| 1. |
- Bäckström, Ingela, 1963-, et al.
(författare)
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A Hospital Without Departments?
- 2022
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Ingår i: Proceedings M2D2022. - 9789895475629 - 9789895475636 ; , s. 957-958
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Konferensbidrag (refereegranskat)abstract
- Increasing the efficiency of patient treatment as well as improving patient care quality and reducing waiting times are challenges facing healthcare systems around the world (Fine, et al., 2009). Furthermore, there is a challenge to increase the number of patients treated and to cut waiting times while retaining costs under control as well as becoming a more attractive employer (van Rossum et al., 2016). In order to meet the challenges in healthcare, different Quality Management (QM) initiatives have been applied (Seidl and Newhouse,2012). Lean and Six Sigma are popular QM initiatives originating from manufacturing but also used in the healthcare sector. Six Sigma and Lean can be used to detect value adding processes and also confirming control and sustainability of change through establishing plans (ibid). The purpose of this paper is to describe a shared picture of the situation and to identify general possibilities for improvements focusing on the transitions between wards.
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| 2. |
- Bäckström, Ingela, 1963-, et al.
(författare)
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A proposed model for developing quality and efficiency in transitional care
- 2023
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Ingår i: The TQM Journal. - 1754-2731 .- 1754-274X. ; 35:9, s. 107-122
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of this study is to develop a model describing different factors that affect quality andefficiency in transitional care.Design/methodology/approach – A meta-synthesis focusing on the transitions between wards wasconducted within a research project. The results from eight studies within that research project have beencombined and analysed from a holistic view.Findings – The findings are a model with a description of seven different categories consisting of the identifiedfactors affecting quality and efficiency in transitional care. Those categories are (1) learning organisation,(2) standardising and structuring, (3) applying a holistic view, (4) understanding organisational culture in ahealth care context, (5) management and leadership, (6) for whom value is created and (7) working together. The results from the study have been verified in previous research.Research limitations/implications – The result of the completed meta-synthesis is based on studiesconducted at two medium-sized hospitals in Sweden. The developed model can be used in a similar context toimprove quality and efficiency in patient transfers by management and employees working based on thevarious factors.Originality/value – This model describes factors (success factors, prerequisites, conditions and lack thereof) affecting the ability to achieve quality and efficiency in transitional care that can be used in future research aswell as for practical improvements.
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| 3. |
- Bäckström, Ingela, 1963-, et al.
(författare)
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Slutrapport för projektet Ökad kvalitet och effektivitet i vårdkedjor : Finansierat av Familjen Kamprads stiftelse, projekt nr 20170084
- 2022
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Rapport (populärvet., debatt m.m.)abstract
- Projektet har fokuserat på att skapa ny kunskap om och hur förbättrade vårdprocesser och vårdkulturer kan resultera i minskade återinläggningar, färre oönskade händelser i samband med förflyttning samt medföra för närstående en förbättrad upplevelse vid patient omflyttningar. Det övergripande syftet med projektet har varit att skapa ny kunskap om hur kvalitet och effektivitet i hälso- och sjukvårdens vårdkedja kan förbättras med specifikt fokus på ledarskap, vårdkontinuitet, säkerhetskultur och lärande.
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| 4. |
- Häggström, Marie, PhD, 1967-, et al.
(författare)
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Success Factors for Quality and Safety of Intensive Care Unit Transitional Care – Listening to the Sharp End
- 2023
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Ingår i: Quality Innovation Prosperity. - : Technical University of Kosice. - 1335-1745 .- 1338-984X. ; 27:1, s. 1-20
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this paper was to present success factors for increasing quality and safety of intensive care unit (ICU) transitional care as described by co-workers at the sharp end using the core values of total quality management (TQM) as a theoretical lens.Methodology/Approach: The study had a qualitative design, with data from nine interdisciplinary focus group discussions, including co-workers from the intensive care and general wards. Data were sorted into TQM core values and analysed using qualitative content analysis.Findings: Quality and safety in transfer processes requires a holistic view, avoiding silos, shared arenas for collaboration, and evidence-based methodologies and tools for safe transfers.Research Limitation/Implication: A limitation of this study is that it only portrays the challenges encountered by two hospitals during the process of transitional care in the ICU.Originality/Value of paper: By using TQM core values as a theoretical lens, we could present a usable, holistic picture of success factors and how to improve the transfer process.
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| 5. |
- Ingelsson, Pernilla, 1968-, et al.
(författare)
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Taking differences in quality culture into account when improving ICU transitional care.
- 2022
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Ingår i: <em>Proceedings M2D2022</em>. - 9789895475636 ; , s. 925-926
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Konferensbidrag (refereegranskat)abstract
- Measuring the presence of a number of quality values and aspects can help to understand how to approach improving transitional care in a healthcare setting. The purpose of this paper is to present the results from a questionnaire measuring the quality culture in both ICU and two different general wards. The purpose is also to present an analyze of the result in order to create an understanding of how differences and/or similarities in the quality culture could affect the application of Quality Management (QM) in order to improve ICU transitional care.
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| 6. |
- Sten, Lilly-Mari, PhD student, 1971-, et al.
(författare)
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Improving Team Collaboration in Patient Transfer Processes by Co-Workers’ Perceptions and Suggestions
- 2021
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Ingår i: Quality Innovation Prosperity. - : Technical University of Kosice, Faculty of Materials, Metallurgy and Recycling. - 1335-1745 .- 1338-984X. ; 25:2, s. 1-18
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose was twofold: first to describe how co-workers within a team perceived team collaboration in patient transfers from an intensive care unit (ICU) to general wards and, second, to describe co-workers’ suggestions for an improved future state of team collaboration.Methodology/Approach: Focus group discussions (FGDs) were conducted at two medium-sized hospitals located in Sweden. Participants were multidisciplinary and from both ICUs and general wards. Data were analysed using qualitative deductive content analysis.Findings: An expressed need for improving team collaboration was a defined and well-designed ICU transitional care process with a holistic view of how to create quality of care, and a standardised process for continuous improvements. This should involve co-workers from different professions and hospital units, as well as patients and relatives. Other views raised by the co-workers were clearer definitions of roles, responsibilities and deeper insights on how team members depend on each other’s work efforts to succeed.Research Limitation/Implication: This study was conducted at two hospitals, hence no generalizable conclusions can be made.Originality/Value of paper: Co-workers collaborating in a ICU transitional care process can have important insights in how to improve team collaboration. This can be of great importance in increasing quality of care where multiprofessional teams from different organisational cultures are collaborating.
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| 7. |
- Sten, Lilly-Mari, PhD student, 1971-, et al.
(författare)
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The relationship between teamwork and sustainable quality culture in transitional care
- 2023
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Ingår i: Proceedings of Excellence In Services International Conference (EISIC). - : Emerald Group Publishing Limited. - 9791221039054
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Konferensbidrag (refereegranskat)abstract
- Purpose: To explore how teamwork and sustainable quality culture relate to each other in transitional care from the perspective of intensive care personnel.Methodology: The questionnaire ‘Assessing Quality Culture Health Care edition’ (Sten et al., 2021) was used to measure teamwork and sustainable quality culture within an ICU setting. This questionnaire consisted of 50 statements and 16 factors.The results were statistically analysed using SPSS. Initially, no significant differences in scores were found between the two ICUs. Consequently, the results were treated as one set of data. Pearson’s Product-Moment Correlation was used to compare the measured factors for team collaboration within and between hospital units (6 factors) and the measured factors for sustainable quality culture (10 factors) to determine whether the factors correlated with each other. Correlations with an R-value above 0.50 (significant level 0.01) were considered high and treated as a correlation.Findings: All means for the factors measuring teamwork within hospital units were higher than the factors measuring teamwork between hospital units, which could indicate a lack of system view. The results also showed that it was only the factors measuring teamwork within hospital units that correlated to four of the sustainable quality culture factors, namely ‘AI’, ‘Pride’, ‘System view’ and ‘Continuous improvement’. The sustainable quality culture factors, ‘Leadership commitment’ and ‘Participation of everybody’, did not correlate with any of the factors concerning teamwork. This result suggest that these factors might need to be adjusted in the questionnaire to fit within the healthcare context.Research limitations/implications: This research is limited to intensive care personnel’s perceptions of transitional care at two medium-sized hospitals located in rural areas of Sweden.Originality/Value: No studies have been found that investigate the relationship between teamwork and sustainable quality culture within transitional care from the perspective of intensive care personnel. A sustainable quality culture can have an impact on teamwork and therefore also on patient safety. Insights from this study may have practical implications for the development of teamwork and sustainable quality culture within health care aimed at increasing care quality and patient safety.
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| 8. |
- Boström, Jonas
(författare)
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Knowledge for Improving Healthcare Service Quality : Combining Three Perspectives
- 2020
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Swedish public sector in general, and healthcare specifically, is struggling with large deficits: 19 of 21 regions have large negative results in 2019. The demands made by the citizens and their elected politicians that healthcare should offer effective, accessible, good and equal care are difficult to meet. However, when it comes to emergency care, Swedish healthcare scores high on international rankings. The difficulties and challenges today lie in ensuring good and equal care for the large groups of people with multiple illnesses, and patients who need long-term care from different healthcare providers. A complicated system has become even more complex.Organizational research has shown conflicts between different ways of working to improve and change the organization and the methods that support the daily work of providing healthcare services. Furthermore, quality research shows that there are knowledge gaps to be filled when it comes to understanding how complex problems should be handled and what kind of knowledge could contribute. This also applies to the tensions and conflicts that can arise when knowledge from patients, other professions and fields of knowledge must be integrated with the knowledge that the professions (physicians, nursing) possess. Several public organizations have in recent years also adopted methods, tools and approaches from the design field. Especially user involvement (human-centric), collaboration and visualization. Design research often highlights the methods which are favorable for handling complexity.The overall purpose of this thesis was therefore to gain a deeper understanding of how the quality development work in healthcare is expressed and how it is affected when different perspectives of knowledge are integrated - with a focus on improvement knowledge, professional knowledge and design thinking. Since the purpose of the licentiate thesis was to gain a deeper understanding of what happens when new knowledge to develop quality in healthcare emerges, the method is based on a qualitative approach. Three research questions were formulated and led to three studies. The first study, a literature review, showed that there is limited research in the area but that there are indications that user involvement in development work affects employees' attitudes and values. In study number two, a case study was set up using design methods and involving users. The results showed tensions between the improvement work and the daily clinical operations. This tension could primarily be attributed to the conflict between faster and slowerxviprocesses (doing and thinking), when moving between different practicing skills (design, improvement and professional). The last study aimed to understand more about the management's view of this, relatively new knowledge (design) in healthcare, in relation to the traditional way to work with improvement and change. The result stresses that there are potential conflicts between the different fields of knowledge. But the interviews were also interpreted as showing the synergy effects that can arise when different practitioners meet, and the results also show that different ways of thinking can challenge the traditional ways of handling improvement and change in the development of healthcare.The thesis result overall strengthens the research that shows that design can add another dimension to traditional improvement work in healthcare. However, there is also frustration about something which is perceived as more abstract and reflective and which can sometimes be slower than what the solutions-oriented professions, who work under great time pressure and with scarce resources, are used to. Furthermore, the thesis highlights the problem that also has been described in previous research and which signals the (in)ability to both share new knowledge and to absorb it.
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| 9. |
- Bäckström, Ingela, 1963-, et al.
(författare)
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Experiences with and causes of work interruptions and fragmentation in academia - How can they be managed?
- 2023
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Ingår i: 26th Excellence In Services International Conference (EISIC). - 9791221039054
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Konferensbidrag (refereegranskat)abstract
- Purpose: The purpose of this research is to explore experiences with and causes of the work interruptions and fragmentation that occur in the daily work of academic staff. This research also aims to explore strategies for managing these issues.Methodology: As part of a research project, data were collected from a workshop featuring academics to investigate their experiences of workfragmentation and the strategies they used to manage this issue. These academics were asked to individually write down ways of creating coherent time and their perceptions of the reasons underlying the fragmentation of work. They were then asked to discuss and reflect on this topic in groups based on their work roles, after which the groups’ answers were summarized. The written answers were analysed by a total of four researchers working on this project in two separate rounds.Findings: The analysis resulted in fourteen group labels of experiences and causes of work interruptions and fragmentation, including Knowledge, Resources, Communication, Unplanned tasks, Planning, Digital systems, Processes, Job duties, Administration, (Over)ambition, Meetings, Set-up time, Quality work and Help and support. In the analysis of the strategies used to manage work interruptions and fragmentation, seven groups were identified: Conscious planning to create space for coherent time, Need for knowledge that offers the ability to create coherent time, Control the communication, Support/lead, Working hours, Prioritize, and Respect others and their time.Research limitations/implications: The research was conducted by reference to a group of heads of subjects drawn from one university.Originality/Value: Qualitative research on interruptions and fragmentation in higher education institutes (HEI) is rare.
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| 10. |
- Häggström, Marie, PhD, 1967-, et al.
(författare)
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How can patient transfers be improved by combining QM, Nursing and Health care sciences?
- 2018
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Ingår i: Proceedings of the 21th QMOD Conference.
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Konferensbidrag (refereegranskat)abstract
- Purpose - The purpose of this paper is to present the state of the art when it comes to QM and nursing science, focusing on patient transfers from Intensive Care Unit (ICU) to general wards, using the TQM values: ‘customer focus’, ‘leadership commitment’, ‘participation of everybody’, ‘continuous improvement’, ‘process focus’ and ‘base decisions on facts’ as an analytical framework.Methodology/approach Literature from the research fields of QM and nursing sciences was reviewed and analyzed with the TQM values as a framework.Findings – No articles were found concerning QM within the specific area of patient transfer from ICU to general wards but the results are a summary of QM research and nursing science sorted under the TQM values. A result is that interdisciplinary care can improve a culture of safety and it can decrease mortality rates, staff turnover and increase quality of care and patient satisfaction. This means that there is a need for working with the QM culture in the patient transfer from ICU to general wards.Practical implications – This review identified a large need for empirical research in the field of health care where CI methods needs to be described, for example what tool or method that was applied and how it was applied and how the implementation were conducted.
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| 11. |
- Häggström, Marie, PhD, 1967-, et al.
(författare)
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How to improve the transfer process from intensive care to general wards - listening to the co-workers
- 2019
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Ingår i: Leadership and strategies for Sustainable Quality and Innovation in the 4th Industrial Revolution. Lund. - Lund.
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Konferensbidrag (refereegranskat)abstract
- Background - Many errors and threats to patient safety are caused by deficiencies in the organization, such as inadequate procedures, inadequate planning and lack of information or communication. A specific danger to patient safety is the various gaps in the continuity of care. An example of the gap is the transfer of patients from the high-tech intensive care environment to the less frequent personnel ward environment, a process called ICU transitional care. ICU-nurses, ward-nurses, physicians, and other healthcare professionals, may provide this care. The effects of a poorly coordinated discharge can lead to readmission to the ICU and avoidable deaths.This study is a part of a research project financed by The Kamprad Family Foundation, with a purpose to gain new knowledge about how efficiency and quality in patient transfers within healthcare care can be improved. The purpose will be achieved through cooperation between the two research subjects Quality Management and Nursing science.Purpose - The purpose of this paper was to gain knowledge about how to improve patient transfers from intensive care to the general ward, by describing the intensive care co-workers generated suggestions.Methodology/approach – Six interdisciplinary focus groups interviews were conducted with co-workers at two hospitals in Sweden. The interviews were taped, verbatim transcribed and analysed with a mixed method. The QM values: ‘customer focus’, ‘leadership commitment’, ‘participation of everybody’, ‘continuous improvement’, ‘process focus’ and ‘base decisions on facts’ were used as an analytic framework.Findings - The co-workers suggested that the process should be defined and structured. The analyses showed a total of 94 suggestions that mainly were focused at following areas; planning, information, and communication, interest in the transfer process, enough resources, standardize and create routines, learning, follow up and evaluate.Practical implications - ICU transitional care is multifaceted and needs a holistic, system thinking solution. The findings indicate that the process could be safer, and more efficient by implementing the co-worker generated suggestions. The suggestions can be used to improve patients’ transfers in many contexts in healthcare, not only ICU transitional care.
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| 12. |
- Ingelsson, Pernilla, 1968-, et al.
(författare)
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Assessing Quality Management culture in order to develop ICU transitional care
- 2019
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Ingår i: <em>22nd QMOD conference</em>.
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Konferensbidrag (refereegranskat)abstract
- Purpose - The purpose of this paper is to present and analyse the result from using a questionnaire measuring the presence of a number of QM values, as well as the use of Appreciative Inquiry (AI) and the feeling of pride in a healthcare setting focusing on transitional care. Methodology/approach – Co-workers at two different hospital’s intensive care units answered a previously developed and tested questionnaire. A new factor was developed in order to measure customer focus in the healthcare context. The result was analysed using SPSS with the aim of finding areas to improve the patient transfer process from intensive care to general ward. Findings – The questionnaire can be used to create an understanding of the existing culture in an organization but it needs to be analysed qualitatively. The result from the examined organizations show a common culture in the two units even though they are located in different hospitals and cities. The result further shows some differences between professions but overall, the result points at a relatively high agreement to the QM values in the organization indicating the presence of a quality culture. Practical implications – Using a QM value survey in the healthcare context could help developing the care from a different point of view then ordinary. It could help to shift focus from individual to group and system.
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| 13. |
- Ingelsson, Pernilla, 1968-
(författare)
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Creating a Quality Management Culture : Focusing on Values and Leadership
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- When applied successfully, the QM initiatives TQM and Lean enhance an organization´s ability to meet and exceed the expectations of the customers as well as co-workers and other stakeholders. There are however also QM initiatives that fail and one reason for this is the organization’s inability to create a supportive culture, a culture that rests on a number of values which aim at improving the quality and thereby customer satisfaction. Even though this is known by both practitioners and researchers, little has been written on how to achieve a QM culture in practice and there are not many methodologies and tools designed directly with purpose of creating this culture. In addition, the measurements used for monitoring organizational success focus mainly on ‘hard’ process or financial measures such as lead-time reduction and operating income. The purpose of this thesis has been to ‘examine how a strong organizational culture can be created and to contribute with knowledge about how to create and measure a QM culture’. To fulfill this purpose, a number of case studies have been carried out and a questionnaire has been developed in order to measure the presence and importance of a number of QM values.The research presented in this thesis reinforces the fact that culture is an important factor to take into account when applying QM initiatives. A structured way of working with culture and the development of a strategy on how the culture in the organization will be changed is needed. This in combination with methodologies and tools aiming directly at enhancing a QM culture. The research also shows that the relationship between organizational culture, values and behaviors needs to be considered when working to create a strong QM culture. Most of the methodologies and tools found in the case studies aim directly at reinforcing the ‘right’ behaviors in the organization, hence enhancing the underlying values. For instance, the way an organization works with selection, e.g. recruitment and promotion, based on behaviors rather than documented merits is one methodology found in the research. The leadership was found to be important when it came to building or strengthening the culture. Managers are considered key players and need to act as role models, displaying the desired behaviors themselves. The managers need to be present among their co-workers and aware of how their own actions affect the possibility to build a strong QM culture.Another conclusion drawn is the need to measure the ‘softer’ side of QM. One starting point when applying a QM initiative should be the assessment of the existing culture in the organization as a complement to the ‘harder’ measures. The research presented in this thesis suggests that the questionnaire that has been developed could be an appropriate tool for this purpose. If the existing culture in an organization does not support the values within QM, the behaviors of managers and co-workers that are needed to improve quality and thereby customer satisfaction could be hard to achieve.
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| 14. |
- Sten, Lilly-Mari, et al.
(författare)
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Improving ICU transitional care by combining quality management and nursing science - two scientific fields meet in a systematic literature review
- 2020
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Ingår i: International Journal of Quality and Service Sciences. - : Emerald Group Publishing Limited. - 1756-669X .- 1756-6703. ; 12:3, s. 385-403
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe purpose of this literature review was to explore to what extent quality management (QM) and nursing science offer complementary perspectives to provide better quality care, by looking at QM core concepts and tools.Design/methodology/approachA systematic literature review was conducted. Papers published in academic journals between January 2013 and December 2019 were included. A deductive content analysis was chosen using QM core values as an analytical framework.FindingsThe results showed that QM core values, methodologies and tools were found in the reviewed articles about intensive care unit (ICU) transitional care. The results indicated that core values in QM and the core competencies within nursing science in ICU transitional care are mutually dependent upon each other and exist as a whole. ICU transitional care is, however, a complex interpersonal process, characterized by differences in organizational cultures and core values and involving multidisciplinary teams that collaborate across hospital units. The QM core value that was least observed was committed leadership.Research limitations/implicationsCombining QM and nursing science can contribute to a deeper understanding of how to improve the ICU transitional care process by bringing complementary perspectives.Practical implicationsThe included articles portray how QM is applied in ICU transitional care. Implications for future research focus on enhancing the understanding of how QM and nursing science can bring complementary perspectives in order to improve ICU transitional care and how QM values, methodologies and tools can be used in ICU transitional care. Committed leadership and team collaboration in ICU transitional care are areas that call for further research.Originality/valueThe findings contribute to the body of literature by providing important insights in terms of how QM core values, methodologies and tools are present in research about ICU transitional care and how the two research subjects, namely, QM and nursing science, bring complementary perspectives.
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| 15. |
- Sten, Lilly-Mari, et al.
(författare)
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The development of a measurement instrument focusing on team collaboration in patient transfer processes
- 2021
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Ingår i: International Journal of Quality and Service Sciences. - 1756-669X .- 1756-6703. ; 13:1, s. 45-62
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Team collaboration is essential to ensure the quality of care and patient safety when critically ill patients are transferred from an intensive care unit (ICU) to a general ward. Measuring team collaboration in the patient transfer process can help gain insights into how team collaboration is perceived and how it can be improved. The purpose of this paper is to describe the development and testing of a questionnaire aiming to measure perceived team collaboration in the patient transfer process from ICU to the general ward. This study also aims to analyze the results to see how the survey could help improve team collaboration within ICU transitional care.Design/methodology/approach: Statements, factors and main areas intended to measure perceived team collaboration were developed from a theory. The questionnaire was tested in two ICUs at two hospitals located in Sweden, and the results were analyzed statistically.Findings: The results showed that the questionnaire could be used for measuring perceived team collaboration in this process. The results from the survey gave insights that can be useful when improving team collaboration in ICU transitional care.Research limitations/implications: The collaboration between two research subjects, Nursing Science and Quality Management, has given new perspectives in how cultural and systemic differences and opportunities can help improving team collaboration in ICU transitional care, by shifting focus from the individual to team, culture, system, process and continuous improvement. Practical implications: The developed questionnaire can be used to measure perceived team collaboration and to identify areas for improving team collaboration in the ICU transitional care process.Originality/value: There is a sparse amount of research about measuring team collaboration in ICU transitional care, and this study contributes to filling this research gap.
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| 16. |
- Sten, Lilly-Mari, et al.
(författare)
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The development of a measurement instrument focusing on team collaboration in the patient transfer process from intensive care to the general ward
- 2019
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Konferensbidrag (refereegranskat)abstract
- Purpose - The purpose of this paper is to describe the development and testing of a questionnaire aiming to measure team collaboration in the patient transfer process from the ICU to the general ward. The purpose is also to analyze the results to see how the survey can help improve team collaboration within ICU transitional care. Methodology/approach – Twenty statements were developed from theory and intended to measure team collaboration within and between hospital units. These statements were added to an existing questionnaire measuring values from QM theory. The questionnaire was tested in two ICUs in two hospitals located in Sweden, and the results from the statements regarding team collaboration were analyzed with SPSS. Findings – The results indicate that there is an internal consistency reliability between the developed factors and statements measuring team collaboration within and between hospital units. The results from the survey also show that this measurement tool can be a basis for improving team collaboration in the studied context.
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