure around it has resulted in a clearly visible and valued role across the university. Furthermore, Education Leaders experience being positioned at the heart of the department’s educational activities, performing hub-like work in relation to those they lead. However, some challenges related to the complexity of the department contexts are also identified.
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| 7. |
- Karlsson, Sara, et al.
(författare)
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Not just another evaluation : A comparative study of four educational quality projects at Swedish universities
- 2014
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Ingår i: Tertiary Education and Management. - : Springer Science and Business Media LLC. - 1358-3883 .- 1573-1936. ; 20:3, s. 239-251
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Tidskriftsartikel (refereegranskat)abstract
- In this study, four recent self-initiated educational quality projects at Swedish universities are compared and analyzed. The article focuses on how the universities have handled the tension between external demands and internal norms. The aim is to contribute to an improved understanding of quality management in contemporary universities. On the one hand, the projects are found to be built on similar rationales associated with accountability, reputation building and strategic management. This is interpreted as a response to the shared external policy context. They are also found to mirror similar ambitions regarding raising the status of education. On the other hand, the projects are found to differ considerably in their actual design, methodology, implementation, stakeholders and outcomes. This is interpreted as an active adaptation to the unique internal academic norms and cultures that exist in each university.
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| 9. |
- Nilsson, Kerstin, 1947, et al.
(författare)
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Leading implementation of the management innovation value-based healthcare at a Swedish University Hospital
- 2017
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Ingår i: Journal of Hospital Administration. - 1927-6990 .- 1927-7008. ; 6:1, s. 51-59
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study is to explore medical and care staff’s experiences of leading the implementation of the management innovation, named value-based healthcare (VBHC) at a large Swedish University Hospital. Methods: In this study an explorative design was used. Data was collected with individual open-ended repeated interviews with 20 members of four teams leading the implementation of VBHC. The interviews were transcribed verbatim and qualitatively analysed. Results: Findings from this interview study showed that not all participants were comfortable with being appointed as leaders for the VBHC implementation process. Some found it rather too challenging instead. Participants described characteristics such as openness, visibility, approachability, and the ability to be a role model as necessary when leading implementation work. Leadership strategies emphasized were participation and involvement but also the ability to control implementation processes. Anchoring was effectuated by means of a pedagogical approach including dialogues and feedback before making step-by-step changes in everyday work itself. Conclusions: This study shows that leadership is a challenging experience in the context of a team responsible for implementing VBHC, however commendable the management innovation in itself may be. The expectations connected to the leadership role in the context of VBHC implementation must be clarified. Awareness is needed of the extent of the mandates accorded to the care and medical staff appointed as leaders of VBHC teams, especially since care and medical staff are formally speaking not as managers.
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| 10. |
- Nilsson, Kerstin, 1947, et al.
(författare)
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Leading Processes of Patient Care and Treatment in Hierarchical Healthcare Organizations in Sweden – Process Managers’ Experiences
- 2015
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Ingår i: Leadership in Health Services. - 1751-1879 .- 0952-6862. ; 28:2, s. 135-148
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Tidskriftsartikel (refereegranskat)abstract
- Purpose - The purpose of this study is to gain better understanding of the roles and functions of process managers by describing Swedish process managers' experiences of leading processes involving patient care and treatment when working in a hierarchical health-care organization. Design/methodology/approach - This study is based on an explorative design. The data were gathered from interviews with 12 process managers at three Swedish hospitals. These data underwent qualitative and interpretative analysis with a modified editing style. Findings - The process managers' experiences of leading processes in a hierarchical health-care organization are described under three themes: having or not having a mandate, exposure to conflict situations and leading process development. The results indicate a need for clarity regarding process manager's responsibility and work content, which need to be communicated to all managers and staff involved in the patient care and treatment process, irrespective of department. There also needs to be an emphasis on realistic expectations and orientation of the goals that are an intrinsic part of the task of being a process manager. Research limitations/implications - Generalizations from the results of the qualitative interview studies are limited, but a deeper understanding of the phenomenon was reached, which, in turn, can be transferred to similar settings. Originality/value - This study contributes qualitative descriptions of leading care and treatment processes in a functional, hierarchical health-care organization from process managers' experiences, a subject that has not been investigated earlier.
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