| 1. |
- Janlöv, Ann-Christin, et al.
(författare)
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An improvement program as a way to intensify inter-professional collaboration in the community for people with mental disabilities : a follow-up
- 2016
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Ingår i: Issues in Mental Health Nursing. - : Taylor & Francis. - 0161-2840 .- 1096-4673. ; 37:12, s. 885-893
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to follow up inter-professional experiences of improvement work one year after a completed CII improvement program aiming at improve health care and social services for people with mental disabilities living in ordinary housing. This study was performed with a qualitative descriptive approach which employed six focus group interviews followed by a thematic analysis. The results revealed four themes; Self-awareness and insights; Behavior and actions in daily practice; Organizational cultures and subcultures; and Organizational practices, using Ken Wilbers' integral theory of four quadrants of realities as a holistic frame in the discussion.
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| 2. |
- Hagell, Peter, et al.
(författare)
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Effects of method of translation of patient-reported health outcome questionnaires : a randomized study of the translation of the Rheumatoid Arthritis Quality of Life (RAQoL) Instrument for Sweden
- 2010
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Ingår i: Value in Health. - : Wiley-Blackwell. - 1098-3015 .- 1524-4733. ; 13:4, s. 424-430
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To compare two versions of a questionnaire translated using forward-backward (FB) translation and dual-panel (DP) methodologies regarding preference of wording and psychometric properties.METHODS: The Rheumatoid Arthritis Quality of Life instrument was adapted into Swedish by two independent groups using FB and DP methodologies, respectively. Seven out of thirty resulting items were identical. Nonidentical items were evaluated regarding preference of wording by 23 bilingual Swedes, 50 people with rheumatoid arthritis (RA), and 2 lay panels (n = 11). Psychometric performance was assessed from a postal survey of 200 people with RA randomly assigned to complete one version first and the other 2 weeks later.RESULTS: Preference did not differ among the 23 bilinguals (P = 0.196), whereas patients and lay people preferred DP over FB item versions (P < 0.0001). Postal survey response rates were 74% (FB) and 75% (DP). There were more missing item responses in the FB than the DP version (6.9% vs. 5.6%; P < 0.0001). Floor/ceiling effects were small (FB, 6.1/0%; DP, 4.4/0.7%) and reliability was 0.92 for both versions. Construct validity was similar for both versions. Differential item functioning by version was detected for five items but cancelled out and did not affect estimated person measures.CONCLUSIONS: The DP approach showed advantages over FB translation in terms of preference by the target population and by lay people, whereas there were no obvious psychometric differences. This suggests advantages of DP over FB translation from the patients' perspective, and does not support the commonly held view that FB translation is the "gold standard."
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| 3. |
- Jakobsson, Ulf, et al.
(författare)
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Construct validity of the SF-12 in three different samples
- 2012
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley-Blackwell. - 1356-1294 .- 1365-2753. ; 18:3, s. 560-566
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives Studies have challenged the validity and underlying measurement model of the physical and mental component summary scores of the 36-item Short-Form Health Survey in, for example the elderly and people with neurological disorders. However, it is unclear to what extent these observations translate to physical and mental component summary scores derived from the 12-item short form (SF-12) of the 36-item Short-Form Health Survey. This study evaluated the construct validity of the SF-12 in elderly people and people with Parkinson's disease (PD) and stroke.Methods SF-12 data from a general elderly (aged 75+) population (n = 4278), people with PD (n = 159) and stroke survivors (n = 89) were analysed regarding data quality, reliability (coefficient alpha) and internal construct validity. The latter was assessed through item-total correlations, exploratory and confirmatory factor analyses.Results Completeness of data was high (93–98.8%) and reliability was acceptable (0.78–0.85). Item-total correlations argued against the suggested items-to-summary scores structure in all three samples. Exploratory factor analyses failed to support a two-dimensional item structure among elderly and stroke survivors, and cross-loadings of items were seen in all three samples. Confirmatory factor analyses showed lack of fit between empirical data and the proposed items-to-summary measures structure in all samples.Conclusions These observations challenge the validity and interpretability of SF-12 scores among the elderly, people with PD and stroke survivors. The standard orthogonally weighted SF-12 scoring algorithm is cautioned against. Instead, when the assumed two-dimensional structure is supported in the data, oblique scoring algorithms appear preferable. Failure to consider basic scoring assumptions may yield misleading results.
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| 4. |
- Orrung Wallin, Anneli, 1973-, et al.
(författare)
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Job strain and stress of conscience among nurse assistants working in residential care
- 2015
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Ingår i: Journal of Nursing Management. - : Wiley-Blackwell. - 0966-0429 .- 1365-2834. ; 23:3, s. 368-379
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim was to investigate job strain and stress of conscience among nurse assistants working in residential care and to explore associations with personal and work-related aspects and health complaints. Background It is important to investigate job strain and stress of conscience, both for the well-being of the nurse assistants themselves and for the impact on the quality of care they provide. Method Questionnaires measuring job strain, stress of conscience, personal and work-related aspects and health complaints were completed by NAs (n = 225). Comparisons of high and low levels of job strain and stress of conscience and multiple linear regression analyses were performed. Result Organisational and environmental support and low education levels were associated with low levels of job strain and stress of conscience. Personalised care provision and leadership were related to stress of conscience and the caring climate was related to job strain. Conclusion There is a need for support from the managers and a supportive organisation for reducing nurse assistants work-related stress, which in turn can create a positive caring climate where the nurse assistants are able to provide high quality care. Implications for nursing management The managers' role is essential when designing supportive measures and implementing a value-system that can facilitate personalised care provision.
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| 5. |
- Ledwith, Margaret, et al.
(författare)
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Participatory practice : community-based action for transformative change
- 2009
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Bok (populärvet., debatt m.m.)abstract
- Participatory Practice explores the core ideas of participatory practice and how theory and practice can be integrated to achieve transformative change. The ideas in the book are founded on two premises: firstly, that transformative practice begins in the everyday stories that people tell about their lives and that practical theory generated from these narratives is the best way to inform both policy and practice. Secondly, that participatory practice is a tool for examining this knowledge in that it allows practitioners to examine the way they view the world and to situate their local practice within bigger social issues. The book is expected to be of interest to both academics and community-based practitioners. Professor Springett commented: “Writing the book was a transformative experience in itself because we had to cross the divide between our different professions. The idea to write it came from our joint concern for the appropriation of the language of participation by many politicians and agencies without a real examination of what true participation actually consists of."
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| 6. |
- Sjövall, Katarina, et al.
(författare)
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Sick leave of spouses to cancer patients before and after diagnosis
- 2010
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Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 49:4, s. 467-473
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Tidskriftsartikel (refereegranskat)abstract
- Background. The impact of cancer on spouses of cancer patients may be considerable in many aspects. Our objective was to evaluate sick leave in spouses of cancer patients before and after the diagnosis. Material and methods. Using Swedish population-based registries, we studied sick leave of spouses to patients with newly diagnosed colon, rectal, lung, prostate, or breast cancer. We identified the cancer patients via the Swedish Cancer Registry and obtained information of their spouse through linkage with the population register. We assessed the number of sick leave episodes and sick days one year before until one year after the spouses' cancer diagnosis by cross-referencing with Swedish Social Insurance Agency data. We also compared the number of sick days of spouses with the general population adjusted for age, sex and partner status. Results. In general, spouses (N=1 923) to cancer patients had an increase in the frequency of new episodes of sick leave in the months before and after the cancer diagnosis. Spouses of lung cancer patients had most sick leave episodes, and the largest number of sick days per person. In comparison to the general population, spouses in the lung cancer group also had the highest standardised sick day ratio 1.76; 95% confidence interval 1.24, 2.40. The corresponding risk for spouses in other groups of cancer was not significantly increased. Discussion. In Sweden there is often increased sick leave of spouses to cancer patients. It may be due to emotional stress and physical reactions that follow with cancer which needs to be further explored in order to provide adequate support and care.
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| 7. |
- Andersson, Anders-Petter, 1969-, et al.
(författare)
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Designing empowering vocal and tangible interaction :
- 2013
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Ingår i: The International conference on new interfaces for musical expression. - Kaejeon, Korea : Seoul National University. ; , s. 406-412
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Konferensbidrag (refereegranskat)abstract
- Our voice and body are important parts of our self-experience, and our communication and relational possibilities. They gradually become more important for Interaction Design due to increased development of tangible interaction and mobile communication. In this paper we present and discuss our work with voice and tangible interaction in our ongoing research project RHYME. The goal is to improve health for families, adults and children with disabilities through use of collaborative, musical, tangible media. We build on the use of voice in Music Therapy and on a humanistic health approach. Our challenge is to design vocal and tangible interactive media that through use reduce isolation and passivity and increase empowerment for the users. We use sound recognition, generative sound synthesis, vibrations and cross-media techniques to create rhythms, melodies and harmonic chords to stimulate voice-body connections, positive emotions and structures for actions.
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| 8. |
- Andersson, Anders-Petter, 1969-, et al.
(författare)
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Vocal and tangible technology for music and health
- 2013
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Ingår i: Book of abstracts. - Oslo : The Norwegian Academy of Music. ; , s. 24-24
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Konferensbidrag (refereegranskat)abstract
- Our voice and body are important parts of our self-expression and self-experience. They are also essential for our way to communicate and build relations cross borders like abilities, ages, locations, backgrounds and cultures. Voice and tangibility gradually become more important when developing new music technology for the Music Therapy and the Music and Health fields, due to new technology possibilities that have recently arisen. For example smartphones, computer games and networked, social media services like Skype. In this paper we present and discuss our work with voice and tangible interaction in our ongoing research project. The goal is to improve health for families, adults and children with severe disabilities through use of collaborative, musical, tangible sensorial media. We build on use of voice in Music Therapy and studies by Lisa Sokolov, Diane Austin, Kenneth Bruscia and Joanne Loewy. Further we build on knowledge from Multi-sensory stimulation and on a humanistic health approach. Our challenge is to design vocal and tangible, sensorially stimulating interactive media, that through use reduce isolation and passivity and increase empowerment for all the users. We use sound recognition, generative sound synthesis, vibrations and cross- media techniques, to create rhythms, melodies and harmonic chords to stimulate body- voice connections, positive emotions and structures for actions. The reflections in this paper build on action research methods, video observations and research-by-design methods. We reflect on observations of families and close others with children with severe disabilities, interacting in three vocal and tangible installations.
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| 9. |
- Andersson, Johanna, et al.
(författare)
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Assessing outcome in collaboration : the impact of assessment on collaboration practice
- 2013
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Ingår i: Critical Management Studies Conference 2013.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Today the concept of efficiency is a guiding light in public management. Increased efficiency is thought to control spending and provide better services. Two approaches to achieve this are through assessments such as evaluation and audits; and collaboration between different actors. Collaboration can imply e.g. networks or partnerships and vary in intensity and formality. Regardless of form, collaborative efforts are generally thought to achieve services better adapted to address complex social problems, and diminishing overlaps and unclear responsibilities caused by fragmentation. Assessments are used to determine whether or not a program or a service is efficient, but the act of assessment itself is also intended to increase efficiency. Thus, the act of assessment influences the practice it is assessing. Furthermore, in order to be assessed, a program or a service has to be “evaluable”, which may also influence practice. Collaboration is often a solution to previous sector failure, and at the same time it is perceived as difficult to both achieve and sustain. Assessments are used as a tool to determine whether or not collaborative advantage is achieved and if the investments in collaboration should be pursued.Assessments of collaboration are a challenge since it confronts the regular vertical forms of organizing and thereby the focus of assessment. The challenge can be boiled down to the question of what collaborative arrangements can, and should, be held accountable for.Based on an ethnographic study and two years of field work, this question is critically analyzed with an example from Sweden. The financial coordination of rehabilitation measures act came into effect in 2004, and regulates the construction of coordination associations. The foundation of an association is a pooled budget to which all members, four different public authorities in the field of vocational rehabilitation, contribute. An important condition behind the law was the notion that public services were not adapted to, and therefore had trouble handling, some groups with complex problems needing support from two or more organizations at the same time. The overall, and ultimate, aim with financial coordination is to improve the working ability in the target population. Though the objective of the associations is, according to the law, to support collaboration, finance efforts within the collected area of responsibility and evaluate these efforts. The financed efforts may be both operative and strategic, and should in some way complement the operations of the member organizations or aim at development of new knowledge or methods. The associations have no power to make decisions of authority in relation to the target population, which remains with the professionals in the member organizations. Following this, it may be argued that the first target group of the associations is the regular organizations and next, as a secondary target group; the individuals in the target population. This means also that the target population is not the associations’ own but the regular organizations’ target groups. The aim with the associations is thus to contribute to the regular organizations working better in relation to this group. The associations have no tools at their disposal to contribute to the overall goal but the pooled budget. Their responsibility is to construct the budget, distribute the resources and follow up.However, as the findings presented and discussed in this paper show, the associations are generally held accountable to more than that in the frequent assessments being performed on both the associations and the efforts they finance. First, the associations are generally seen by others as being the efforts they finance. This makes the view of them almost like a new organization or authority, even though the efforts actually are organizationally owned and performed by regular organizations. Second, they are held accountable to the aim of improved working ability of the target group, i.e. the overall policy goal. Their objective to support collaboration and the notion that the law was introduced in order to ensure that, through collaboration, those individuals in the intersection of different organizations get the needed help is thus overlooked and focus is turned to effects on individuals.This paper argues that the assessments have highly influenced practice in the associations, and has shifted focus from organizational outcomes such as increased equity and quality of services due to decreased fragmentation, to individual outcomes such as employment and dependency of benefits. These latter outcomes are easier to account for and are also in line with conventional more hierarchical assessments. Since many associations perceive themselves to be questioned due to lacking efficiency, they may start seek legitimacy and thereby behave in line with the focus of assessments and start to “produce” improved working ability instead of supporting collaboration. Furthermore, the assessments and their focus on individuals tend to treat the associations not as a collaborative structure between four actors with a supportive aim, but as a regular organization with authoritative power. When the associations are held accountable for a group’s outcome, this group has been “passed on” from ordinary organizations on to the associations. Organizational outcome related to collaboration is greatly overlooked, in line with the “common wisdom” that collaboration is not an end in itself, and an end in public management collaboration must thus be measured as individual benefit. Increased quality and equity in services are thus outcomes that are not only not being assessed but might also be at risk of being lost with the current assessment focus. Last, there is an evident risk that the narrow and vertical assessment focus increases, instead of decreases, horizontal fragmentation within the welfare system due to its impact on coordination association practice.
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| 10. |
- Andersson, Johanna, et al.
(författare)
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Integration in Vocational Rehabilitation : a Literature Review
- 2011
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Ingår i: Integration inHealth and Healthcare.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Context: With the increasing specialisation of services, integration has become important for health and other welfare organisations in order to address the complex problems of their patients or clients. This is particularly in care of the elderly, psychiatric care and vocational rehabilitation. The following presentation reports a review of literature on integration in vocational rehabilitation, focusing on models of integration as well as barriers and facilitators.Methods: The review was based on a search in scientific journals from 1995 to 2010. It generated 13132 articles, which were reduced to 1005 after an initial overview. The abstracts were read by members of the research group. Each abstract was read by two members independently. If they agreed the article was included or excluded, but if not the whole group discussed the abstract. This procedure reduced the number of articles to 205, which were read in full text. Finally, 62 articles were included for thematic content analysis.Results: Most of the studies came from Sweden, while others came from Canada, Australia, UK, Netherlands, Norway and Denmark. In these studies different models of integration were identified. They were classified as structural or process oriented. The structural models included case management, partnerships, co-location and financial coordination, while the process oriented models included informal contacts, interorganisational meetings and multidisciplinary teams. There were also a number of barriers as well as facilitators of integration. The barriers included structural and cultural differences, while communication, trust and continuity were important facilitators.Discussion: There are different models of integration, but also many combinations. Case management is often combined with interorganisational meetings or multidisciplinary teams. There are also informal contacts in all models. There is a clear mirror effect between the different barriers and facilitators. Leadership may be either a barrier or a facilitator. In the same way, differences between organisations may be both barriers and facilitators. These results seem to be valid also for other fields of integration, for example care of the elderly, psychiatric care, and other forms of community care.
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| 11. |
- Andersson, Johanna, et al.
(författare)
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Organizational approaches to collaboration in vocational rehabilitation : an international literature review
- 2012
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Ingår i: International Journal of Integrated Care. - 1568-4156 .- 1568-4156. ; 11, s. e137-
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Collaboration between welfare organizations is an important strategy for integrating different health and welfare services. This article reports a review of the international literature on vocational rehabilitation, focusing on different organizational models of collaboration as well as different barriers and facilitating factors.Methods: The review was based on an extensive search in scientific journals from 1995 to 2010, which generated more than 13,000 articles. The number of articles was reduced in different steps through a group procedure based on the abstracts. Finally, 205 articles were read in full text and 62 were included for content analysis.Results: Seven basic models of collaboration were identified in the literature. They had different degrees of complexity, intensity and formalization. They could also be combined in different ways. Several barriers and facilitators of collaboration were also identified. Most of these were related to factors as communication, trust and commitment.Conclusion: There is no optimal model of collaboration to be applied everywhere, but one model could be more appropriate than others in a certain context. More research is needed to compare different models and to see whether they are applicable also in other fields of collaboration inside or outside the welfare system.
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| 12. |
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| 13. |
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| 14. |
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| 15. |
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| 16. |
- Furenbäck, Ingela, 1963-
(författare)
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Improving the quality of care through communication arena
- 2013
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Ingår i: International Journal of Integrated Care. - 1568-4156 .- 1568-4156. ; 13:WCIC Conf Suppl
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: Collaboration has become an increasingly more common strategy when developing care sectors while, coincidentally, experience and research show that collaboration development may be problematic in itself. This study aims to achieve better understanding of collaboration processes.Method: A local project that aimed at improving the quality of healthcare and social care by developing the co-operation between organizations took place in Sweden, and by using participatory action research, PAR, this process was followed between 2004 and 2008. Material was gathered through participant observation from the perspective of patients, relatives, staff, managers and politicians. A descriptive narrative was compiled and a hermeneutic interpretation was performed.Results: Initially, the development of collaboration was impeded due to lack of communication between the participants from various levels within the organizations. With the support of PAR, communication arenas were arranged to handle social interaction as well as different perspectives and conflicts, which led to improved collaboration within the organizations as well as between the care organizations.Conclusion: Development of collaboration between organizations reflects how collaboration within one organization works. Collaboration is a social and interpersonal phenomenon, and readily available communication arenas are crucial for its development.
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| 17. |
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| 18. |
- Holmberg, Leif, 1943-
(författare)
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Task uncertainty and rationality in medical problem solving
- 2006
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Ingår i: International Journal for Quality in Health Care. - 1353-4505 .- 1464-3677. ; 18:6, s. 458-462
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Tidskriftsartikel (refereegranskat)abstract
- ISSUE: Medical problem-solving situations are characterized by various degrees of 'task uncertainty'--i.e. uncertainty related to the definition of a problem, the effect of a technology, the value of a solution, and so on. The need for professional discretion varies and depends on the degree of perceived task uncertainty. SUGGESTED SOLUTION: In this report it is argued that, in order to obtain rationality in problem-solving processes, differences in the degree of task uncertainty need to be met by variation in the structure of the health care organization. IMPLICATIONS: The main implications of this view are that (under norms of rationality) problem-solving processes with low task uncertainty must be organized in one way and processes with high task uncertainty in another. Furthermore, processes with high and low task uncertainty also need to be evaluated according to different standards. Some hypotheses regarding the different organizational requirements are presented.
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| 19. |
- Johansson, Ulla, et al.
(författare)
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Nutritionsbehandling inom slutenvården : Svenska sjukhus klarar inte Europarådets riktlinjer
- 2006
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 103:21-22, s. 1718-1724
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Tidskriftsartikel (refereegranskat)abstract
- Sjukdomsrelaterad undernäring har beskrivits i Europa sedan ett tiotal år. Problemet har föranlett Europarådet att 2003 anta en resolution med rekommendationer till medlemsländerna om nutritionsbehandling på sjukhus.I en enkätstudie genomförd bland svenska läkare, sjuksköterskor och dietister undersöktes attityder till och rutiner för nutritionsbehandling inom slutenvården – i relation till Europarådets rekommendationer.Totalt 1 656 personer (38 procent) svarade på enkäten. Av dessa ansåg 88 procent att nutritionsstatus ska screenas vid inläggning, medan endast 22 procent beskrev att så verkligen sker. Nästan hälften ansåg att utbildningen i klinisk nutrition för vårdpersonal var otillräcklig. En otydlighet i ansvarsfördelningen beskrevs av majoriteten av dem som svarat.Undersökningen visar att svensk slutenvård inte lever upp till Europarådets rekommendationer om nutritionsbehandling. Brister har också definierats vad gäller riktlinjer och organisation.För framtiden efterlyses en nationell handlingsplan för att implementera Europarådets resolution i svensk hälso- och sjukvård.
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| 20. |
- Leppänen, Vesa, 1966-
(författare)
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Maktutövning i telefonrådgivning
- 2008
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Ingår i: Holmström, i. (red.), Telefonrådgivning inom hälso- och sjukvård. - Lund : Studentlitteratur. - 9789144047768 ; , s. 19-36
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 21. |
- Lindström, Petra Nilsson, et al.
(författare)
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Evaluating the usability of two salutogenic instruments on health and work experience, using cognitive interviewing
- 2018
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Ingår i: Journal of Workplace Behavioral Health. - : Routledge. - 1555-5240 .- 1555-5259. ; 33:3-4, s. 241-259
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Tidskriftsartikel (refereegranskat)abstract
- Workplace surveys are used in workplace health promotion as a basis for improvements at the workplace. But there is lack of psychometrically and qualitatively validated work-health related instruments with a salutogenic approach. The purpose of this study was, therefore, to evaluate the two instruments, the Salutogenic Health Indicator Scale and the Work Experience Measurement Scale, among staff of different professions in a healthcare setting. These instruments were evaluated with cognitive interviews conducted at a hospital in Sweden. The respondents were purposefully selected from various criteria such as profession, age, and sex (N = 14). The respondents read the items aloud and then spoke about how they experienced the items. A deductive (partly inductive) content analysis was done from Tourangeau's four concepts of respondent actions: comprehension, retrieval, judgment, and response. Two main categories emerged: (1) interpreting and (2) responding, and an additional six subcategories: difficulty, essence, direction, keywords, strategy, and alternatives. The results showed strengths and weaknesses of the instruments. The results were discussed from various validity aspects: face validity, content validity, and user validity. The validity aspects were connected to concepts of respondent actions as well as to questionnaire and respondent factors for motivation.
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| 22. |
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| 23. |
- Nilsson, Petra, 1980-, et al.
(författare)
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How to make a workplace health promotion questionnaire process applicable, meaningful, and sustainable
- 2011
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Ingår i: Journal of Nursing Management. - : Wiley-Blackwell. - 0966-0429 .- 1365-2834. ; 19:7, s. 906-914
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Tidskriftsartikel (refereegranskat)abstract
- Background In workplace health promotion, a questionnaire could be of great use. Unfortunately, fatigue regarding answering questionnaires has recently become greater than before. An action research approach could be a possible way of increasing employee participation.Aim This study reports an attempt to explore key aspects for participation in, and commitment to, a workplace health promotion questionnaire process.Method The study was conducted at two wards in a Swedish hospital. Data was collected during an action research process. Data were analysed with regard to a framework of questions.Findings The three key aspects for participation in, and commitment to, a workplace health promotion questionnaire process were: an applicable questionnaire, a meaningful questionnaire process and a continuous and sustainable questionnaire process. A structure is presented as practical advice to managers, describing how such a process could be established to be applicable, meaningful and sustainable.Conclusion This study has identified key aspects and prerequisites for questionnaire processes. The prerequisites – share decision-making, involve a core group and follow a structure – are discussed and proposed for managers and workgroups to consider in further workplace health promotion questionnaire processes.Implications for nursing management The key aspects and prerequisites presented could provide a stimulating standpoint or advice, useful for planning and accomplishing workplace questionnaire processes.
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| 24. |
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| 25. |
- Nordgren, Lars, et al.
(författare)
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Choice of primary care in Sweden : a discourse analysis of citizen statements
- 2011
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Ingår i: Offentlig Förvaltning. Scandinavian Journal of Public Administration. - 2000-8058 .- 2001-3310. ; 15:3, s. 25-40
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Tidskriftsartikel (refereegranskat)abstract
- Through a discourse analysis of the end-users’ statements on their choice of primary care, there is a focus on how they use certain discourses in society with regard to which discourses governs their choices of primary care. For this purpose, a group interview was administered in a location in the south of Sweden. It was strategically designed to on the whole include individuals with following characteristics: age between 20-45 years, and 65 year or older, and also living in a small community. The following main discourses have been identified in the discussion; freedom of choice; i.e. to say that one has actively chosen one’s health centre or doctor, to be able to reject and re-select care-givers, networking; i.e. ‘to say that friends’ and acquaintances’ experiences affect the choice of a new health centre and professional service, i.e. to say that doctors and other staff should give professional service. It seems like choice of care has improved the possibilities of the citizens to choose preferred care provider, or drop one due to dissatisfaction. When implementing reforms in health care it is valuable to take into account the voices of the users, as they are able to contribute to the development of health care.
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| 26. |
- Nordgren, Lars, et al.
(författare)
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The value creation-concept in hospitals : Health values from the patients’ perspective
- 2013
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Ingår i: Nordisk sygeplejeforskning. - 1892-2678 .- 1892-2686. ; 3:2, s. 105-116
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Based on the concept of value creation the aim was to analyse a sample of patients’ unstructured responses, and to show what the patients perceived to be healthcare values.Method: Using content analysis the patients’ responses to three questions underwent a categorization involving the identification, coding, and emerging of themes.Results: This is good: fellow feeling, receptivity, proficiency, efforts matched to requirements, popular food, informed patients. The theme was professional care. This I would like to change: offer more conventional forms of accommodation, better quality food, better cleaning, more time to their patients, better information, and improved accessibility. The theme was patients want good service when in hospital. Other complaints were linked to care, resulting in; improve personal integrity, friendlier demeanour, more focusing on the individual. The theme was patients expect to be acknowledged and respected by nursing staff. However, the answers did not convey anything essentially new.Conclusion: The patients expressed different values. It is debatable to use service management concepts in healthcare in a simplistic way. Practice implications: Patients’ unstructured answers are of interest in improving the attitudes of the co-workers.
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| 27. |
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| 28. |
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| 29. |
- Petersson, Pia, 1961-, et al.
(författare)
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Local interpretations of health policy concepts : the exemple of Närsjukvård in Sweden
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Health care systems in Europe face many challenges requiring greater integration of health and social care. The health policy response in government financed health systems has varied but a consistent feature has been continual change in an attempt to secure greater efficiencies and to meet patient expectations concerning service quality. This paper explores the manifestation of this phenomenon in a subregion of Sweden, where a new concept ‘Närsjukvård’ (literally Nearby Care) was introduced. Method: Data was collected through interviews and questionnaires. A convenience sample of 57 practitioners and managers was interviewed. A questionnaire with four statements based upon the findings from the interviews was answered by 1361 practitioners, managers and politicians working in primary health care, in municipalities and in hospitals. Results: The findings illustrated that the concept was interpreted as; accessibility to hospital beds, accessibility to primary health care, collaboration between care providers and continuity and developed home care. The study revealed different understanding and interpretations partly depending on the respondents’ professional domain and their organisational elonging. Conclusion: A prerequisite for creating a common meaning to the expression ‘Närsjukvård’ is that activities that help the creation of meaning are offered at and between all domain levels and organisations.
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| 30. |
- Rudenstam, Nils-Gunnar, 1950-, et al.
(författare)
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Inter-organizational cooperation : a rehabilitation project based on cooperation between health care and three social service agencies
- 2014
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Ingår i: Health. - 1949-4998 .- 1949-5005. ; 6:5, s. 342-349
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Cooperation between organizations is an often-suggested remedy for handling unsolved borderland problems. However, actual projects aiming at cooperation are seldom very successful. The purpose here is to highlight obstacles related to cooperation between different organizations based on a case study of a rehabilitation project where health care and several social service organizations (social insurance, social welfare, and the local employment agency) were involved. Data were gathered through participation and interviews. Findings: It seems that efficient cooperation requires an understanding of the participating organizations’ differences in work logic as well as work practices. Furthermore, only certain fairly standardized “normal” problems may be handled through organized cooperation while non-routine exceptional problem requires a more fully integrated work organization. Implications: Obstacles to cooperation are highlighted and ways to improve the possibilities of cooperation between organizations are suggested although such possibilities are generally hampered by differences in work logic.
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| 31. |
- Sanneving, Linda, et al.
(författare)
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Health system capacity : maternal health policy implementation in the state of Gujarat, India
- 2013
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Ingår i: Global Health Action. - 1654-9716 .- 1654-9880. ; 6, s. 19629-
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The Government of Gujarat has for the past couple of decades continuously initiated several interventions to improve access to care for pregnant and delivering women within the state. Data from the last District Family Heath survey in Gujarat in 2007-2008 show that 56.4% of women had institutional deliveries and 71.5% had at least one antenatal check-up, indicating that challenges remain in increasing use of and access to maternal health care services.Objective: To explore the perceptions of high-level stakeholders on the process of implementing maternal health interventions in Gujarat. Method: Using the policy triangle framework developed by Walt and Gilson, the process of implementation was approached using in-depth interviews and qualitative content analysis.Result: Based on the analysis, three themes were developed: lack of continuity; the complexity of coordination; and lack of confidence and underutilization of the monitoring system. The findings suggest that decisions made and actions advocated and taken are more dependent on individual actors than on sustainable structures. The findings also indicate that the context in which interventions are implemented is challenged in terms of weak coordination and monitoring systems that are not used to evaluate and develop interventions on maternal health.Conclusions: The implementation of interventions on maternal health is dependent on the capacity of the health system to implement evidence-based policies. The capacity of the health system in Gujarat to facilitate implementation of maternal health interventions needs to be improved, both in terms of the role of actors and in terms of structures and processes.
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| 32. |
- Willumsen, Elisabeth, et al.
(författare)
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A conceptual framework for assessing interorganizational integration and interprofessional collaboration
- 2012
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Ingår i: Journal of Interprofessional Care. - 1356-1820 .- 1469-9567. ; 26:3, s. 198-204
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Tidskriftsartikel (refereegranskat)abstract
- The need for collaboration in health and social welfare is well documented internationally. It is related to the improvement of services for the users, particularly target groups with multiple problems. However, there is still insufficient knowledge of the complex area of collaboration, and the interprofessional literature highlights the need to develop adequate research approaches for exploring collaboration between organizations, professionals and service users. This paper proposes a conceptual framework based on interorganizational and interprofessional research, with focus on the concepts of integration and collaboration. Furthermore, the paper suggests how two measurement instruments can be combined and adapted to the welfare context in order to explore collaboration between organizations, professionals and service users, thereby contributing to knowledge development and policy improvement. Issues concerning reliability, validity and design alternatives, as well as the importance of management, clinical implications and service user involvement in future research, are discussed.
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| 33. |
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| 34. |
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| 35. |
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| 36. |
- Åhgren, Bengt
(författare)
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Chain of care development in Sweden : results of a national study
- 2003
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Ingår i: International journal of integrated care. - 1568-4156. ; 3, s. e01-
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Tidskriftsartikel (refereegranskat)abstract
- Chains of Care are today an important counterbalance to the ever-increasing fragmentation of Swedish health care, and the ongoing development work has high priority. Improved quality of care is the most important reason for developing Chains of Care. Despite support in the form of goals and activity plans, seven out of ten county councils are uncertain whether they have been quite successful in the development work. Strong departmentalisation of responsibilities between different medical professions and departments, types of responsibilities and power still remaining in the vertical organisation structure, together with limited participation from the local authorities, are some of the most commonly mentioned reasons for the lack of success. Even though there is hesitation regarding the development work up to today, all county councils will continue developing Chains of Care. The main reason is, as was the case with Chain of Care development up to today, to improve quality of care. Although one of the main purposes is to make health care more patient-focused, patients in general seem to have limited impact on the development work. Therefore, the challenge is to design Chains of Care, which regards patients as partners instead of objects.
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| 37. |
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| 38. |
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| 39. |
- Åhgren, Bengt
(författare)
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Competition and integration in Swedish health care
- 2010
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 96:2, s. 91-97
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Tidskriftsartikel (refereegranskat)abstract
- Despite of an insignificant track record of quasi-market models in Sweden, new models of this kind have recently been introduced in health care; commonly referred to as "choice of care". This time citizens act as purchasers; choosing the primary care centre or family physician they want to be treated by, which, in turn, generates a capitation payment to the chosen unit. Policy makers believe that such systems will be self-remedial, that is, as a result of competition the strong providers survive while unprofitable ones will be eliminated. Because of negative consequences of the fragmented health care delivery, policy makers at the same time also promote different forms of integrated health care arrangements. One example is "local health care", which could be described as an upgraded community-oriented primary care, supported by adaptable hospital services, fitting the needs of a local population. This article reviews if it is possible to combine this kind of integrated care system with a competition driven model of governance, or if they are incompatible. The findings indicate that some choice of care schemes could hamper the development of integration in local health care. However, geographical monopolies like local health care, enclosed in a noncompetitive context, lack the stimulus of competition that possibly improves performance. Thus, it could be argued that if choice of care and local health care should be combined, patients ought to choose between integrated health care arrangements and not among individual health professionals. (C) 2010 Elsevier Ireland Ltd. All rights reserved.
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| 40. |
- Åhgren, Bengt, 1950-
(författare)
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Competition-exposed integration : an impossible composition?
- 2013
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Ingår i: What healthcare can we afford?. ; , s. 106-
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- ContextSwedish health care, like many other health care systems, is in a constant development mode to meet never-ending demands for improved efficiency and quality. Competitive and integrative policies are for example concurrently introduced in Swedish primary care; citizens‘ choice of primary care is launched while primary care is expected to integrate its activities with other providers for the creation of =local health care‘. Competition has though a tendency fragment the provision of services. The aim of this study is therefore to explore whether or not these two strategies are compatible in practice.MethodsGroup interviews were conducted at four locations in Sweden. The groups included persons aged between 20 and 45 years, 46 and 64 years and 65 years or over. The interviewees were living either in a big town or in a small community. Altogether, 21 randomly selected individuals participated in the group interviews. A deductive approach was chosen: six question topics were formulated with guidance from a theoretical framework about choice of care. The group interviews were thus semistructured without any predetermined codes. Each group interview took between 1 and 1.5 h to complete. Moreover, the conversations were recorded and transcribed as verbatim reports. As a consequence of the deductive approach, directed content analysis was chosen for the analysis of the group conversations.ResultsChoice of care is executed from the perspectives of being a prospective or current patient, which, in practice, imply choices are performed passive and active respectively. If the later group perceive interpersonal continuity, accessibility and demeanour of health professionals as favourable, they remain faithful to their actively chosen provider. The only condition that seems to trigger this group of patients to reconsider their choices is if they been the subject of bad manners. Those executing passive choices are less faithful to their original choice. When these former prospective patients, often younger persons, are in need of primary care they often disregard their choice if waiting times are shorter at other providers. This group generally prefer accessible service and seldom consider where it is provided. The group of passive choices also include citizens accepting suggestions presented by the authorities, founded on the conviction that ―they know what is best for me.DiscussionMany patients that have made active choices are thus faithful to their choices. This is rare in a consumer-market, which is characterized by high degree of exchangeability of providers; a condition which by and large corresponds with the attitude of those making passive choices. Nevertheless, a majority of patients stay with their choice of provider, often selected among a limited number of options. Moreover, health care providers and patients have long-term relationships, which is typical of a producer-market. In other words, if politicians strive for a competition-exposed primary care, the competition concept ought not to be founded on the theories of a consumer-market. The principles of a producer-market seem instead to be more applicable, which imply that providers will be competitive if they are able to build stable relations with their patients, which, in turn, facilitate for integrative arrangements among health care providers.
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| 41. |
- Åhgren, Bengt
(författare)
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Creating Integrated Care : Evaluation and Management of Local Care in Sweden
- 2007
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Ingår i: Journal of Integrated Care. - 1476-9018. ; 15:6, s. 14-21
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Tidskriftsartikel (refereegranskat)abstract
- It seems impossible to create a comprehensive evaluation model which fully takes into account the multi-dimensional context of integrated health and social care. Clinical integration, as a prerequisite for efficient outcomes of integration, must nonetheless get special attention. For more extensive evaluations, a quality chain matrix, including co-operating acts by different providers, has proven to be useful. Examples of evaluated services in Sweden are given, and the management benefits of the use of evaluation data are highlighted.
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| 42. |
- Åhgren, Bengt, 1950-
(författare)
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Creating integrated health care
- 2007
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Ingår i: International Journal of Integrated Care. - 1568-4156 .- 1568-4156. ; 7:Oct-Dec, s. e38-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 43. |
- Åhgren, Bengt, et al.
(författare)
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Determinants of integrated health care development : chains of care in Sweden
- 2007
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Ingår i: International Journal of Health Planning and Management. - 0749-6753 .- 1099-1751. ; 22:2, s. 145-157
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Tidskriftsartikel (refereegranskat)abstract
- Local health care in Sweden is an emerging form of integrated care, linked together by chains of care. Experiences show, however, that the development of chains of care is making slow progress. In order to study the factors behind this development, an embedded multiple-case study design was chosen. The study compared six health authorities in Sweden, three with successful and three with unsuccessful chain of care development. Three major determinants of integrated health care development were identified: professional dedication, legitimacy and confidence. In more detail, space for prime movers and trust between participants were crucial success factors, while top-down approaches targeting at the same time a change of management systems were negative for the development of chains of care. Resistance from the body of physicians was a serious obstacle to such a development. Local health care depends on developed chains of care, but it seems that health care managers do not have the management systems necessary to run these clinical networks, mainly due to a lack of acceptance from the medical profession. This is an impossible situation in the long run, since the number of chains of care is likely to increase as a result of the emerging local health care. Copyright (c) 2007 John Wiley & Sons, Ltd.
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| 44. |
- Åhgren, Bengt
(författare)
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Dissolving the Patient Bermuda Triangle
- 2010
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Ingår i: International Journal of Care Coordination. - 2053-4354. ; 14:4, s. 137-141
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Tidskriftsartikel (refereegranskat)abstract
- The differentiation of roles, tasks and responsibilities in health care has gradually increased because of efforts to decentralize, specialize and professionalize our health-care systems. These development approaches can on the one hand be regarded as successful, although there is also a negative flipside. Increased differentiation has concurrently fragmented the delivery of health care, which, in turn, can be divided into structural, clinical and cultural fragmentation. Patients are lost as a result of these conditions of fragmentation. This phenomenon can metaphorically be described as a ‘Patient Bermuda Triangle’. Actions to dissolve the Patient Bermuda Triangles are commonly termed ‘Integrated health care’, a global buzzword that includes integrated care pathway as well as other integrated health-care strategies. Moreover, integrated care is a means to an end: improved patient outcome. To achieve this, it is crucial to have necessary prerequisites in place: both functional and interactional conditions. This procedure seems to be an organic process where the stakeholders go through gradual changes until the optimum level of integration, as well as mutualistic interactions, is established. If these conditions are concealed or impossible to achieve, developmental work should be ended to avoid the evolvement of antagonistic relations between the stakeholders concerned. This state will likely establish a Patient Bermuda Triangle or reinforce an existing one.
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| 45. |
- Åhgren, Bengt, et al.
(författare)
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Evaluating integrated health care : a model for measurement
- 2005
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Ingår i: International journal of integrated care. - 1568-4156. ; 5:Jul-Sep, s. e01-
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: In the development of integrated care, there is an increasing need for knowledge about the actual degree of integration between different providers of health services. The purpose of this article is to describe the conceptualisation and validation of a practical model for measurement, which can be used by managers to implement and sustain integrated care.THEORY: The model is based on a continuum of integration, extending from full segregation through intermediate forms of linkage, coordination and cooperation to full integration.METHODS: The continuum was operationalised into a ratio scale of functional clinical integration. This scale was used in an explorative study of a local health authority in Sweden. Data on integration were collected in self-assessment forms together with estimated ranks of optimum integration between the different units of the health authority. The data were processed with statistical methods and the results were discussed with the managers concerned.RESULTS: Judging from this explorative study, it seems that the model of measurement collects reliable and valid data of functional clinical integration in local health care. The model was also regarded as a useful instrument for managers of integrated care.DISCUSSION: One of the main advantages with the model is that it includes optimum ranks of integration beside actual ranks. The optimum integration rank between two units is depending on the needs of both differentiation and integration.
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| 46. |
- Åhgren, Bengt, et al.
(författare)
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Evaluating intersectoral collaboration : a model for assessment by service users
- 2009
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Ingår i: International journal of integrated care. - 1568-4156. ; 9, s. e03-
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: DELTA was launched as a project in 1997 to improve intersectoral collaboration in the rehabilitation field. In 2005 DELTA was transformed into a local association for financial co-ordination between the institutions involved. Based on a study of the DELTA service users, the purpose of this article is to develop and to validate a model that can be used to assess the integration of welfare services from the perspective of the service users.THEORY: The foundation of integration is a well functioning structure of integration. Without such structural conditions, it is difficult to develop a process of integration that combines the resources and competences of the collaborating organisations to create services advantageous for the service users. In this way, both the structure and the process will contribute to the outcome of integration.METHOD: The study was carried out as a retrospective cross-sectional survey during two weeks, including all the current service users of DELTA. The questionnaire contained 32 questions, which were derived from the theoretical framework and research on service users, capturing perceptions of integration structure, process and outcome. Ordinal scales and open questions where used for the assessment.RESULTS: The survey had a response rate of 82% and no serious biases of the results were detected. The study shows that the users of the rehabilitation services perceived the services as well integrated, relevant and adapted to their needs. The assessment model was tested for reliability and validity and a few modifications were suggested. Some key measurement themes were derived from the study.CONCLUSION: The model developed in this study is an important step towards an assessment of service integration from the perspective of the service users. It needs to be further refined, however, before it can be used in other evaluations of collaboration in the provision of integrated welfare services.
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| 47. |
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| 48. |
- Åhgren, Bengt, 1950-
(författare)
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Health Care Delivery System : Sweden
- 2014
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Ingår i: The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society. - : Wiley-Blackwell. - 1444330764 - 9781444330762 ; , s. 866-872
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Bokkapitel (refereegranskat)abstract
- In Sweden it is a public sector duty to finance and facilitate the provision of health care. It is thus a “Beveridge” health care system. All residents have accordingly the right to obtain the publicly financed health care. The system is decentralized and includes 21 county councils and 290 municipalities. Furthermore, it rests on a democratic platform: each of these authorities is governed by a parliament, with its representatives elected for a four-year period at every general election.
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| 49. |
- Åhgren, Bengt, 1950-, et al.
(författare)
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Integrated Care : Pathfindings from Sweden
- 2013
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Ingår i: Integrated care for Ireland in an international context. - Cork, Ireland : Oak Tree Press. - 9781781190807 - 1781190801 - 9781781191040 - 1781191042 ; , s. 90-102
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 50. |
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