| 1. |
- Bartha, Erzsebet, et al.
(författare)
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Combining functional dependency and ASA III classification for risk stratification-predictors, risk factors, and outcomes following major surgery study (NCT02626546)
- 2017
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Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 61:8, s. 1011-1011
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: In elderly reclassification of ASA3 class by functional dependency improved prediction of postoperative mortality. We hypothesized that such a reclassification could improve the risk prediction of adverse outcomes also following high risk surgery.Method: We analyzed data collected by the PROFS study in four Swedish academic hospitals. The inclusion criteria were: adults, ASA≥3, major or xmajor/complex surgery (UK surgical severity coding). ASA 3 patients were reclassified into ASA 3a (functionally independent) and 3b (functionally dependent). The adverse outcomes were postoperative complications (yes/no) screened by Postoperative Morbidity Survey (days 3, 7, 10) and mortality (30-day). Complications graded ≥2 by Clavien-Dindo classification were considered. The predictive value of reclassification was analyzed by logistic regression models.Results: Between 2015 Nov2th and 2016 Feb19th 1089 patients were include; 13 were excluded (violation of inclusion criteria), 3 were lost to follow-up and 1073 were analyzed. ASA 3b (vs ASA 3a) patients had higher risk for mortality and for postoperative complications at days 7 and 10. ASA 4 (vs ASA 3) patients had higher risk of all adverse outcomes (Table 1). When age was added in the regression model ASA 3b patients still had higher risk for postoperative complications at day 10, but the significance disappeared when also urgency was added.Conclusion: The loss of significance by adding urgency in the model might be attributed to the dominance of urgent procedures in ASA3b and ASA4 groups. Reclassification of ASA 3 patients by dependency is recommended, as it may predict adverse outcomes and support clinical judgment.
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| 2. |
- Eriksson, Henrik, 1973, et al.
(författare)
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Exploring Quality Challenges and the Validity of Excellence Models
- 2016
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Ingår i: International Journal of Operations & Production Management. - 0144-3577 .- 1758-6593. ; 36:10, s. 1201-1221
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose is to identify and explore important quality-related challenges facing organizations, and how current excellence models incorporate these challenges.Methodology: The article is based on a Delphi study in Swedish organizations, 49 challenges were generated and ranked according to importance. The top 10 ranked challenges were compared to the principles of four excellence models.Findings: The excellence models seem to still be relevant since their content matches many of the challenges identified. The MBNQA and the SIQ models were found to have the most comprehensive coverage, while the ISO model had limited coverage.Research Limitations/Implications: Three areas for further research were identified: 1) how QM can evolve in different contexts with varying needs in terms of adaptive and explorative capabilities, 2) the interfaces of QM and sustainability, and ways to understand how customers and stakeholders can be active contributors to improvements and 3) the roles of the owners and board of directors in QM, and how to organize and distribute responsibilities of the QM work.Practical and Social Implications: Three important challenges could be addressed in upcoming revisions of excellence models: 1) making QM a strategic issue for company owners; 2) involving customers in the improvement activities; and 3) developing processes that are robust, while still easily adaptable.Originality/Value: The Delphi study has identified upcoming challenges in the QM area based on input from 188 quality professionals.
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| 3. |
- Eriksson, Maria, 1976-
(författare)
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Customer value in commercial experiences : Expecting the unexpected
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- To an ever greater extent, customers desire experiences that are highly emotional, personally designed and memorable. Today’s customer has an increasing need to be entertained and often searches for pleasurable offerings of hedonic value. Many academics also argue that commercial experiences deliver a higher customer value than goods and services. More research regarding the character of the commercial experience is needed to understand the needs of the customer and what creates value to the customer. However the existing tools and methods for measuring customer value and customer satisfaction seldom contain the elements pointed out as important to customers in a commercial experience. Is it enough to focus on values, methods and tools developed within for instance Total Quality Management (TQM) or is there a need for further development to include the offering of a commercial experience? The overall purpose of this thesis has been to explore the field of commercial experiences and establish new knowledge on how customer value is created when delivering commercial experiences. Within the overall purpose the research also intended to contribute to the area of quality development. In order to fulfill the overall purpose three research questions were asked and three case studies and one validation study were conducted. In the first case study, focus was on exploring the commercial experience sector and searching for best practices as regards how to create value to the customer. One organization was studied and empirical data was collected by site visit, direct observation, participant observation, open seminars, follow-up interview questions and documentation. In the second case study the aim was on how organizations were working to create customer value in commercial experiences. Empirical data was collected at eight organizations where top managers were interviewed. In the third study the aim was to develop a method or tool to measure customer value in a commercial experience. A validation study and a case study were conducted. In the validation study a questionnaire was developed as a measuring tool for commercial experiences and later tested on customers in the third and last case study. The findings in the three case studies presented in this thesis contribute to expanding earlier research concerning commercial experiences and how customer value is created when delivering them. From the findings of research the commercial experience is defined as “a memorable event that the customer is willing to pay for” and identified as a unique business offering providing hedonic customer value. Further the findings describe the commercial experience by three vital factors: strong engagement, highly emotional and being memorable. To additionally describe the characterizing elements of the commercial experience, the research identified these factors as important to customers: having fun, novelty, surprise, learning, a challenge, co-creation, the unexpected, storytelling, being in control, the venue for the experience (or the room of the experience), personal contact with staff and emotions creating strong engagement. Using the theory of attractive quality by Kano is suggested as one way to recognize elements of high customer value and to identify and deliver the unexpected, novelty and surprise the customers. Further findings of the research revealed that existing tools and methods developed for measuring customer value and satisfaction do not sufficiently consider or measure the effect of customer emotions or the characterizing elements of the commercial experience. As a consequence, a questionnaire was developed and tested to identify and measure elements of value to customers in a commercial experience. From the results, a new instrument for measuring variables of value in a commercial experience is proposed. One of the conclusions is that a specific tool for measuring customer value in commercial experiences is both required and needed. It was also concluded that there is a shortage of well-known and applied methods for measuring customer value in commercial experiences and that further research of this area is needed. The research presented in this thesis also proves that successful organizations delivering commercial experiences have a strong organizational culture built on core values. The conclusion was that working according to the core values of TQM is also a successful approach for these organizations, even though this does not seem to be enough. The characterizing element “co-creating” the experience between the customer and the provider was identified as a vital factor of business success. Giving the customer the power to affect the outcome within certain limitations and an opportunity to enhance the customer value meant that the experience becomes more personal and delivers a higher customer value than other offerings. Further identified ways of working to enhance customer value in the offering were: to recruit and select co-workers not only on competence and skills but also based on the core values; to stimulate creative thinking among co-workers and to further enhance the offering with storytelling and theming. These ways of working were categorized as specific and more unique or necessary in the experience industry and can therefore be vital in the competition between different organizations to deliver superior customer value.
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| 4. |
- Jiang, X., et al.
(författare)
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Shared heritability and functional enrichment across six solid cancers
- 2019
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Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Quantifying the genetic correlation between cancers can provide important insights into the mechanisms driving cancer etiology. Using genome-wide association study summary statistics across six cancer types based on a total of 296,215 cases and 301,319 controls of European ancestry, here we estimate the pair-wise genetic correlations between breast, colorectal, head/neck, lung, ovary and prostate cancer, and between cancers and 38 other diseases. We observed statistically significant genetic correlations between lung and head/neck cancer (r(g) = 0.57, p = 4.6 x 10(-8)), breast and ovarian cancer (r(g) = 0.24, p = 7 x 10(-5)), breast and lung cancer (r(g) = 0.18, p = 1.5 x 10(-6)) and breast and colorectal cancer (r(g) = 0.15, p = 1.1 x 10(-4)). We also found that multiple cancers are genetically correlated with non-cancer traits including smoking, psychiatric diseases and metabolic characteristics. Functional enrichment analysis revealed a significant excess contribution of conserved and regulatory regions to cancer heritability. Our comprehensive analysis of cross-cancer heritability suggests that solid tumors arising across tissues share in part a common germline genetic basis.
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| 5. |
- Johansson, Kristina, et al.
(författare)
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D-Dimer is associated with first-ever intracerebral hemorrhage : a nested case-control study
- 2018
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Ingår i: Stroke. - : Lippincott Williams & Wilkins. - 0039-2499 .- 1524-4628. ; 49:9, s. 2034-2039
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose - Hypertension is the most important risk factor for intracerebral hemorrhage (ICH), but further characterization is needed for groups at high risk of ICH. One way to predict the risk of developing a disease is with plasma biomarkers. This study aimed to investigate the association between the biomarker, D-dimer, and ICH risk.Methods - This population-based, nested case-control study was conducted using data from 2 population-based surveys; the Vasterbotten Intervention Programme and MONICA Northern Sweden (Monitoring Trends and Determinants in Cardiovascular Disease). All participants underwent a health examination and blood sampling at baseline before the event. Cases (n=141) were diagnosed with a first-ever ICH between 1985 and March 2007. One or 2 controls (n=255) were matched to each case.Results - The median age was 60 years; 39% of participants were women; and the median time from blood sampling to ICH was 5.2 years. When D-dimer was evaluated as a continuous variable, it was significantly associated with ICH. After multivariable adjustment (for hypertension, body mass index, cholesterol levels, diabetes mellitus, and smoking), the odds ratio was 1.36 per SD of D-dimcr (95% CI, 1.05-1.77). When participants were stratified in 3 groups according to time from blood sampling at health examination to ICH, we found that the association between D-dimer levels and ICH was most pronounced in individuals with the shortest time from blood sampling to ICH event (<3.5 years; odds ratio, 1.78; 95% CI, 1.05-3.05).Conclusions - High plasma concentrations of D-dimer were associated with increased risk of a future ICH, after adjusting for cardiovascular risk factors. This association was predominantly driven by the cases with the shortest time from blood sampling to ICH event.
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| 6. |
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| 7. |
- 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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| 8. |
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| 9. |
- Palm, Klas, 1964-, et al.
(författare)
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Agencies, it’s Time to Innovate! : Exploring the current understanding of the Swedish government’s call for innovation
- 2015
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Ingår i: International Journal of Quality and Service Sciences. - Bingley : Emerald Group Publishing Limited. - 1756-669X .- 1756-6703. ; 7:1, s. 34-49
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Tidskriftsartikel (refereegranskat)abstract
- PurposeInnovation is currently at the top of many agendas worldwide: not only in the private sector, but also when it comes to increasing quality, efficiency, and effectiveness in public administration. InSweden, this is reflected in the recent call from the Government for innovation in public management. However, innovation has not traditionally occurred to any significant extent on the strategic level of Swedish public management. Furthermore, governmental administration is a complex system in need of coordination and alignment for this new call to be effectively realized in practice. The purpose of this paper is hence to explore the phenomenon of innovation in the current Swedish governmental administration system. More specifically, the paper explores the current understanding within the system of what innovation is, as well as why and how it should be achieved. Methodology/approach This study has been based on a qualitative approach with a case consisting of three embedded units: the Government itself, a ministry and a government agency. The data have been collected from documents and interviews. Findings The study shows that there is currently a notable disparity when it comes to how aspects of innovation are understood at different levels within the Swedish governmental administration system. Furthermore, the recent business development to increase the standardization of work processes is perceived as having created poorer preconditions for working with innovations. Practical implicationsThe results highlight critical areas of disparity and possibilities for improvement towards a shared understanding and aligned innovation actions within the system. Originality/valueThe articlecontributes knowledgeabout the current understanding of innovation in the Swedish governmental administration system.
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| 10. |
- Palm, Klas, 1964-
(författare)
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Balancing Control and Breakthrough in Public Management
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Previous research shows that a good balance between focus on development of existing processes with development of new and innovative products, processes or services has a positive effect on organizational excellence. However, the relationship between these two quality perspectives is not easy to maintain and it is a challenge for every organization to find an appropriate balance between them. Previous research shows also that there is often a striking overemphasis on continuous improvement and stepwise refinement at the expense of working with innovations. Consequently, it has become necessary to find forms for development of the balance between improvement of existing processes and innovations. It is a question of how to manage both exploitation (improvement of existing processes) and exploration (innovations). Being able to manage both exploitation and exploration and maintain a good balance is known as organizational ambidexterity.The purpose of this thesis is to develop existing knowledge of how organisational ambidexterity and innovation can be understood and developed as an approach to increasing customer value in the context of the public sector. In order to meet the purpose, the research behind this thesis was conducted through six studies. The results have been presented in six scientific articles. The analytical focus in the research has been on management of public organization. Thus, the unit of analysis has been public sector management both at national, regional and municipal level. The studies have been conducted with a qualitative approach and data collection has primarily been done through semi- structured interviews. Most of the data has been collected in Sweden.Through the studies, it appears that the current quality practice in the Swedish public sector to a large extent relates to and supports exploitation, but not exploration. The empirical findings give examples of organizations that have a large focus on systematic measurement and control of the work process. An inhibition of increased customer value is indicated in the studied organizations’ current emphasis on exploitation at the expense of exploration. The research also shows that there are a number of impediments for the public organizations studied to combine their current quality practice with an improved ability to explore. It appears that there is a need for development of the leeway for exploration in order to increase the ability to be ambidextrous.The research behind this thesis empirically identifies a number of enablers the public organization may need to work actively with in order to develop organizational ambidexterity. Some of these enabling factors harmonize with quality movement core values. This applies to core values like committed leadership, focus on customers and a holistic system perspective. In addition, the following factors are perceived to be enabling factors for organizational ambidexterity: specific budgets for both exploration and exploitation; development of a culture in which employees feel that they are allowed to make mistakes; a good dialogue both internally and with external stake holders; focusing on the implementation of innovations and clear incentives for work on exploration as well as for work on exploitation. Finally, the empirical data also shows that an enabling factor is to get different professions involved in explorative processes. This can be achieved by working through ambassadors who can promote the explorative processes.The enablers, which have been empirically identified in this research as important for organizational ambidexterity, have also previously been identified by scholars as enablers for innovations. The research behind this thesis contributes to the empirical sorting out which - out of a wide range of factors - may be the most important factors for organizational ambidexterity.
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