| 1. |
- Goldgruber, Judith, et al.
(författare)
-
ESTHER-Thinking in der (integrierten) Gesundheitsversorgung – Ein radikaler Ansatz für mehr Customer Centricity
- 2023
-
Ingår i: Kunden begeistern. - Wiesbaden : Springer. - 9783658382636 - 9783658382643 ; , s. 229-245
-
Bokkapitel (refereegranskat)abstract
- Im Alter von 65 Jahren dürfen Schweden auf 16 weitere gesunde Lebensjahre hoffen, Schwedinnen sogar auf 16,5. Im EU-Durchschnitt sind es rund zehn, in Österreich und Deutschland rund acht Jahre weniger. Ein wesentlicher Grund sind bessere Prävention und Nachsorge. Eine schwedische Region konnte innerhalb von zehn Jahren Krankenhauseinweisungen ihrer älteren Einwohnerinnen und Einwohner um zwei Drittel senken und zugleich die Kosten um umgerechnet 3,5 Milliarden Euro senken – im europäischen Gesundheitswesen einzigartige Erfolge. Doch welche Geschichte steckt hinter diesen beeindruckenden Zahlen? Es ist die Geschichte von Esther.
|
|
| 2. |
- Kirvalidze, Mariam, et al.
(författare)
-
Effectiveness of integrated person-centered interventions for older people's care : Review of Swedish experiences and experts' perspective
- 2024
-
Ingår i: Journal of Internal Medicine. - : John Wiley & Sons. - 0954-6820 .- 1365-2796.
-
Tidskriftsartikel (refereegranskat)abstract
- Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field. image
|
|
| 3. |
- Mulvale, Gillian, et al.
(författare)
-
Adopting, implementing and assimilating coproduced health and social care innovations involving structurally vulnerable populations : findings from a longitudinal, multiple case study design in Canada, Scotland and Sweden
- 2024
-
Ingår i: Health Research Policy and Systems. - : BioMed Central (BMC). - 1478-4505. ; 22:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Innovations in coproduction are shaping public service reform in diverse contexts around the world. Although many innovations are local, others have expanded and evolved over time. We know very little, however, about the process of implementation and evolution of coproduction. The purpose of this study was to explore the adoption, implementation and assimilation of three approaches to the coproduction of public services with structurally vulnerable groups.METHODS: We conducted a 4 year longitudinal multiple case study (2019-2023) of three coproduced public service innovations involving vulnerable populations: ESTHER in Jönköping Region, Sweden involving people with multiple complex needs (Case 1); Making Recovery Real in Dundee, Scotland with people who have serious mental illness (Case 2); and Learning Centres in Manitoba, Canada (Case 3), also involving people with serious mental illness. Data sources included 14 interviews with strategic decision-makers and a document analysis to understand the history and contextual factors relating to each case. Three frameworks informed the case study protocol, semi-structured interview guides, data extraction, deductive coding and analysis: the Consolidated Framework for Implementation Research, the Diffusion of Innovation model and Lozeau's Compatibility Gaps to understand assimilation.RESULTS: The adoption of coproduction involving structurally vulnerable populations was a notable evolution of existing improvement efforts in Cases 1 and 3, while impetus by an external change agency, existing collaborative efforts among community organizations, and the opportunity to inform a new municipal mental health policy sparked adoption in Case 2. In all cases, coproduced innovation centred around a central philosophy that valued lived experience on an equal basis with professional knowledge in coproduction processes. This philosophical orientation offered flexibility and adaptability to local contexts, thereby facilitating implementation when compared with more defined programming. According to the informants, efforts to avoid co-optation risks were successful, resulting in the assimilation of new mindsets and coproduction processes, with examples of how this had led to transformative change.CONCLUSIONS: In exploring innovations in coproduction with structurally vulnerable groups, our findings suggest several additional considerations when applying existing theoretical frameworks. These include the philosophical nature of the innovation, the need to study the evolution of the innovation itself as it emerges over time, greater attention to partnered processes as disruptors to existing power structures and an emphasis on driving transformational change in organizational cultures.
|
|
| 4. |
|
|
| 5. |
- Vackerberg, Nicoline, et al.
(författare)
-
Commentary : Bridging the silos. A comparative analysis of Implementation Science and Improvement Science
- 2022
-
Ingår i: Frontiers in health services. - : Frontiers Media S.A.. - 2813-0146. ; 2
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- A Commentary onBridging the silos: A comparative analysis of Implementation Science and Improvement ScienceNilsen, P., Thor, J., Bender, M., Leeman, J., Andersson-Gäre, B., and Sevdalis. N. (2022). Front. Health Serv. 1:817750. doi: 10.3389/frhs.2021.817750
|
|
| 6. |
|
|
| 7. |
- Vackerberg, Nicoline, et al.
(författare)
-
What is best for Esther? A simple question that moves mindsets and improves care
- 2023
-
Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 23:1, s. 1-16
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Persons in need of services from different care providers in the health and welfare system often struggle when navigating between them. Connecting and coordinating different health and welfare providers is a common challenge for all involved. This study presents a long-term regional empirical example from Sweden-ESTHER, which has lasted for more than two decades-to show how some of those challenges could be met. The purpose of the study was to increase the understanding of how several care providers together could succeed in improving care by transforming a concept into daily practice, thus contributing with practical implications for other health and welfare contexts.METHODS: The study is a retrospective longitudinal case study with a qualitative mixed-methods approach. Individual interviews and focus groups were performed with staff members and persons in need of care, and document analyses were conducted. The data covers experiences from 1995 to 2020, analyzed using an open inductive thematic analysis.RESULTS: This study shows how co-production and person-centeredness could improve care for persons with multiple care needs involving more than one care provider through a well-established Quality Improvement strategy. Perseverance from a project to a mindset was shaped by promoting systems thinking in daily work and embracing the psychology of change during multidisciplinary, boundary-spanning improvement dialogues. Important areas were Incentives, Work in practice, and Integration, expressed through trust in frontline staff, simple rules, and continuous support from senior managers. A continuous learning approach including the development of local improvement coaches and co-production of care consolidated the integration in daily work.CONCLUSIONS: The development was facilitated by a simple question: "What is best for Esther?" This question unified people, flattened the hierarchy, and reminded all care providers why they needed to improve together. Continuously focusing on and co-producing with the person in need of care strengthened the concept. Important was engaging the people who know the most-frontline staff and persons in need of care-in combination with permissive leadership and embracing quality improvement dimensions. Those insights can be useful in other health and welfare settings wanting to improve care involving several care providers.
|
|
| 8. |
- Vackerberg, Nicoline, et al.
(författare)
-
What is best for Esther? Building improvement coaching capacity with and for users in health and social Care-A case study
- 2016
-
Ingår i: Quality Management in Health Care. - : LIPPINCOTT WILLIAMS & WILKINS. - 1063-8628 .- 1550-5154. ; 25:1, s. 53-60
-
Tidskriftsartikel (refereegranskat)abstract
- While coaching and customer involvement can enhance the improvement of health and social care, many organizations struggle to develop their improvement capability; it is unclear how best to accomplish this. We examined one attempt at training improvement coaches. The program, set in the Esther Network for integrated care in rural Jonkoping County, Sweden, included eight 1-day sessions spanning 7 months in 2011. A senior citizen joined the faculty in all training sessions. Aiming to discern which elements in the program were essential for assuming the role of improvement coach, we used a case-study design with a qualitative approach. Our focus group interviews included 17 informants: 11 coaches, 3 faculty members, and 3 senior citizens. We performed manifest content analysis of the interview data. Creating will, ideas, execution, and sustainability emerged as crucial elements. These elements were promoted by customer focusembodied by the senior citizen trainershared values and a solution-focused approach, by the supportive coach network and by participants' expanded systems understanding. These elements emerged as more important than specific improvement tools and are worth considering also elsewhere when seeking to develop improvement capability in health and social care organizations.
|
|
| 9. |
- Ärleskog, Caroline, et al.
(författare)
-
Balancing power in co-production: introducing a reflection model
- 2021
-
Ingår i: Humanities & Social Sciences Communications. - : Springer Science and Business Media LLC. - 2662-9992. ; 8
-
Tidskriftsartikel (refereegranskat)abstract
- The role and position of users in health and welfare has recently changed to become more active in co-production of care. When more co-production is preferred, challenges related to power need to be considered. In this paper, power is seen as the possibility to influence. The paper focuses on power in co-produced improvement work by introducing a reflection model based on Franzen's power triangle, further developed from improvement coaches' perceptions. First, empirical data from interviews with improvement coaches were analyzed and then the theoretical model was created. Twelve coaches were included in the interviews, all of them with experience of co-production and improvement work within a region in southeast Sweden. By combining the empirical results with the power triangle, a reflection model concerning power dimensions was developed. The results showed the necessity of reflection regarding several power-related factors. Resources were found to be important and depending on contextual settings. Attitudes and perceptions among personnel and users were also vital. To accomplish co-production, the power dimension must be considered, and the power triangle acknowledges different power dimensions and how they affect each other. The model has a systematic character and allows adjustments to the power dimensions within any other context. It can inspire and be used by improvers working with co-production to promote deeper professional and organizational reflection and thereby contribute to new insights on how to balance power in co-producing health and welfare services.
|
|
