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- Korlén, S., et al.
(författare)
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Managerial strategies to make incentives meaningful and motivating
- 2017
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Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Ltd.. - 1477-7266 .- 1758-7247. ; 31:2, s. 126-141
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Policy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby incentives are filtered through organizations to influence staff motivation, and the key role of managers is often overlooked. The purpose of this paper is to explore the strategies managers use as intermediaries between financial incentives and the individual motivation of staff. The authors use empirical data from a local case in Swedish specialized care. Design/methodology/approach: The authors conducted an exploratory qualitative case study of a patient-choice reform, including financial incentives, in specialized orthopedics in Sweden. In total, 17 interviews were conducted with professionals in managerial positions, representing six healthcare providers. A hypo-deductive, thematic approach was used to analyze the data. Findings: The results show that managers applied alignment strategies to make the incentive model motivating for staff. The managers’ strategies are characterized by attempts to align external rewards with professional values based on their contextual and practical knowledge. Managers occasionally overruled the financial logic of the model to safeguard patient needs and expressed an interest in having a closer dialogue with policy makers about improvements. Originality/value: Externally imposed incentives do not automatically motivate healthcare staff. Managers in healthcare play key roles as intermediaries by aligning external rewards with professional values. Managers’ multiple perspectives on healthcare practices and professional culture can also be utilized to improve policy and as a source of knowledge in partnership with policy makers.
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- Simic, M., et al.
(författare)
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Effect of various dating formulae on sonographic estimation of gestational age in extremely preterm infants
- 2012
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 40:2, s. 179-185
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Gestational age (GA) is one of the most important obstetric factors and prediction of date of delivery is usually based on ultrasonographic fetal measurements. Our aim was to determine whether applying three different dating formulae to a cohort of extremely preterm infants influenced the estimation of their GA. Methods This was a study of 513 infants delivered before 27 gestational weeks, included in a Swedish national population study (EXPRESS), with information available on mid-trimester ultrasonographically measured biparietal diameter and femur length. We applied using these parameters three dating formulae, the Persson & Weldner formula, commonly used in Sweden, the Hadlock formula and the Mul formula, and compared their GA estimates to the clinically reported GA (recorded at delivery) and the last menstrual period (LMP)-based GA. Results The mean reported GA was 173.2 days, corresponding well to the GA according to the Persson & Weldner dating formula (173.3). The mean GA according to LMP, the Hadlock formula and the Mul formula were 176.8, 175.3 and 175.6 days, respectively. The Hadlock and Mul GA estimates differed significantly from that based on the Persson & Weldner formula (both P-values < 10-6). Among 68 pregnancies with a reported duration of 22 weeks, 33 (49%) had a duration of 23 weeks or more when GA was calculated according to LMP and 22 (32%) when GA was calculated according to the Hadlock formula. Conclusion Estimated GA among infants delivered before 27 gestational weeks varied significantly depending on the dating formula used to calculate the estimated date of delivery; this might influence the clinical management of extremely preterm fetuses and infants. Copyright (c) 2012 ISUOG. Published by John Wiley & Sons, Ltd.
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- Smith, J, et al.
(författare)
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Copeptin and MR-proADM in umbilical cord plasma reflect perinatal stress in neonates born to mothers with diabetes and MR-proANP reflects maternal diabetes
- 2013
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Ingår i: Biomarkers in medicine. - : Future Medicine Ltd. - 1752-0371 .- 1752-0363. ; 7:1, s. 139-146
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To examine concentrations of three cardiovascular propeptides in umbilical cord plasma of neonates born to mothers with Type 1, Type 2 and gestational diabetes. Measurement of cardiovascular markers in umbilical cord plasma may potentially help identify neonates at risk of postnatal complications. Neonates born to mothers with diabetes have an increased risk of neonatal morbidity and mortality, and measurement of these new biomarkers may potentially help identify neonates at risk of these complications. Subjects & methods: Copeptin, midregional proadrenomedullin (MR-proADM) and mid-regional pro-A-type natriuretic peptide (MR-proANP) were measured in cord plasma of neonates (n = 63) born to mothers with the three types of diabetes. Associations with maternal glycemic control, mode of delivery and neonatal metabolic acidosis were examined. Results: Umbilical cord plasma copeptin concentrations were lowest in neonates after elective cesarean sections (6.1 pmol/l; interquartile range [IQR]: 4.5–9.1) compared with emergency cesarean sections (156 pmol/l; IQR: 9.6–311; p = 0.019) and vaginal delivery (831 pmol/l; IQR: 107–2407; p < 0.0001). MR-proADM was also affected by mode of delivery; however, this seemed more likely to be caused by an inverse association with the acid–base balance. In this population, only MR-proANP plasma concentrations were related to type of diabetes. Neonates born to mothers with Type 1 diabetes had higher concentrations (median 260 pmol/l; IQR: 222–318) compared with Type 2 diabetes (175 pmol/l; IQR: 169–200; p = 0.003) and gestational diabetes (200 pmol/l; IQR: 149–276; p = 0.009). Conclusion: Umbilical cord plasma copeptin and MR-proADM concentrations primarily reflect perinatal stress associated with mode of delivery and the degree of fetal acidosis, whereas MR-proANP concentrations are higher in neonates born to mothers with Type 1 diabetes.
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- Xodo, S, et al.
(författare)
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Why STAN might not be dead
- 2017
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Ingår i: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. - : Informa UK Limited. - 1476-4954. ; 30:19, s. 2306-2308
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Tidskriftsartikel (refereegranskat)
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