| 1. |
- Marcusson, Jan, et al.
(författare)
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Proactive healthcare for frail elderly persons : study protocol for a prospective controlled primary care intervention in Sweden
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.
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| 2. |
- Kahm, Therese, 1973-
(författare)
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Creating a Force of Development in Swedish Healthcare : A Contribution from the First-Line Managers’ Perspective When Driving Improvement Work Based on Lean
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is about the healthcare managers, working at operational levels, defined as the first-line managers. These managers often are given the role and responsibility to integrate improvements into daily work. A stronger development ability of Swedish healthcare requires first-line managers with a developed ability to lead change. Thereby efforts must be made to provide these managers with supportive work conditions when leading and developing organizations. One approach to organizational development is Lean, which refers to a strong improvement culture based upon a supportive and highly engaged leadership as well as a strong customer focus. The purpose of this thesis is to contribute to knowledge about and an understanding of the conditions that influence first-line healthcare managers’ abilities to drive improvement work based on Lean. Some of the conditions investigated are; time, receiving support from the own manager, feeling joy in improvement work and being assured about the effects of Lean.The thesis is based on three separate analyses of a web-based survey, which relate to the two research questions. The study was conducted in a Swedish healthcare organization two years after the initiation of Lean. The analyses are presented in three separate papers. The first research question considers; How can an instrument be developed that investigates first-line managers’ views on their role, conditions and ability to drive improvement work based on Lean? The second question is; What can be learned from using the instrument that investigates first-line managers’ views on their role, conditions and ability to drive improvement work based on Lean? A qualitative study based on a hermeneutic, inductive, qualitative research approach was conducted in order to meet the research purpose and answer the research questions.The thesis is mainly based on three papers. In paper 1 it is stated that the assuredness about the effects of Lean was quite high among the managers when the survey was conducted, such as that Lean contributes to a greater patient focus and to the development of an improvement culture. In paper 2 it is noted that the first-line managers view their role as crucial in improvement work based on Lean. Time, support from coworkers, and a clear vision and clear goals were the three conditions they considered to be most important for their ability. The results presented in paper 3 show that to initiate improvement work based on Lean, they ask for own managers who are assured about Lean and include them in discussions. They view their role and responsibility in relation to their coworkers as extensive, for instance increating a culture where problems and mistakes are viewed as possibilities to improve and for encouraging that new work procedures are tested. The findings indicate a need for a deeper understanding of Lean. It is concluded that a thorough understanding of Lean is a main condition for the first-line managers´ ability to drive improvement work based on the approach. Developing a common view of Lean takes time, which is important to emphasize in the practical setting to motivate for a long-term perspective. This development takes highly motivated, assured and persistent leaders with a continuous improvement attitude and a mission to improve healthcare together.There is also an applied research question; How can the use of the instrument contribute to developing first-line managers’ role, conditions, and ability to drive improvement work based on Lean? In its essence, Lean is concerned with improving a system and since the instrument raises questions about relationships between organizational members, it sets focus on the system and calls on a system view. The responsibility for one management level must continuously be set I relation to another, when putting the pieces together in the “improvement puzzle”. Change depends on adjustments in human behavior and the instrument establishes a focus on the people in the processes necessary for development and results. The instrument also provides opportunity and structure to investigate and talk about the soft conditions important for the ability, such as receiving support from the own manager, and feeling inspiration and being assured. The practice of Lean requires changes in attitudes, new habits, new skills in the whole system, meaning in each individual from the executive management to the front-line workers. Thereby self-reflection becomes important, which requires forums for dialogue. It is concluded that such forums can influence first-line healthcare managers’ abilities to drive improvement work based on Lean. In dialogue forums improvement work can be reflected upon and learned from together.
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| 3. |
- Poksinska, Bonnie, Biträdande professor, 1973-, et al.
(författare)
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The pros and cons of cancer care pathways from the health care professionals’ perspective
- 2019
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Ingår i: Operations adding value to society.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this paper is to outline pros and cons of cancer care pathway (CCP)components perceived by health care professionals involved in the diagnostic process.The results are based on a comprehensive national survey. The biggest pros follow from the component of care pathway description, which make cancer diagnostics more processoriented and standardised and thereby contribute to more timely, safe and patient-centred for the CCP patients. The component of standardised criteria for referral are associated with most cons. The biggest cons are the perceived “crowding out” effects, which imply impaired access and longer waiting times for non-CCP patients.
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| 4. |
- Rotter, Thomas, et al.
(författare)
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What Is Lean Management in Health Care? : Development of an Operational Definition for a Cochrane Systematic Review
- 2019
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Ingår i: Evaluation & the Health Professions. - : Sage Publications. - 0163-2787 .- 1552-3918. ; 42:3, s. 366-390
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Tidskriftsartikel (refereegranskat)abstract
- Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization?s mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.
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| 5. |
- Smeds, Magdalena, et al.
(författare)
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The effects of cancer care pathways on waiting times
- 2019
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Ingår i: International Journal of Quality and Service Sciences. - : Emerald Group Publishing Limited. - 1756-669X .- 1756-6703. ; 11:2, s. 204-216
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe Swedish health-care system currently implements cancer care pathways (CCPs) for better and more timely cancer diagnostics. The purpose of this paper is to elucidate and define “crowding out” effects associated with the CCP implementation.Design/methodology/approachA document study based on implementation reports and action plans from Swedish county councils (n = 21) and a case study in one county council were conducted. Qualitative data collection and analysis were used to acquire more knowledge about the “crowding out” effects associated with the CCP implementation.FindingsThree effects discussed under “crowding out” were defined. The first effect, called the push-out effect, occurs when other patients have to wait for care longer in favour of CCP patients. Another effect is the inclusion effect, whereby “crowding out” is reduced for vulnerable patients due to the standardised procedures and criteria in the referral process. The final effect is the exclusion effect, where patients in need of cancer diagnostics are, for some reason, not referred to CCP. These patients are either not diagnosed at all or diagnosed outside CCP by a non-standard process, with the risk of longer waiting times.Originality/value“Crowding out” effects are an urgent topic related to CCP implementation. While these effects have been reported in international research studies, no shared definition has been established to describe them. The present paper creates a common base to measure the “crowding out” effects and support further development of CCPs to avoid the negative effects on waiting times.
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| 6. |
- Wiger, Malin, 1980-, et al.
(författare)
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Key strategies to integrated care for older people in Sweden
- 2019
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Konferensbidrag (refereegranskat)abstract
- Care for older people must often be provided across health and community settings. The fragmentation of care processes and lack of continuity are common problems. Better and more efficient care models need to be developed to meet the needs of the growing population of older people. Based on case studies in the Swedish health care system this paper focuses on identifying strategies for achieving integrated care for older people. Five key strategies are described: integration of care processes, development of targeted care services, establishing home-based care services, coordination of care services, and use of technology to streamline care.
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