| 1. |
- Andersson, Ulf, 1985-
(författare)
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Clinical reasoning among emergency medical service clinicians : An iterative and fragmented process involving the collaborative effort(s) of many
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of the thesis was to generate knowledge and understanding of clinical reasoning in the context of EMS from the perspective of EMS clinicians.Method: Three different methodologies were employed to describe various aspects of clinical reasoning. In Study I, an integrative literature review was conducted to summarise the existing literature related to clinical reasoning in EMS. After conducting systematic searches and screening, 38 articles were identified and analysed through an inductive thematic analysis. Studies II and III were conducted as case studies within an EMS organisation to capture clinical reasoning as it takes place in the naturalistic environment. In total, 34 patient encounters were observed, and group and individual interviews were conducted with EMS clinicians and organisational representatives at various hierarchical levels within the EMS organization. The data were analysed through pattern matching and triangulation in a computerised software program for qualitative analysis. Study IV was conducted as a goal-directed task analysis which focused on what EMS clinicians need in terms of achieving situation awareness. An online survey was created and answered by 30 EMS subject matter experts, consisting of active EMS clinicians, academic teachers in specialist ambulance nursing programmes, and researchers in the field of EMS. The data were analysed using qualitative content analysis and descriptive statistics.Main results: Clinical reasoning in EMS is a continuously ongoing, iterative, and fragmented process. Information is gathered, analysed, and utilised at any given point during the mission. This information is then reasoned against various goals or instructions provided by the EMS organisation or what is perceived as the most suitable action by the EMS clinician. In the reasoning process, the clinicians take the patients’ and their relatives’ points of interest into account, striving to fulfil these. The clinical reasoning process continues after and between the missions well, and clinicians constantly evaluate their decisions and care provision for future improvement. Even if medical and caring interventions are the focus of clinical reasoning, this process involves the consideration of other aspects as well, such as logistics and safety for everyone present. Nevertheless, there seems to be a vague mandate for decision making among EMS clinicians in relation to other collaborative partners. Furthermore, organisational support for clinical reasoning and development is lacking, often due to economic limitations.Conclusion: This thesis contributes to the caring science field with an increased understanding of the complexity of clinical reasoning in EMS. EMS clinicians today need to rely on themselves or their partners to have sufficient knowledge or experience to handle the situation encountered and provide safe patient care. As the reasoning process involves more than the physical patient encounter, additional support is needed to inform clinicians in decisions related to logistics and safety. As the reasoning process involves more than the physical patient encounter, additional support is needed to inform clinicians in decisions related to logistics and safety. EMS clinicians today need to rely on themselves or their partner to have sufficient knowledge or experience to handle situations encountered and provide patient safe care.
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| 2. |
- Berlin, Johan, 1975, et al.
(författare)
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Backsourcing in the private and public sectors — A systematic review
- 2023
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Ingår i: Financial Accountability and Management. - 0267-4424 .- 1468-0408. ; 39:3
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Tidskriftsartikel (refereegranskat)abstract
- This article provides a systematic review of the literature on backsourcing. The aim is to synthesize existing literature in order to compare and analyze similarities and differences in backsourcing in the private and public sectors. The study asks questions about: which methods and theories have been used, why backsourcing has been implemented, and what reasons have been described for backsourcing. The study is based on an analysis of 500 articles about backsourcing and 33 articles in the final data set. The results show that backsourcing is primarily caused by: increased costs, lack of quality, and contract problems in the private sector, along with loss of control, cost saving, and changed strategy in the public sector. The study's synthesis highlights three explanations for how backsourcing is managed and interpreted in both the sectors. The article contributes specifically to summarizing current research on backsourcing, synthesizing how backsourcing has been studied, illustrating gaps in the research, as well as explaining relevant differences between private and public backsourcing.
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| 3. |
- Berlin, Johan, 1975, et al.
(författare)
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Exploring the psychometric properties of the externalizing spectrum inventory-brief form in a Swedish forensic psychiatric inpatient sample
- 2023
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The Externalizing Spectrum Inventory-Brief Form (ESI-BF) [1] is a 160-item self-report instrument designed for the assessment of externalizing psychopathology, yet few studies to date have evaluated its psychometric properties, structural fit, and criterion validity in forensic psychiatric settings. Methods Here, we investigated these aspects in a sample of forensic psychiatric inpatients (n = 77) from a maximumsecurity forensic psychiatric hospital in Sweden. We firstly investigated the reliability. Secondly, using confirmatory factor analysis, the structure of the ESI-BF. And thirdly, using a Bayesian approach, assessed how the three ESI-BF subfactors relate to criterion measures of antisocial behaviors, substance use, and lifetime externalizing spectrum diagnoses. Results The ESI-BF demonstrated good to adequate reliability and internal consistency, with all but four facet scales exhibiting a and. values = 0.80. Average inter-item correlations for the facet scales ranged from 0.31 to 0.74. However, all structural models exhibited poor to mediocre fit, with model fit values for the CFI being 0.66, 0.79 and 0.87 and RMSEA values of 0.14, 0.12 and 0.09. for the unidimensional correlated factors and bifactor model, respectively. Regarding criterion validity, all subscales of the item-based ESI-BF three-factor model exhibited robust correlations with the Life History of Aggression total, aggression and antisocial/consequences subscales, with correlations ranging from 0.29 to 0.55. All ESI-BF subfactors demonstrated robust associations, yet with different externalizing outcomes, lending tentative support to its criterion validity. Conclusion Despite remaining ambiguities regarding its structural fit, the ESI-BF may be promising for assessing externalizing psychopathology in forensic psychiatric populations. However, further investigation of the ESI-BF is needed before any firm conclusions can be drawn about its appropriateness in forensic psychiatric settings.
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| 4. |
- Berlin, Johan, 1975, et al.
(författare)
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How do street-level bureaucrats manage high workloads? Collegial mechanisms at the organisational level—experiences from public healthcare organisations
- 2022
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Ingår i: European Management Review. - : Wiley. - 1740-4754 .- 1740-4762. ; 19:2, s. 299-312
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to understand and explain how street-level bureaucrats manage high workloads in public healthcare organisations. Data was collected through observations, interviews and documents. The results show that high workloads are reduced through use of collegial mechanisms at the organisation level. The study shows that workloads are reduced in a two-step process, the first is a negotiation between professionals and the second in the meeting with patients. The two-step process explains the limitation problems in more detail and makes an important contribution by explaining how high workloads are reduced in public health services.
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| 5. |
- Berlin, Johan, 1975, et al.
(författare)
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Involuntary backsourcing in the public sector ‐ From conflict to collaboration
- 2022
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Ingår i: Public Administration. - : Wiley. - 0033-3298 .- 1467-9299. ; 100:3, s. 674-691
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to contribute to the literature on how involuntary backsourcing in public organisations is performed in practice and how it affects the relationship between principal and agent. The study focuses on two questions; 1) Which stages characterise the process when public contracts are involuntary terminated? 2) How does involuntary backsourcing affect the relationship between principal and agent during the transfer period? The study's case concerns public backsourcing in Sweden, in particular, how a metropolitan municipality manages involuntary backsourcing. This study provides in‐depth insights into backsourcing and its practice, as well the degree to which the conflict dimension between the parties is affected. The study shows ‐ paradoxically ‐ that the relationship between principal and agent during the transition phase is characterised by dependence, mutual exchange of information, collaboration and less conflict. The study contributes to developing the theory of backsourcing, particularly the behaviour that is played out between principal and agent in the transition stage. The findings identify the need for public organisations which make outsourcing decisions to have contingency plans for bringing operations back in‐house.
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| 6. |
- Berlin, Johan, et al.
(författare)
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Self-report versus clinician-ratings in the assessment of aggression in violent offenders
- 2021
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Ingår i: Criminal Behaviour and Mental Health. - : Wiley. - 0957-9664 .- 1471-2857. ; 31:3, s. 198-210
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Tidskriftsartikel (refereegranskat)abstract
- Background The construct of aggression is central to work with violent offenders, but it is a broad construct that can be assessed by many different methods and instruments. Its measurement may, however, have profound implications for treatment planning. We need more knowledge about how different methods for assessing aggression relate to each other. Aims Our aims were to investigate, first, the convergence and concordance of two methods of assessing aggression: self-report and clinical assessment and, second, to determine the degree to which aggression can be discriminated from neighbouring constructs, such as hostility, anger and criminal behaviour. Methods A nationally representative Swedish cohort of 269 18-25-year-old incarcerated violent offenders was recruited. Data were collected through structured self-reports of aggression, anger and hostility traits (Aggression Questionnaire-Revised Swedish Version) and clinical assessments of lifetime prevalence of aggressive and antisocial behaviours (Life History of Aggression). Criminal records were retrieved from the Swedish National Crime Register. Results Self-ratings and clinician-ratings of aggression were highly convergent and concordant, especially regarding physical aggression. Violent offence records were weakly, if at all, correlated, while self-reported hostility was weakly, or not at all, correlated with self-reported or with clinician-rated aggression. There was an inverse relationship between aggression and criminal records of sexual offences. Conclusions and Implications Even though a combination of self-reports and clinician-ratings may provide a better overview of an individual's aggressive behaviours, our results indicate that they yield such similar information that either alone would be sensitive enough. Our results do not, however, support using one of these methods as a proxy for the other since choice of measure and accepted concordance between them depend on the context within which the assessment is conducted. We reconfirmed that official records of violent offending are unlikely to be adequate measures of outcome after interventions to reduce aggressive behaviours.
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| 7. |
- Berlin, Johan, 1975-, et al.
(författare)
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Styrning av hälso- och sjukvård
- 2021. - Andra upplagan
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Hälso- och sjukvården står i dag inför en rad ekonomiska, demografiska och medicinska utmaningar. Hur den ska styras och organiseras blir därför en angelägen fråga. Den här boken, som nu kommer i sin andra upplaga, beskriver några av de styrmodeller som har tillämpats inom vården under de senaste decennierna. Hit hör exempelvis beställarstyrning, kundvalsmodellen, balanserad styrning, teamarbete, prestationsfinansering och processorientering. Författarna lyfter fram fördelar och nackdelar med de olika modellerna och visar vad de tenderar att leda till på kort respektive lång sikt.
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| 8. |
- Berlin, Johan, 1975-
(författare)
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Överbelastning i människobehandlande organisationer : en jämförelse mellan socialtjänst, sjukvård och polis
- 2023. - 2.
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Ingår i: Människobehandlande organisationer. - : Natur och kultur. - 9789127462205 ; , s. 234-252
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Bokkapitel (refereegranskat)abstract
- Bokinfo: Människobehandlande organisationer är en antologi som ger en bred överblick över välfärdens kärnverksamheter, vården, skolan och omsorgen, och beskriver vad som utmärker och skiljer dessa verksamheter från privata företag och organisationer när det gäller uppdrag, organisation, ledarskap och förändringsarbete.I den första utgåvan från 2015 var utgångspunkten de förändringar som globaliseringen, teknikutvecklingen och marknadiseringen i form av New Public Management (NPM) medfört för de människobehandlande organisationerna. I denna andra utgåva har författarna, förutom att uppdatera och förnya innehållet utifrån aktuell forskning, även tagit hänsyn till andra betydande händelser i omvärlden, som flyktingkrisen i mitten av 2010-talet och coronapandemin. Dessutom har de följt upp det ökande intresset för granskning och kontroll och den växande kritiken mot NPM. Är alternativet en mer tillitsbaserad ledning och styrning inom välfärdssektorn?Sex nya kapitel har tillkommit. De tar upp kunskapsbildning och forskning om människobehandlande organisationer, migration och flyktingmottagande, hur man hanterar hög belastning inom grässrotsbyråkratier, standardisering och horisontell kunskapsstyrning, chefers roll och vardag inom socialtjänsten samt tillsyn inom social barnavård.Människobehandlande organisationer vänder sig till studerande på socionom-, läkar-, vård- och lärarutbildningar liksom studerande inom ekonomi, statsvetenskap, psykologi, sociologi och offentlig förvaltning. Den är även avsedd för praktiskt verksamma i människobehandlande organisationer.Bokens redaktörer Staffan Johansson, Peter Dellgran och Staffan Höjer är professorer i socialt arbete vid Göteborgs universitet. Övriga författare är forskare inom socialt arbete eller angränsande områden vid ett flertal svenska universitet.
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