| 1. |
- Jansson von Vultée, Pia, et al.
(författare)
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The impact of organisational settings on physician wellbeing
- 2007
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Ingår i: International Journal of Health Care Quality Assurance. - : Emerald. - 0952-6862 .- 1758-6542. ; 20:6, s. 506-515
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of this research is to show that the Swedish health care system has undergone major changes during the last decades, which have exerted strong influence on the operational freedom of physicians. Design/methodology/approach – This study consisted of 169 physicians in management positions, who answered a questionnaire assessing the relationship between their organizational settings and their perceived wellbeing. The organizational setting was defined as contact with top management, decision-making influence, well defined organization and whether the physician is acting as a leader. The perceived wellbeing was defined as social climate, work related exhaustion, work satisfaction, influence, development ability and supportive leadership. Findings – According to the results, organizational support improves work satisfaction and mental energy, and decreases work related exhaustion among physicians. This all leads to decreasing turnover rate among physicians. Originality/value – These results point to the importance of maintaining a positive and supportive atmosphere for physicians in their work environment in order to encourage physicians to remain and take on management positions in the health care system. Furthermore enhancing physician influence over decision making processes is important to counteract work-related exhaustion and it might also contribute to a more efficient organization.
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| 2. |
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| 3. |
- Wilde-Larsson, Bodil, 1951-, et al.
(författare)
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International comparisons of patients' views on quality of care
- 2005
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Ingår i: International Journal of Health Care Quality Assurance. - : Emerald Group Publishing Limited. - 0952-6862 .- 1758-6542. ; 18:1, s. 62-73
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – To compare patients’ views on quality of care in different countries using a theory-based instrument, while at the same time controlling for the following potential confounders: type of care system (private vs public), type of care (kind of health problem), gender, age, and subjective wellbeing.Design/methodology/approach – Patients capable of communicating in wards (medical and surgical departments) and day surgery departments in England, France, Norway, and Sweden were recruited consecutively, to participate in a programme run by the health-care company Capio. Ward patients: England (n =1,236), France (n =1,051), Norway (n =226), and Sweden (n =428). Day surgery patients: England (n =887), France (n =544), Norway (n =101), and Sweden (n =742). Average response rate across settings: approximately 75 per cent. Patients evaluated the quality of the care they actually received and the subjective importance they ascribed to different aspects of care. The questionnaire “Quality from the patient's perspective” (QPP) was used (modified short version).Findings – Cross-national comparisons were made within each of the two care contexts (wards and day surgery) separately for men and women. Quality of care evaluations were adjusted for age and subjective wellbeing. English and French patients scored significantly higher than Norwegian and Swedish on both kinds of ratings (perceived reality and subjective importance), in both kinds of care contexts, and in both sexes.Originality/value – Cross-national comparisons of patients’ views on care can give meaningful guidance for practitioners only if they are context-specific and if well-known confounders are controlled for.
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| 4. |
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| 5. |
- Björkman, Ingeborg, et al.
(författare)
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Developing the role of the drug and therapeutics committees : Perceptions of chairs
- 2007
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Ingår i: International Journal of Health Care Quality Assurance. - : Emerald. - 0952-6862. ; 20:2, s. 161-178
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – According to Swedish law, every county is required to have a local drug and therapeutics committee (DTC) to contribute to safe and cost-effective drug use. The law presents merely a framework and gives no detailed instructions addressing, for example, organisation and methods. The aim of this study is to explore the variation of conceptions of the role of the DTCs among committee Chairs and to compare the results with an earlier study. Design/methodology/approach – Data were collected by questionnaires and telephone interviews with committee chairs, which were analysed using a phenomenographic approach. Findings – Four conceptions were identified, namely: traditional, patient-aware, influential, holistic and cooperative, which all involved prescribers. In one conception the DTC acted as an expert to decision-makers. One conception included the notion that cooperation across the bureaucratic borders was important. Patients were involved in two conceptions. Comparison with the earlier study showed a trend toward higher patient awareness and a higher agreement on DTC goals with an increased focus on quality issues. Originality/value – This study demonstrates an alternative research method bringing in new perspectives when exploring activities within healthcare. Patient involvement in the work of the DTCs is increasing, but should be further explored and developed.
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| 6. |
- Björkman, Ingeborg, et al.
(författare)
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The role of drug and therapeutics committees : Perceptions of chairs and information officers
- 2005
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Ingår i: International Journal of Health Care Quality Assurance. - : Emerald. - 0952-6862. ; 18:4, s. 235-48
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – Improved quality and safety in drug use is a public health goal of major importance. In Sweden, local drug and therapeutics committees (DTCs) have adopted the task of working for safe and rational drug use. This study aimed to explore how chairs conceived the role of the DTCs, to explore how information officers conceived their own role, and to determine whether the respondents included patients in their answers. Design/methodology/approach – Data were collected using questionnaires and the answers were analysed according to phenomenographic method to identify conceptions. “Patient awareness” was studied by content analysis. Findings – In both groups the prescribers were the focus of attention, and only a few respondents mentioned patients. A variation of four conceptions was found among chairs and three among information officers. It would be beneficial if DTCs used this knowledge in their development. Originality/value – The importance of “patient awareness” within DTCs must be further explored.
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| 7. |
- Harenstam, K.P., et al.
(författare)
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Patient safety as perceived by Swedish leaders
- 2009
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Ingår i: International Journal of Health Care Quality Assurance. - : Emerald. - 0952-6862. ; 22:2, s. 168-182
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this paper is to survey Swedish healthcare leaders patient safety awareness, the priority they give to safety issues and their views on suitable safety management strategies. Design/methodology/approach: A total 623 leaders of a sample of 1,129 responded to a mail questionnaire (55 percent response rate). Descriptive statistics of the responses are presented as frequency distributions across respondent subgroups. Means were tested for similarity by a repetitive one-way ANOVA procedure. Homogeneous response groups were sought by hierarchical cluster analysis. Findings: Swedish healthcare leaders show relatively high safety awareness and how their organizations prioritize safety management. There is a marked polarization between leaders; half feel that the system works reasonably well, and that adequate funds are available to improve or maintain services. The other half thinks the system needs major change and calls for additional funding. A majority sees system errors as the main cause for adverse events; a substantial minority find human errors to be more important. Two-thirds were willing to make safety performance information on organizations and specialties public, one third was restrictive. Research limitations/implications: Survey instruments used to explore leaders patient safety views have not yet been rigorously tested against psychometric criteria. One hospital type was slightly over-represented and three regions somewhat under-represented in the respondent groups. Originality/value: This is the first systematic attempt to explore the views of Swedish healthcare leaders on patient safety. It provides input to a national strategy to improve patient safety.
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| 8. |
- Jonsson, PM, et al.
(författare)
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Patient claims and complaints data for improving patient safety
- 2008
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Ingår i: International journal of health care quality assurance. - : Emerald. - 0952-6862. ; 21:1, s. 60-74
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is to describe patient complaints and claims data from Swedish databases and assess their value for scientific research and practical health care improvement.Design/methodology/approachThe article first describes previous research into patient claims and similar schemes. It then presents three types of data on patient claims and complaints in Sweden: data generated by the Patient Insurance Fund, the Medical Responsibility Board and the Patients' Advisory Committees and considers methodological issues in using the data.FindingsThe databases' value is problems related to spontaneous reporting, which makes it difficult to know how much the data correspond to general injury rates and health care patterns. Another issue is the balance between the size of study materials and the timeliness, e.g. when diagnosis‐specific analysis requires data pooling over several years in order to reach adequate case numbers. Adjustment for confounders not present in the databases, e.g. data on hospital case‐mix, may add to difficulties using the data in comparative analyses of safety performanceResearch limitations/implicationsThe databases' safety analysis and quality improvement value depends on understanding their function, data collection method and their limitations as a source of data about the true incidence and prevalence of injuries and safety problems.Originality/valueThis is the first thorough review of the possibilities and limitations associated with the use of claims and complaints data in health care research and improvement.
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| 9. |
- Lindberg, Eva, et al.
(författare)
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Implementing TQM in the health care service
- 2005
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Ingår i: International journal of health care quality assurance incorporating leadership in helath services. - : Emerald. - 1366-0756 .- 2051-3135. ; 18:5, s. 370-84
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The present study seeks to present a case study over four years following an implementation process of total quality management (TQM) on an ICU (intensive care unit). Design/methodology/approach – The aim was to describe consequences shown in the organisational climate, workload and staff wellbeing. A case study design was employed using a longitudinal method of data collection. Findings – Downsizing due to diminishing resources was a parallel process probably disturbing the TQM implementation. The workload increased by 20 per cent, whereas organisational and individual variables remained stable over time. However, sick leave increased dramatically and was higher than the general level within the Swedish population. The ICU had the capacity to adapt successfully by regulating working hours to workload. It is speculated that another cause behind sickness absence exists other than the general opinion. The literature used for the discussion departs from the relation between people's understanding and acting, sensemaking, and organisational theories describing complex adaptive systems emphasizing attraction patterns. Organisational ambiguity was a main finding in an earlier study that was used for interpretation of the result in the present study. As ambiguity seems to be a major and increasing problem, it has consequences for management as well as for continuous quality development. Originality/value – The implication of the study is the need to be able to successfully work in an ambiguous situation and use the quality system as a device in day-to-day work.
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| 10. |
- Ovretveit, J, et al.
(författare)
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Hospital quality management system in a low income Arabic country: an evaluation
- 2006
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Ingår i: International journal of health care quality assurance incorporating Leadership in health services. - : Emerald. - 1366-0756. ; 19:6-7, s. 516-32
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Tidskriftsartikel (refereegranskat)abstract
- The paper seeks to present findings from an evaluation of a quality management system implemented in a low‐income country hospital.Design/methodology/approachThis is a single‐case before and after evaluation.FindingsThe quality system, although only 70 per cent implemented, resulted in increasing compliance with a few selected standards and produced modest improvements in patient satisfaction and utilisation. Hospital doctors and managers wanted to continue to develop the system and described conditions they thought important to spread to other hospitals.Research limitations/implicationsNo objective, clinical outcomes data were gathered, and the short timescale meant that the system was not fully implemented at the time of the evaluation.Practical implicationsIt is possible to improve patient care in rural hospitals with a few extra resources, in a culture not familiar with management processes, and to engage otherwise poorly motivated doctors in systematic improvement. However, certain conditions are necessary for introducing, sustaining and spreading quality improvement programmes.Originality/valueThis study and report is one of the first, detailed and systematic evaluations of a hospital quality management system in a highly resourced constrained situation in an Arabic country, which has implications for improving health care in other developing countries.
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