| 1. |
- Allerby, Katarina, et al.
(författare)
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Increasing person-centeredness in psychosis inpatient care: care consumption before and after a person-centered care intervention
- 2023
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Ingår i: Nordic Journal of Psychiatry. - 0803-9488 .- 1502-4725. ; 77:6, s. 600-607
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with psychotic disorders often need hospitalization with long stays. Person-centered care (PCC) has been shown to improve care quality and decrease the length of hospital stay in non-psychiatric settings. We carried out an educational intervention for inpatient staff, aiming to increase person-centeredness at a major Swedish psychosis clinic. The aim of this study was to test if the intervention could be associated with decreased length of hospital stay (LoS), involuntary stay (LoIS), and reduction in rapid readmissions. Methods: Data from the clinic’s administrative registry were compared for patients with a discharge diagnosis within the schizophrenia-spectrum treated during the one-year periods before and after the PCC intervention. Results: Contrary to our hypotheses, a quantile regression estimated longer LoS post-intervention, median difference 10.4 d (CI 4.73–16.10). Neither age, sex nor diagnostic category were associated with LoS. Of all inpatient days, ∼80% were involuntary. While LoIS was numerically longer post-intervention, the difference did not reach significance in the final regression model (median difference 7.95 d, CI −1.40 to 17.31). Proportions with readmission within 2 weeks of discharge did not differ (7.7% vs 5.2%, n.s.). Conclusions: Increased length of inpatient care was observed after the PCPC intervention. This could reflect an increased focus on the unmet needs of persons with serious psychotic conditions, but it needs to be explored in future research using a more rigorous study design. Trial registration: This study is part of a larger evaluation of Person-Centered Psychosis Care (PCPC), registered during data collection (after the study start, before analysis) at clinicaltrials.gov, identifier NCT03182283.
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| 2. |
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| 3. |
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| 4. |
- Allerby, Katarina, 1980, et al.
(författare)
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Person-Centered Psychosis Care (PCPC) In An Inpatient Setting : Ward Level Data And Staff Workload
- 2019
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Ingår i: Schizophrenia Bulletin. - : Oxford University Press. - 0586-7614 .- 1745-1701. ; 45:Supplement 2, s. S304-S304
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Tidskriftsartikel (refereegranskat)abstract
- Background: The person-centered care approach has been little tested in inpatient settings for persons with schizophrenia. An intervention, PersonCentered Psychosis Care (PCPC), was created to increase person-centered care through an educational intervention for staff. The education had a participatory approach where participants were involved in shaping the education and creating projects aimed at care development. The PCPC intervention focused on the patient’s narrative, the creation of a partnership between the patient and staff, and on coming to an agreement between the patient and staff concerning the care. The present study aims to compare staff experienced workload and ward level data before and after implementation of the intervention.Methods: The study was carried out on 4 hospital wards (43 beds) at the Psychosis Clinic, Gothenburg, Sweden. Data was collected during a 6-month pre-intervention period, followed by an implementation period of 3 years, and finally a post intervention data collection period (9 months). During both data collection periods, one nurse per ward filled out a measure of daily subjective workload (a VAS scale with 0 indicating no burden at all and 10 indicating the highest imaginable burden). Additional ward level data (length of hospital stay, involuntary interventions, rehospitalization rates) were collected via the clinic’s electronic monitoring system.Results: The pre-intervention ratings (n=505) showed a mean subjective workload of 5.48 (SD=1.94). The post intervention workload (n=465) showed a mean of 4.51 (SD=2.08) which represents a significant reduction of experienced workload (t (968) = p <.0005). Analyses regarding length of hospital stay, involuntary interventions, and rehospitalization rates are underway and will be presented.Discussion: The findings indicate an improvement in the work environment for hospital staff and provide a quantitative result in line with staff experiences previously reported in our focus group study. The before and after design has its limitations, but the positive findings motivate further testing with a more rigorous design such as a cluster randomized study.
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| 5. |
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| 6. |
- Colldén, Christian, 1983, et al.
(författare)
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A value-based taxonomy of improvement approaches in healthcare
- 2017
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Ingår i: Journal of Health, Organisation and Management. - 1477-7266. ; 31:4, s. 445-458
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The concept of value is becoming increasingly fashionable in healthcare and various improvement approaches (IAs) have been introduced with the aim of increasing value. The purpose of this paper is to construct a taxonomy that supports the management of parallel IAs in healthcare. Design/methodology/approach: Based on previous research, this paper proposes a taxonomy that includes the dimensions of view on value and organizational focus; three contemporary IAs – lean, value-based healthcare, and patient-centered care – are related to the taxonomy. An illustrative qualitative case study in the context of psychiatric (psychosis) care is then presented that contains data from 23 interviews and focuses on the value concept, IAs, and the proposed taxonomy. Findings: Respondents recognized the dimensions of the proposed taxonomy and indicated its usefulness as support for choosing and combining different IAs into a coherent management model, and for facilitating dialog about IAs. The findings also suggested that the view of value as “health outcomes” is widespread, but healthcare professionals are less likely than managers to also view value as a process. Originality/value: The conceptual contribution of this paper is to delineate some important characteristics of IAs in relation to the emerging “value era”. It also highlights the coexistence of different IAs in healthcare management practice. A taxonomy is proposed that can help managers choose, adapt, and combine IAs in local management models.
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| 7. |
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| 8. |
- Colldén, Christian, 1983, et al.
(författare)
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Value configurations for balancing standardization and customization in chronic care: a qualitative study
- 2021
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Demands for both customization and standardization are increasing in healthcare. At the same time, resources are scarce, and healthcare managers are urged to improve efficiency. A framework of three value configurations – shop, chain, and network – has been proposed for how healthcare operations can be designed and organized for efficient value creation. In this paper, use of value configurations for balancing of standardization and customization is explored in the context of care for chronic mental conditions. Methods: A typical case is presented to illustrate the manifestations of conflicting demands between customization and standardization, and the potential usefulness of the value configurations framework. Qualitative data were collected from managers and care developers in two focus groups and six semi-structured interviews, completed by a national document describing a care pathway. Data were coded and analysed using an insider-outsider approach. Results: Operationalization of the balance between standardization and customization were found to be highly delegated and ad hoc. Also, the conflict between the two demands was often seen as aggravated by scarce resources. Value configurations can be fruitful as a means of discussing and redesigning care operations if applied at a suitable level of abstraction. Applied adequately, all three value configurations were recognized in the care operations for the patient group, with shop as the overarching configuration. Some opportunities for improved efficiency were identified, yet all configurations were seen as vital in the chronic care process. Conclusions: The study challenges the earlier proposed organizational separation of care corresponding to different value configurations. Instead, as dual demand for customization and standardization permeates healthcare, parallel but explicated value configurations may be a path to improved quality and efficiency. Combined and intermediate configurations should also be further investigated.
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| 9. |
- Elg, Mattias, 1968-, et al.
(författare)
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Service action research: review and guidelines
- 2020
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Ingår i: Journal of Services Marketing. - : Emerald Group Publishing Limited. - 0887-6045. ; 34:1, s. 87-99
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Forskningsöversikt (refereegranskat)abstract
- Purpose Conducting research that is both practice- and theory-relevant is important for the service research community. Action research can be a fruitful approach for service researchers studying the transformative role of service research and wanting to make contributions to both the research community and to practical development. By exploring the current use of action research in service research, this study aims to make suggestions for enhancing the contribution to theory and practice development and to propose criteria for research quality for action research in service research. Design/methodology/approach This study builds on a systematic literature review of the use of action research approaches in service research. Findings The study makes three main contributions. First, it posits that any action research project needs to consider the four elements of problem identification, theorization, creating guiding concepts and intervention. Second, based on these elements mirrored in service action research, it outlines and analyzes three approaches to action research (i.e. theory-enhancing, concept developing and practice-enhancing). Third, it suggests a move from instrumental to a more conceptual relevance of the research and elaborates on the criteria for research quality. Originality/value This study contributes to the understanding of how action research may be applied for conducting high-quality collaborative research in services and proposes measures to enhance research quality in action research projects focusing services.
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| 10. |
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| 11. |
- Elg, Mattias, et al.
(författare)
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The role of quality managers in contemporary organisations
- 2011
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Ingår i: Total Quality Management and Business Excellence. - : Informa UK Limited. - 1478-3363 .- 1478-3371. ; 22:8, s. 795-806
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Tidskriftsartikel (refereegranskat)abstract
- A key question for firms nowadays is how to organise work with quality management. This naturally includes the role of the quality managers and it appears as if the profession of quality managers is at a crossroads. Alternatives are that the role of a quality manager broadens to include quality at a strategic level in the firm and that Six Sigma specialists and Lean Production managers drive the development of quality management in the future. In this paper, we present the results from a survey of 212 quality managers in Swedish organisations. The purpose is to contribute to an understanding of how the management of quality is designed and practised in contemporary organisations. This study shows that a quality manager's operational responsibility is quite narrowly defined. The agenda of the quality manager is mainly related to quality standards, such as ISO 9000 and environmental management systems. These programmes frame the work of the quality manager, which in many cases leaves other programmes, such as Six Sigma and Lean Production, to other departments or parallel improvement structures.
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| 12. |
- Goulding, Anneli, 1966, et al.
(författare)
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Study protocol design and evaluation of a hospital-based multi-professional educational intervention: Person-Centred Psychosis Care (PCPC)
- 2018
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 18:269
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Tidskriftsartikel (refereegranskat)abstract
- Background: While patient involvement in mental health care is repeatedly stressed in policy documents, there are actually few studies that evaluate person-centred care interventions within psychiatric services. We present here the design and planned evaluation of an educational intervention for inpatient staff involved in the care of persons with schizophrenia and similar psychoses. Methods/design: The care intervention will be assessed using a non-randomised trial with a before and after approach. The intervention involves an educational and experimental learning phase for hospital staff, followed by an implementation phase. The intervention is multi-professional; psychiatrists, psychiatric nurses, psychiatric carers, social workers, occupational therapists, and a medical secretary will be engaged in a participatory approach where they practice how to create a partnership and explore recovery-related goals together with patients. Patient-related outcomes include empowerment and satisfaction with care. Ward-level outcomes include daily ward burden, length of inpatient stay, and number of days with involuntary care. In addition, qualitative methods will be applied to capture patient, next-of-kin, and staff perspectives. Discussion: The care intervention is expected to contribute to the improvement of inpatient care for persons with severe and complex mental health issues. Trial registration: The trial was retrospectively registered at ClinicalTrials.gov June 9, 2017, identifier: NCT03182283.
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| 13. |
- Greenhalgh, Trisha, et al.
(författare)
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The NASSS-CAT Tools for Understanding, Guiding, Monitoring, and Researching Technology Implementation Projects in Health and Social Care : Protocol for an Evaluation Study in Real-World Settings
- 2020
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Ingår i: JMIR Research Protocols. - : JMIR Publications. - 1929-0748. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Projects to implement health care and social care innovations involving technologies are typically ambitious and complex. Many projects fail. Greenhalgh et al’s nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to analyze the varied outcomes of such projects.Objective: We sought to extend the NASSS framework to produce practical tools for understanding, guiding, monitoring, and researching technology projects in health care or social care settings.Methods: Building on NASSS and a complexity assessment tool (CAT), the NASSS-CAT tools were developed (in various formats) in seven co-design workshops involving 50 stakeholders (industry executives, technical designers, policymakers, managers, clinicians, and patients). Using action research, they were and are being tested prospectively on a sample of case studies selected for variety in conditions, technologies, settings, scope and scale, policy context, and project goals.Results: The co-design process resulted in four tools, available as free downloads. NASSS-CAT SHORT is a taster to introduce the instrument and gauge interest. NASSS-CAT LONG is intended to support reflection, due diligence, and preliminary planning. It maps complexity through stakeholder discussion across six domains, using free-text open questions (designed to generate a rich narrative and surface uncertainties and interdependencies) and a closed-question checklist; this version includes an action planning section. NASSS-CAT PROJECT is a 35-item instrument for monitoring how subjective complexity in a technology implementation project changes over time. NASSS-CAT INTERVIEW is a set of prompts for conducting semistructured research or evaluation interviews. Preliminary data from empirical case studies suggest that the NASSS-CAT tools can potentially identify, but cannot always help reconcile, contradictions and conflicts that block projects’ progress.Conclusions: The NASSS-CAT tools are a useful addition to existing implementation tools and frameworks. Further support of the implementation projects is ongoing. We are currently producing digital versions of the tools, and plan (subject to further funding) to establish an online community of practice for people interested in using and improving the tools, and hold workshops for building cross-project collaborations. International Registered Report Identifier (IRRID): DERR1-10.2196/16861
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| 14. |
- Gremyr, Andreas, et al.
(författare)
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A learning health system for people with severe mental illness : a promise for continuous learning, patient coproduction and more effective care
- 2019
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Ingår i: Digital Psychiatry. - : Taylor & Francis. - 2575-517X. ; 2:1, s. 8-13
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Tidskriftsartikel (refereegranskat)abstract
- A Learning Health System (LHS) promotes the patient being at the very center of his or her care. Patient coproduction of care in an LHS is enabled by a focus on improving outcomes through the use of tools and visualizations that use the harnessed knowledge obtained from every previous treatment of similar patients. Interest in the concept of LHS is growing, and there are promising results in real-world applications. Almost no research has focused on LHSs for severe mental illness (LHS4SMI). By using a user-centered system design approach, a persona and use-case scenarios were created to illustrate how schizophrenia care could be co-produced in an LHS compared to standard care in a non-LHS. The illustration highlight increased participation through decisions informed by all treatments for all similar patients through the use of user interfaces that support continuous evaluation, increased understanding, compensation for cognitive impairment and participation of next of kin in the care process. We propose that an LHS4SMIs like schizophrenia has enormous potential in enabling continuous learning, patient coproduction, and more effective care.
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| 15. |
- Gremyr, Andreas, et al.
(författare)
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How a Point-of-Care Dashboard Facilitates Co-production of Health Care and Health for and with Individuals with Psychotic Disorders : A Mixed-methods Case Study
- 2022
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Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 22
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIndividuals with psychotic disorders experience widespread treatment failures and risk early death. Sweden’s largest department specializing in psychotic disorders sought to improve patients’ health by developing a point-of-care dashboard to support joint planning and co-production of care. The dashboard was tested for 18 months and included more than 400 patients at two outpatient clinics.MethodsThis study evaluates the dashboard by addressing two questions:Can differences in health-related outcome measures be attributed to the use of the dashboard?How did the case managers experience the accessibility, use, and usefulness of the dashboard for co-producing care with individuals with psychotic disorders? This mixed-method case study used both Patient-Reported Outcome Measures (PROM) and data from a focus group interview with case managers. Data collection and analysis were framed by the Clinical Adoption Meta Model (CAMM) phases: i) accessibility, ii) system use, iii) behavior, and iv) clinical outcomes. The PROM used was the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0), which assesses functional impairment and disability. Patients at clinics using the dashboard were matched with patients at clinics not using the dashboard. PROM data were compared using non-parametric statistics due to skewness in distribution. The focus group included five case managers who had experience using the dashboard with patients.ResultsCompared to patients from clinics that did not use the dashboard, patients from clinics that did use the dashboard improved significantly overall (p = 0.045) and in the domain self-care (p = 0.041). Focus group participants reported that the dashboard supported data feedback-informed care and a proactive stance related to changes in patients’ health. The dashboard helped users identify critical changes and enabled joint planning and evaluation.ConclusionDashboard use was related to better patient health (WHODAS scores) when compared with matched patients from clinics that did not use the dashboard. In addition, case managers had a positive experience using the dashboard. Dashboard use might have lowered the risk for missing critical changes in patients’ health while increasing the ability to proactively address needs. Future studies should investigate how to enhance patient co-production through use of supportive technologies.
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| 16. |
- Gremyr, Andreas
(författare)
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Improving health with and for individuals with schizophrenia using a learning health system approach : From idea to daily practice
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Psychotic disorders like schizophrenia have a typical onset in early adulthood with symptoms of hallucinations and disturbances of thought. Despite knowledge on what constitutes effective schizophrenia care, more than 70% of treatment attempts fail in Sweden, sometimes leading to early death. An appraisal of schizophrenia care shows a lack of ways to jointly plan and evaluate care, and an absence of a trustworthy theory-of-change. The Learning Health System (LHS) is a vision that has been translated into theories and models associated with improved outcomes for patients with other chronic conditions. The aim of this thesis is to enhance the understanding of the applicability of the LHS vision in the context of schizophrenia care, from the perspectives of both individuals and the health system in enabling coproduction of better health by addressing two research questions:i) How can improvement of health for individuals with schizophrenia and improvement of system performance be supported by coproduction in an LHS model?ii) Can an LHS-based intervention, i.e. the use of a point of care dashboard, contribute to better health for individuals with schizophrenia?Studying the existing published knowledge of LHS show that the concept has not yet been applied in mental healthcare settings but has potential to increase patient coproduction, continuous improvement and better health. Different forms of coproduction are supported in the most comprehensive LHS models and applications, ranging from dashboards at point of care to platforms that can help facilitate improvement initiatives.A case study, focused on studying the use and usefulness of a point-of-care dashboard at patient visits in outpatient care at the Department of Schizophrenia Spectrum Disorders at Sahlgrenska University Hospital in western Sweden. Use of the dashboard is associated with improved communication and health for patients. Assessment of the dashboard-project’s complexity using the Non-adoption, abandonment, scale-up, spread and sustainability complexity assessment tool (NASSS-CAT) was perceived as helpful in evaluating challenges and provided insight that can guide future development. An LHS model, that builds on both the reviewing of the literature and practical testing, is proposed.Further research is proposed in two areas, exploration of how dashboard initiatives can support coproduction and better health for individuals with complex chronic conditions and further development of LHS models by studying different LHS initiatives regarding system properties, forms of coproduction at play and effects on health outcomes for individuals and populations.
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| 17. |
- Gremyr, Andreas, et al.
(författare)
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The role of co-production in Learning Health Systems
- 2021
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 33:Supplement 2, s. ii26-ii32
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Co-production of health is defined as 'the interdependent work of users and professionals who are creating, designing, producing, delivering, assessing, and evaluating the relationships and actions that contribute to the health of individuals and populations'. It can assume many forms and include multiple stakeholders in pursuit of continuous improvement, as in Learning Health Systems (LHSs). There is increasing interest in how the LHS concept allows integration of different knowledge domains to support and achieve better health. Even if definitions of LHSs include engaging users and their family as active participants in aspects of enabling better health for individuals and populations, LHS descriptions emphasize technological solutions, such as the use of information systems. Fewer LHS texts address how interpersonal interactions contribute to the design and improvement of healthcare services.OBJECTIVE: We examined the literature on LHS to clarify the role and contributions of co-production in LHS conceptualizations and applications.METHOD: First, we undertook a scoping review of LHS conceptualizations. Second, we compared those conceptualizations to the characteristics of LHSs first described by the US Institute of Medicine. Third, we examined the LHS conceptualizations to assess how they bring four types of value co-creation in public services into play: co-production, co-design, co-construction and co-innovation. These were used to describe core ideas, as principles, to guide development.RESULT: Among 17 identified LHS conceptualizations, 3 qualified as most comprehensive regarding fidelity to LHS characteristics and their use in multiple settings: (i) the Cincinnati Collaborative LHS Model, (ii) the Dartmouth Coproduction LHS Model and (iii) the Michigan Learning Cycle Model. These conceptualizations exhibit all four types of value co-creation, provide examples of how LHSs can harness co-production and are used to identify principles that can enhance value co-creation: (i) use a shared aim, (ii) navigate towards improved outcomes, (iii) tailor feedback with and for users, (iv) distribute leadership, (v) facilitate interactions, (vi) co-design services and (vii) support self-organization.CONCLUSIONS: The LHS conceptualizations have common features and harness co-production to generate value for individual patients as well as for health systems. They facilitate learning and improvement by integrating supportive technologies into the sociotechnical systems that make up healthcare. Further research on LHS applications in real-world complex settings is needed to unpack how LHSs are grown through coproduction and other types of value co-creation.
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| 18. |
- Gremyr, Andreas, et al.
(författare)
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Using Complexity Assessment to Inform the Development and Deployment of a Digital Dashboard for Schizophrenia Care: Case Study
- 2020
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 22:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health care is becoming more complex. For an increasing number of individuals, interacting with health care means addressing more than just one illness or disorder, engaging in more than one treatment, and interacting with more than one care provider. Individuals with severe mental illnesses such as schizophrenia are disproportionately affected by this complexity. Characteristic symptoms can make it harder to establish and maintain relationships. Treatment failure is common even where there is access to effective treatments, increasing suicide risk. Knowledge of complex adaptive systems has been increasingly recognized as useful in understanding and developing health care. A complex adaptive system is a collection of interconnected agents with the freedom to act based on their own internalized rules, affecting each other. In a complex health care system, relevant feedback is crucial in enabling continuous learning and improvement on all levels. New technology has potential, but the failure rate of technology projects in health care is high, arguably due to complexity. The Nonadoption, Abandonment, and challenges to Scale-up, Spread, and Sustainability (NASSS) framework and complexity assessment tool (NASSS-CAT) have been developed specifically to help identify and manage complexity in technology-related development projects in health care. Objective: This study aimed to use a pilot version of the NASSS-CAT instrument to inform the development and deployment of a point-of-care dashboard supporting schizophrenia care in west Sweden. Specifically, we report on the complexity profile of the project, stakeholders' experiences with using NASSS-CAT, and practical implications. Methods: We used complexity assessment to structure data collection and feedback sessions with stakeholders, thereby informing an emergent approach to the development and deployment of the point-of-care dashboard. We also performed a thematic analysis, drawing on observations and documents related to stakeholders' use of the NASSS-CAT to describe their views on its usefulness. Results: Application of the NASSS framework revealed different types of complexity across multiple domains, including the condition, technology, value proposition, organizational tasks and pathways, and wider system. Stakeholders perceived the NASSS-CAT tool as useful in gaining perspective and new insights, covering areas that might otherwise have been neglected. Practical implications derived from feedback sessions with managers and developers are described. Conclusions: This case study shows how stakeholders can identify and plan to address complexities during the introduction of a technological solution. Our findings suggest that NASSS-CAT can bring participants a greater understanding of complexities in digitalization projects in general.
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| 19. |
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| 20. |
- Gremyr, Ida, 1975, et al.
(författare)
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Småskaliga live case för att integrera livslångt lärande och arbetslivsanknytning
- 2023
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Ingår i: Proceedings Chalmers Conference on Teaching and Learning 2023. - 9789188041548 ; , s. 47-50
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Konferensbidrag (refereegranskat)abstract
- I detta projekt utvecklas en live-case-modell som stödjer utbildningssamverkan och arbetsintegrerat lärande inom ramen för existerande universitetsutbildning och kurser för livslångt lärande (LLL). I denna modell får ingenjörsstudenter och LLL-studenter från vården arbeta tillsammans med ett verkligt problem från LLL-studenternas organisation. Den småskaliga live-case-modellen är resurseffektiv eftersom den är starkt avgränsad i tid (varaktighet: en vecka), dessutom är den unik då den inte bara fokuserar ingenjörsstudenternas, utan även praktikernas (LLL-studenternas), lärande.
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| 21. |
- Gremyr, Ida, 1975, et al.
(författare)
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The roles of quality departments and their influence on business results
- 2021
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Ingår i: Total Quality Management and Business Excellence. - : Informa UK Limited. - 1478-3371 .- 1478-3363. ; 32:7-8, s. 886-897
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Tidskriftsartikel (refereegranskat)abstract
- This study explores the various roles of quality departments and investigates whether their roles have different influence on business results. Based on a survey of quality managers in 211 Swedish organisations, the analysis identifies four roles of quality departments: firefighters, auditors, process improvers, and orchestrators. The roles vary in their predominant adoption of Quality Management practices ranging from a narrow scope focusing on quality management systems to a broader scope, based on multiple practices. An analysis was performed to identify how each of the identified roles influences business results. The results show that quality departments with a broad focus, combining both explorative and exploitative quality practices, contribute the most to business results.
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| 22. |
- Hellstrand Tang, Ulla, et al.
(författare)
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Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations : Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool
- 2024
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Ingår i: JMIR Human Factors. - : JMIR Publications. - 2292-9495. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations.OBJECTIVE: This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up.METHODS: A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges.RESULTS: The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization's readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization's system and its setting.CONCLUSIONS: Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations.
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| 23. |
- Hellström, Andreas, 1972, et al.
(författare)
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Adopting a Management Innovation in a Professional Organization - The Case of Improvement Knowledge in Healthcare
- 2015
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Ingår i: Business Process Management Journal. - 1463-7154. ; 21:5, s. 1186-1203
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is to study critical practices when adopting improvement knowledge as a management innovation in a professional organization.Design/methodology/approachThis article is based on an action research approach, in which practitioners and researchers are seen as a part of a participative community generating actionable knowledge. Research involved gathering data over a five-year period through more than 250 interviews and 25 focus groups.FindingsThis paper identifies five critical practices for adopting a management innovation in a professional context: (1) focusing on labeling and theorizing to create an organization’s own vocabulary; (2) focusing on the role of internal change agents; (3) allowing for an evolutionary adoption process; (4) building new professional competence through the change agents; (5) and adopting a research-driven approach to the adoption of a management innovation.Practical implicationsFor healthcare practitioners, this paper points to practices to consider when adopting improvement knowledge – for example, identifying the patient as the guiding principle and encouraging involvement and local change initiatives. For practitioners in other professionally driven organizations, this paper identifies critical practices for adopting a management innovation – for example, focusing on theorizing and labeling in order to create an organization’s own vocabulary related to the professional context.Originality/valueOn a generic level, this paper contributes to the understanding of critical aspects when adopting management innovations in a professional organization. In a healthcare context, this paper points to the value of improvement knowledge for improving quality of care. Improvement knowledge is relatively new in healthcare, and this study provides an example of a hospital in which this management innovation helped transform the organization.
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| 24. |
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| 25. |
- Holmberg, Christopher, 1984, et al.
(författare)
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Clinical validity of the 12-item WHODAS-2.0 in a naturalistic sample of outpatients with psychotic disorders
- 2021
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) is a self-administered instrument to assess functional impairment. It is used in the general population as well as different patient groups. However, its application to patients with psychotic disorders may be hampered by disease-specific difficulties of self-estimation. This study aimed to examine the psychometric properties of the short (12-item) WHODAS-2.0 in a naturalistic sample of outpatients attending a psychosis clinic in Gothenburg, Sweden. Methods: Annual data from two outpatient clinics registered 2016–2019 were analyzed retrospectively. The assessment of the short WHODAS-2.0 was based on the first questionnaire completed by 881 patients. Confirmatory factor analysis evaluated previously validated models. Item convergent and discriminant validity as well as internal reliability were computed. Construct validity was assessed by comparing mean differences in accord with previous research regarding patients’ characteristics associated with functioning such as advanced age, diagnosed comorbidities, antipsychotic treatment status, and symptom severity measured with PANSS-8 remission items. Results: A heterogeneous sample was obtained in terms of age (range: 20–92), various living situations, and different geographic areas of birth. Most patients (75%) had been diagnosed with psychotic disorders more than 10 years ago and the majority (89%) were on antipsychotic medication. We confirmed an adjusted two-level factor model with a single second-order disability factor and six first-order factors representing the six IFC dimensions. The WHODAS-2.0 sum score measuring general disability showed good reliability (Cronbach's alpha = 0.89). Construct validity was confirmed as older patients, patients with comorbidities, and patients in assisted living had higher WHODAS-2.0 scores. Patients with no or mild psychotic symptoms had significantly lower WHODAS-2.0 sum scores than patients with more severe symptoms. Conclusions: The findings further validate the 12-item WHODAS-2.0 in a naturalistic sample of outpatients with psychotic disorders. This study corroborates the clinical significance of the short, 12-item WHODAS-2.0 by demonstrating consistent associations between patients’ age, medical comorbidities, living situation, antipsychotic treatment status, and psychotic symptom severity.
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| 26. |
- Holmberg, Christopher, 1984, et al.
(författare)
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Digitally excluded in a highly digitalized country: An investigation of Swedish outpatients with psychotic disorders and functional impairments
- 2022
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Ingår i: European Journal of Psychiatry. - : Elsevier BV. - 0213-6163 .- 2340-4469. ; 36:3, s. 217-221
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Tidskriftsartikel (refereegranskat)abstract
- Access to digital devices and digital services increases accessibility to mental health services. We investigated access to smartphones and digital identification methods (digital-IDs) in an outpatient unit focusing on patients with psychotic disorders and functional impairments. Patients’ case managers completed an online anonymous survey. Most patients (85%) did not have digitalIDs, which is required in Sweden to access digital health care. High age and living in assisted living facilities influenced patients' access to smartphones and digitalID negatively. Even in a highly digitalized society, outpatients with psychotic disorders and functional impairments have much less access to digital technology than the population on average.
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| 27. |
- Holmberg, Christopher, 1984, et al.
(författare)
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Elevated pulse pressure and its associations with demographic and clinical parameters in a clinically representative sample of outpatients with psychotic disorders
- 2022
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Ingår i: BJPsych Open. - : Cambridge University Press. - 2056-4724. ; 8:3
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Tidskriftsartikel (refereegranskat)abstract
- Elevated pulse pressure is associated with metabolic and neurocognitive diseases. Preliminary small-scale studies among patients with psychotic disorders have indicated that these patients had an increased pulse pressure compared with controls. However, it is unclear whether and how these associations are manifested among larger heterogenous samples of patients with psychotic disorders. We examined elevated pulse pressure and its associations with demographic and clinical characteristics in a clinically representative sample of outpatients with psychotic disorders (n = 1289). In a subsample (n = 343), we also examined associations with six domains of functioning. Controlling for age and cardiovascular disease, body mass index (BMI) and employment status independently predicted the odds ratio of having elevated pulse pressure. Elevated pulse pressure was also primarily associated with the physical domains of functioning. Outpatients with psychotic disorders that have high BMI and are unemployed thus seem to be at increased risk for elevated pulse pressure and should therefore be particularly considered for blood pressure screenings.
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| 28. |
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| 29. |
- Lifvergren, Svante, 1961, et al.
(författare)
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Lessons from Sweden’s first large-scale implementation of Six Sigma in healthcare
- 2010
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Ingår i: Operations Management Research. - : Springer Science and Business Media LLC. - 1936-9735 .- 1936-9743. ; 3:3-4, s. 117-128
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Tidskriftsartikel (refereegranskat)abstract
- The Skaraborg Hospital Group (SkaS) has implemented a variety of quality management initiatives in the last 20 years in accordance with its strategy of excelling at quality development to fulfill the needs and expectations of its patients. One such initiative is Six Sigma, which has contributed to more than 40 completed improvement projects. Using an action research approach, this article describes the lessons that were learned from the first 22 Six Sigma projects, completed between 2006 and 2008 and having a success rate of 75%. We further describe how these insights have contributed to other ongoing quality improvement activities at SkaS. In particular, the paper presents some key points not earlier described in other Six Sigma healthcare applications.
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| 30. |
- Lindenfalk, Bertil, et al.
(författare)
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Digitally mediated schizophrenia care – A Swedish case of translating, designing and expert evaluation of Dialog
- 2022
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Ingår i: MEDINFO 2021. - Amsterdam : IOS Press. - 9781643682648 - 9781643682655 ; , s. 882-886
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Konferensbidrag (refereegranskat)abstract
- This work presents initial results of translation, design, development and expert testing of a digitally mediated dialogue based tool for schizophrenia care in Sweden. Dialog+ is a conversational methodology that has been shown to empower patients, promote co-produced and more cost-effective care. Dialog+ was translated and the digital application was redesigned to fit with the local context using human-centered design principles. Initial results of expert user testing, using heuristic evaluations and cognitive walkthroughs, shows promise for the method to work well also in Swedish settings. Initial testing with patients shows promising results. This work exemplifies how care patterns can be improved by considering the information layer of the interaction and creating shared and collaborative working spaces during treatment sessions can help to both empower patients and facilitate a more co-produced treatment plan.
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| 31. |
- Martin, Jason, 1969-, et al.
(författare)
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Närhet på distans : En guide för ledarskap på distans med stöd av digitala arbetssätt
- 2023
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Det du nu läser är en guide tänkt att användas som ett stöd och en vägledning till dig som i arbetet leder eller deltar i aktiviteter på distans med stöd av digitala arbetssätt. Guiden är utvecklad av forskare och organisationer i flera forskningsprojekt som studerar möjligheter och utmaningar i ledarskap på distans med stöd av digitala arbetssätt. Guiden vänder sig i första hand till er som är chefer och ledare med ansvar för att planera och genomföra aktiviteter på distans med stöd av digitala arbetssätt, men den kan även läsas av medarbetare och andra funktioner i era organisationer. En central del i guiden är ”verktygslådan” där vi, utifrån våra egna forskningsresultat samt med stöd av tidigare forskning, har satt ihop ett urval av praktiska verktyg som kan användas för att möjliggöra ett effektivare ledarskap på distans. Guiden och verktygen i verktygslådan tar avstamp i vardagsnära situationer och aktiviteter som vi i våra forskningsprojekt sett innehåller stor potential att förbättra hur arbete på distans med stöd av digitala arbetssätt kan organiseras och ledas. Vi visar vanligt förekommande arbetssätt och verktyg och ger konkreta och praktiska tips på hur ni kan arbeta tillsammans för att kunna uppnå bättre resultat, lära och utveckla både för individer och för organisationen samt bidra till bättre hälsa och välbefinnande. Guiden kan ses som en palett av arbetssätt och verktyg som ni antingen kan pröva direkt och/eller ha som underlag för diskussion i syfte att ta fram egna, skräddarsydda arbetssätt. Använd den som inspiration och hjälpmedel för att utveckla ditt ledarskap och medarbetarskap samt ditt sätt att leda och möjliggöra digitala aktiviteter på distans. Om du vill testa någon eller några av de verktyg och arbetssätt som presenteras i guiden tillsammans forskare så hör av dig till Jason Martin (jason.martin@liu.se) eller Andreas Wallo (andreas.wallo@liu.se) på Linköpings universitet.
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| 32. |
- Martin, Jason, 1969-
(författare)
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Quality Management Competencies-in-use : exploring competence and practice perspectives on quality management work
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Quality management is an established, widespread and well-researched management concept. Yet, surprisingly little research can be found on understanding the potential for action that is required in order to perform quality management work. The field of quality management has a strong emphasis not only on a customer and supplier focus (external), but also on a process focus (internal). This creates a constant challenge in the way in which quality management is conceived and realised. Another challenge is reflected in current research that describes the need for conceptual change in quality management due to extensive ongoing changes in society and the business environment. The nature and pace of technological development, coupled with changes in social behaviour, continuously bring out new customer needs and new ways for customers to interact with the producers of goods and services. This requires adaptive and innovative approaches for organisations, in order to stay competitive and relevant.This thesis uses competence-based and practice-based perspectives to better understand the requirements placed on quality management in meeting these challenges. It investigates what quality management work is and what properties must exist, in terms of competence and practice, in order to make quality management work possible. The purpose of this thesis is, therefore, to explore how the theoretical perspectives of competence and practice can contribute to an increased understanding of what is required to perform quality management work. Three research questions are posed and answered. The first research question concerns the nature of quality management work and how its key factors may be characterised; the second research question deals with competencies of quality management and how these are interrelated with quality management work; the third research question concerns how the interplay between quality management competencies can be understood. The research questions are answered by interpreting the findings of five papers included in the thesis, using a conceptual framework.The results of the thesis suggest two main directions of quality management work: expansive and adaptive quality management work. Expansive work is characterised by explorative practice, radical change to existing processes or the development of new processes, a logic of development, an orientation towards development and innovation, a striving to increase external efficiency and a striving to increase process variation. Adaptive work is characterised by exploitative practice, incremental change to existing processes, a logic of performance, an orientation towards goals and productivity, a striving towards internal efficiency and a striving to decrease process variation. Quality management competencies relate to quality management work in combining role dependency and discretion. Role dependency signifies the potential and capability to assume multiple role-responsibilities. Discretion is the ‘freedom of movement’ for quality practitioners to engage in practices and choose quality management work directions according to task and situation. The interplay between quality management competencies is understood as the combined effects of two competence antecedents: individual and/or collective dispositions to change and learning. This thesis extends research on quality management by increasing our knowledge and understanding of the requirements needed, not only to select and perform existing quality management practices, but also to adopt and engage in practices where emergence is accommodated by ambidexterity.
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| 33. |
- Martin, Jason, 1969-, et al.
(författare)
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Towards a quality management competence framework: Exploring needed competencies in quality management
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background and purpose –Several studies and recent reports address emerging and expanding needs for Quality Management (QM) impacting the professional practices and activities and maybe also the conceptual underpinnings of QM. An integrative approach for QM, facilitating both operational and strategic leverage has been described as becoming increasingly more important. However, few empirical studies have focused on what QM professionals actually do with even fewer studies focusing on what it actually takes to do QM-work, i.e. the competencies of QM.The purpose of this paper is thus to extend the conceptual understanding of QM by introducing an activity and practice-based terminology for describing competencies of QM work in contemporary Swedish organisations and to create a conceptual competence framework suited for successful QM.Design/methodology/approach –This paper is based on a cross-case qualitative study design incorporating four Swedish large size organizations where designated QM professionals (n= 34) were targeted, selected and interviewed.Findings –Four generic QM roles are posited: centralised & strategic, centralised & operational, decentralised & strategic and decentralised & operational roles. A QM competence framework incorporating four essential QM competence dimensions is presented: the human, the contextual, the methods & process and the development competence dimensions. Competencies are discussed in relation to the “production dilemma” of QM and the emerging need of more integrative and business excellence-oriented QM.
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| 34. |
- Martin, Jason, 1969-, et al.
(författare)
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Towards a quality management competence framework: exploring needed competencies in quality management
- 2021
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Ingår i: Total Quality Management and Business Excellence. - : Informa UK Limited. - 1478-3371 .- 1478-3363. ; 32:3-4, s. 359-378
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Tidskriftsartikel (refereegranskat)abstract
- Few empirical studies have focused on what quality management practitioners actually do, with even fewer studies focusing on what it actually takes to do quality management work, i.e. the competencies of quality management. The purpose of this paper is to introduce a competence-based terminology for describing general competencies of quality management work in organisations and to create a competence framework in order to understand what is needed to be a quality management practitioner. This paper is based on an embedded, qualitative multiple-case study design incorporating four Swedish large size organisations where designated quality management practitioners (n = 33) were selected and interviewed. A quality management competence framework incorporating four main quality management competence dimensions is presented: the human, the methods & process, the conceptual and the contextual competence dimensions. Four generic quality management role responsibilities are also posited: centralised & strategic, centralised & operational, local & strategic and local & operational role responsibilities. The competencies and role responsibilities are discussed in relation to the notion of emergent quality management and the emerging need of more integrative and business excellence-oriented quality management.
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| 35. |
- Smeds, Magdalena, Teknisk licentiat, 1990-, et al.
(författare)
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Helping a “sister” out : Bringing engineering students and healthcare practitioners together through live-cases
- 2023
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Konferensbidrag (refereegranskat)abstract
- Universities search for ways to prepare full-time students for real worklife challenges, but also for ways to offer practitioners life-long learning (LLL) opportunities. This paper presents a live-case model integrating full-time engineering students and LLL students from healthcare in a case model focusing learnings for both groups. The small-scale live-case model offers a resource-efficient learning activity for both traditional courses and LLL courses. The unique characteristics is that the model is strongly delineate in time (duration: one week), and that it focuses not only the students' but also the practitioners’ learning.
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| 36. |
- Wallo, Andreas, 1978-, et al.
(författare)
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Charting the path to a sustainable, competitive and green industry in an era of rapid change: proposing a research agenda
- 2024
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Ingår i: Cogent Business & Management. - : Taylor & Francis. - 2331-1975. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Global labor market shifts have spurred the need for innovations and adaptations in workplace norms. This evolution demands a workforce with technical and soft skills to meet sustainability and industry advancements. The paper aims to elucidate the complex challenges related to the ambition to develop a socially sustainable, competitive, and green industry subjected to an accelerating pace of change. It outlines the findings of a Delphi study conducted in Sweden, which integrated workshops, interviews, and surveys with experts from various sectors to identify 14 key challenges. These challenges were synthesized into five themes: innovative competence supply management practices, resilient organizations and production systems, analytics for improvement and learning, socially sustainable work, and green transformation practices. The study provides a set of propositions within these themes, offering a strategic roadmap for future research to foster the growth of industries that are socially responsible, competitive, and committed to environmental sustainability. A practical implication of the study is the recognition of the larger competence ecosystem of which industrial companies are a part. This community must work together to create the knowledge needed to manage the shift to a green, sustainable, and digital working life.
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| 37. |
- Wallo, Andreas, 1978-, et al.
(författare)
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Charting the path to a sustainable, competitive and green industry in an era of rapid change: proposing a research agenda
- 2024
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Ingår i: Cogent Business and Management. - : Taylor & Francis. - 2331-1975. ; 11:1
-
Tidskriftsartikel (refereegranskat)abstract
- Global labor market shifts have spurred the need for innovations and adaptations in workplace norms. This evolution demands a workforce with technical and soft skills to meet sustainability and industry advancements. The paper aims to elucidate the complex challenges related to the ambition to develop a socially sustainable, competitive, and green industry subjected to an accelerating pace of change. It outlines the findings of a Delphi study conducted in Sweden, which integrated workshops, interviews, and surveys with experts from various sectors to identify 14 key challenges. These challenges were synthesized into five themes: innovative competence supply management practices, resilient organizations and production systems, analytics for improvement and learning, socially sustainable work, and green transformation practices. The study provides a set of propositions within these themes, offering a strategic roadmap for future research to foster the growth of industries that are socially responsible, competitive, and committed to environmental sustainability. A practical implication of the study is the recognition of the larger competence ecosystem of which industrial companies are a part. This community must work together to create the knowledge needed to manage the shift to a green, sustainable, and digital working life.
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| 38. |
- Wallo, Andreas, 1978-, et al.
(författare)
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Mapping the challenges of a socially sustainable, competitive, and green industry in the age of rapid change : A Delphi study
- 2023
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This report presents the findings of a Delphi study coordinated by Linköping University (LiU) in collaboration with RISE Research Institutes of Sweden and the Chalmers University of Technology. The study was carried out in 2022 as part of a Vinnova-funded planning project aimed at establishing an interdisciplinary research environment to prepare an application for a new competence centre focused on building a long-term, sustainable Swedish industry. The Delphi study aimed to identify key challenges related to the ambition to develop a socially sustainable, competitive, and green industry subjected to an accelerating pace of change. The Delphi study was based on an interactive research approach to facilitate the cocreation of knowledge for the dual purpose of advancing long-term theory development and innovation processes. The consortium and its reference groups consist of industrial companies (such as AstraZeneca, Ericsson IndustryLab, Rimaster, Saab Aeronautics, Scania, Volvo GTO and Volvo Cars), intermediaries and educational actors (such as Skill, IUC Sverige and Linköping Science Park), labour market organisations (including IF Metall, Industriarbetsgivarna, Unionen, and Teknikföretagen), governmental agencies (the Office for Sustainable Working life), and researchers from LiU, Chalmers, and RISE. There are key industrial targets forming the starting point for the Delphi study that also guide policies and investments in strategic agendas for the industrial stakeholders. For the Swedish industry to be resilient and sustainable, new competence and organisational abilities are required to decrease the dependency on fossil energy in production. Transformation towards electrification, circular economy, and digitalisation are key enablers, and these transitions are ongoing and accelerating at a fast pace. Furthermore, new and constantly emerging targets require organisational resilience, like managing new requirements and targets within energy consumption and supply of competence. The findings of this report include a total of 14 identified challenges. To organise and create conditions for flexible work for all To successfully manage crises and drastic external events To successfully drive and contribute to the green industrial transformation To facilitate employee-driven innovation and organisational learning To attract, develop and retain employees with the right skills To take advantage of and exploit the opportunities of digitalisation To create inclusive workplaces and utilise diversity To organise competence development To collaborate with external parties to ensure the availability of competence To design for socially sustainable work considering efficiency and good health in a dynamic environment To organise the creation of added value for and together with customers and suppliers To systematically drive continuous improvement work in parallel with long-term development work To develop leadership that creates better opportunities both for a climate-neutral footprint and a competitive industry with good working conditions To transform research- and policy-based knowledge into practice The 14 challenges were further analysed according to perceived importance and ability and presented in a priority matrix. According to the priority matrix, the 14 challenges were then synthesised into six main research themes: A. Innovative competence supply practice, B. Resilient organisations & production systems, C. Analytics for improvement & learning, D. Socially sustainable work, E. Green transformation practices, and an open and undefined research theme labelled as Future challenges. The research themes are also presented together with six main analytical and theoretical perspectives in a matrix that can be used to intersect and interweave the research themes to guide the research agenda in a potential future research program.
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| 39. |
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| 40. |
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