| 1. |
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| 2. |
- Andersson, Réka
(författare)
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Gränsdragningar i Vårdens Vardag : Hanteringen av arbetsrelaterad psykisk ohälsa i det svenska välfärdssystemet
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Psykisk ohälsa i arbetslivet är ett stort och växande problem i välfärdssamhället. Problemet har flera bottnar och väcker många frågor om vem som har ansvar, vad det egentligen är för ett slags fenomen och hur det bör hanteras. Den här studien undersöker hur arbetsrelaterad psykisk ohälsa hanteras av yrkesverksamma inom vården, med fokus på företagshälsovård och primärvård. Intresse riktas mot hur yrkesverksamma personerna resonerar kring arbetsrelaterad psykisk ohälsa, vilka dilemman de ställs inför och de strategier de har för att hantera dessa. Den söker också svar på ansvarsfrågan kring detta komplexa problem, inte minst i ljuset av privatiseringen av företagshälsovården.I studien används ett tvärvetenskapligt perspektiv, där begrepp från teknik- och vetenskapsstudier (STS), professionssociologi och organisationsteori kombineras för att analysera olika aspekter av vårdens hantering av arbetsrelaterad psykisk ohälsa. Det empiriska materialet bygger i huvudsak på intervjuer med läkare, psykoterapeuter, kuratorer, arbetsterapeuter, psykologer, rehabiliteringskoordinatorer och beteendevetare, men inkluderar även observationer inom primärvård och företagshälsovård. Hanteringen av arbetsrelaterad psykisk ohälsa i vårdens vardag präglas av att orsaksbilden till problemet är komplext, ansvarsfördelningen otydlig och att psykosociala orsaker till sjukdom är kontroversiellt. I studien diskuteras utmaningarna och möjligheterna kring hanteringen av detta komplexa problem i bred bemärkelse. I analyserna uppmärksammas de yrkesverksammas gränsdragningar kring både ansvar och fenomenet arbetsrelaterad psykisk ohälsa. Begreppet kunskapsinfrastruktur används för att förklara och förstå den kunskapsmässiga och materiella struktur som de yrkesverksamma verkar inom. Analyserna visar att de yrkesverksamma har ett pragmatiskt förhållningssätt och använder olika strategier för att skapa sig handlingsutrymme i hur de hanterar arbetsrelaterad psykisk ohälsa.
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| 3. |
- Anskär, Eva, 1957-
(författare)
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Time flies in primary care : a study on time utilisation and perceived psychosocial work environment
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Time utilisation among primary care professionals has been affected by structural changes and reorganisation performed in Swedish primary care over several decades. The work situation is complex with a heavy administrative work load. The overall aim with this thesis was to describe time utilisation among staff in Swedish primary care and to investigate associations with perceived psychosocial work environment and legitimacy of work tasks.Methods: A multicentre, descriptive, cross-sectional study design was used including all staff categories in primary care i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals (physiotherapists, occupational therapists, psychologists, counsellors, dieticians and chiropodists) at eleven primary care centres located in southeast Sweden. The data collection consisted of a questionnaire including a subjective estimate of workload, the Bern Illegitimate Tasks Scale (BITS) and the Copenhagen Psychosocial Questionnaire (COPSOQ). Also, a time study was performed, where the participants reported their work time based on three main categories; direct patient work tasks, indirect patient work tasks and other work tasks, each with a number of subcategories. The participants reported time spent on different work tasks, day by day during two separate weeks. Response rates were 75% for the questionnaire and 79% for the time study.Results: In paper I the time study revealed that health professionals at the primary care centres spent 37% of their work time with direct patient work tasks. All professions estimated a higher proportion of time spent directly with patients than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress and role conflicts. The proportion of administrative work tasks was associated with role conflicts, the more administration the more role conflicts. Findings in paper II were that more than a quarter of physicians scored above the cut-off value for BITS regarding unnecessary work tasks, which was significantly more than the proportion observed in all other professions in the survey. Across all staff groups, a perception of having to perform illegitimate work tasks was associated with experiencing negative psychosocial work environment and with high proportion of administrative-related work tasks.Conclusions: Swedish primary care staff spend a limited proportion of their work time directly with patients and primary care physicians perceive the psychosocial work environment in negative terms to a greater extent than all other staff members. Allocation of work tasks has an influence on the perceived psychosocial work environment. The perception of having a large number of illegitimate work tasks affects the psychosocial work environment negatively, which might influence the perception the staff have of their professional roles. Perception of high proportion of unreasonable work tasks is associated with a high proportion of non-patient-related administration.This thesis illuminates the importance of decision makers thoroughly considering the distribution and allocation of non-patient related work tasks among staff in primary care, in order to achieve efficient use of personnel resources and favourable working conditions. Hopefully, the results of this study will contribute to further development of primary care so that medical competence will benefit patients as much as possible.
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| 4. |
- Blomqvist, Paula, 1968-, et al.
(författare)
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Why No Nonprofits? : State, Market, and the Strive for Universalism in Swedish Elder Care
- 2019
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Ingår i: Nonprofit and Voluntary Sector Quarterly. - : SAGE Publications. - 0899-7640 .- 1552-7395. ; 48:3, s. 513-531
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Tidskriftsartikel (refereegranskat)abstract
- Elder care is one of the sectors where nonprofit organizations are most active. One exception is the Scandinavian countries, where the nonprofit sector plays a marginal role in this area. In the article, we ask why this is the case. The findings show that in Sweden, nonprofit organizations have found it hard to compete with for-profits and that this inability to compete, in turn, reflects their relative organizational weakness. A main argument in the article is that this weakness must be understood in the context of the historical development of the modern elder care system in Sweden, where social democratic reformers in the 1940s chose to create a universal public system for providing services to the elderly, thereby making the nonprofit sector redundant. Universalism in this interpretation was seen as incompatible with service delivery by private organizations, a view that has come to change in recent years.
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| 5. |
- Brantnell, Anders, 1983-, et al.
(författare)
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Research funders’ roles and perceived responsibilities in relation to the implementation of clinical research results: a multiple case study of Swedish research funders
- 2015
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Ingår i: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundImplementation of clinical research results is challenging, yet the responsibility for implementation is seldom addressed. The process from research to the use of clinical research results in health care can be facilitated by research funders. In this paper, we report the roles of ten Swedish research funders in relation to implementation and their views on responsibilities in implementation.FindingsTen cases were studied and compared using semi-structured interviews. In addition, websites and key documents were reviewed. Eight facilitative roles for research funders in relation to the implementation of clinical research results were identified. Three of them were common for several funders: “Advocacy work,” “Monitoring implementation outcomes,” and “Dissemination of knowledge.” Moreover, the research funders identified six different actors responsible for implementation, five of which belonged to the healthcare setting. Collective and organizational responsibilities were the most common forms of responsibilities among the identified actors responsible for implementation.ConclusionsThe roles commonly identified by the Swedish funders, “Advocacy work,” “Monitoring implementation outcomes,” and “Dissemination of knowledge,” seem feasible facilitative roles in relation to the implementation of clinical research results. However, many actors identified as responsible for implementation together with the fact that collective and organizational responsibilities were the most common forms of responsibilities entail a risk of implementation becoming no one’s responsibility.
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| 6. |
- Edofsson, Ulrika, et al.
(författare)
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The Reliability and Validity of the Swedish Version of the Fatigue and Daytime Sleepiness Scale (FDSS)
- 2017
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Ingår i: Conference book for IDMC-11. San Fransisco, California, Usa: 5-9 September.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Fatigue and excessive daytime sleepiness are frequently experienced by patients with DM1 and these symptoms have a negative impact on daily activity, participation and quality of life. Although there are few successful treatment options, there exists a need to develop instruments with the aim to reliably measure symptoms and follow patients over time in clinical practice and research. The aim of this study was to translate and psychometrically evaluate the Fatigue and Daytime Sleepiness Scale (FDSS). Shortly, the FDSS has been devised with the aim to measure these symptoms as a single clinical entity, consisting of 12 self-assessment questions covering both fatigue and daytime sleepiness. The original version of FDSS has been found to be reliable and valid. The study was performed at the Neuromuscular Centre, Sahlgrenska University Hospital, Gothenburg, Sweden. Methods: The FDSS was translated into Swedish using the forward-and backward procedure. The scale was administered to 43 patients on two occasions at a two week interval. At baseline assessment, the patients also received the question of whether they experienced fatigue and/or sleepiness (yes or no). The group of patients consisted of 24 women and 19 men with an average age of 46.9 years (four with the childhood form, 32 classical and seven with a late onset). The statistical analysis included an evaluation of intra-rater reliability, internal consistency and construct validity. Results: The FDSS showed an excellent intra-rater reliability (PCC = .91) and acceptable internal consistency (Cronbach’s alpha = .71). The scale successfully distinguished patients experiencing fatigue and sleepiness from those who did not (mean FDSS score of 10.8 vs 7.1, p = .002). Discussion: The present study supports the use of the translated version of the FDSS for the measurement of fatigue and daytime sleepiness in patients with DM1. Grant Support: West Sweden Muscle Foundation.
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| 7. |
- Egholm, Cecilie Lindström, et al.
(författare)
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Facilitators for using data from a quality registry in local quality improvement work : a cross-sectional survey of the Danish Cardiac Rehabilitation Database
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:6
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To investigate use of data from a clinical quality registry for cardiac rehabilitation in Denmark, considering the extent to which data are used for local quality improvement and what facilitates the use of these data, with a particular focus on whether there are differences between frontline staff and managers. Design Cross-sectional nationwide survey study. Setting, methods and participants A previously validated, Swedish questionnaire regarding use of data from clinical quality registries was translated and emailed to frontline staff, mid-level managers and heads of departments (n=175) in all 30 hospital departments participating in the Danish Cardiac Rehabilitation Database. Data were analysed descriptively and through multiple linear regression. Results Survey response rate was 58% (101/175). Reports of registry use at department level (measured through an index comprising seven items; score min 0, max 7, where a low score indicates less use of data) varied significantly between groups of respondents: frontline staff mean score 1.3 (SD=2.0), mid-level management mean 2.4 (SD=2.3) and heads of departments mean 3.0 (SD=2.5), p=0.006. Overall, department level use of data was positively associated with higher perceived data quality and usefulness (regression coefficient=0.22, p=0.019), management request for data (regression coefficient=0.40, p=0.008) and personal motivation of the respondent (regression coefficient=1.63, p<0.001). Among managers, use of registry data was associated with data quality and usefulness (regression coefficient=0.43, p=0.027), and among frontline staff, reported data use was associated with management involvement in quality improvement work (regression coefficient=0.90, p=0.017) and personal motivation (regression coefficient=1.66, p<0.001). Conclusions The findings suggest relatively sparse use of data in local quality improvement work. A complex interplay of factors seem to be associated with data use with varying aspects being of importance for frontline staff and managers.
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| 8. |
- Eldh, Ann Catrine, 1965-, et al.
(författare)
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Factors facilitating a national quality registry to aid clinical quality improvement : findings of a national survey
- 2016
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 6:11
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement.Methods: Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression.Results: A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R2=0.76) with ‘Colleagues’ call for local results’ (p=<0.001), ‘Management Request of Registry data’ (p=<0.001), and it was said to be ‘Simple to explain the results to colleagues’ (p=0.02). Using stepwise regression, ‘Colleagues’ call for local results’ was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results.Conclusions: While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.
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| 9. |
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| 10. |
- Ernesäter, Annica, et al.
(författare)
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Telephone nurses' communication and response to callers' concern : a mixed methods study
- 2016
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Ingår i: Applied Nursing Research. - : Elsevier BV. - 0897-1897 .- 1532-8201. ; 29, s. 116-121
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Tidskriftsartikel (refereegranskat)abstract
- AimsTo describe telephone nurses’ and callers’ communication, investigate relationships within the dyad and explore telephone nurses’ direct response to callers’ expressions of concernBackgroundTelephone nurses assessing callers’ need of care is a rapidly growing service. Callers with expectations regarding level of care are challenging.MethodRIAS-and content analysis was performed on a criterion sampling of calls (n=25) made by callers who received a recommendation from telephone nurses of a lower level of care than expected.ResultsTelephone nurses mainly ask close-ended questions, whilst open-ended questions are sparsely used. Relationships between callers’ expressions of Concern and telephone nurses responding with Disapprovalwere found. Telephone nurses mainly responded to concern with close-ended medical questions whilst exploration of callers’ reason for concern was sparse.ConclusionTelephone nurses’ reluctance to use open-ended questions and to follow up on callers’ understanding might be a threat to concordance, and a potential threat to patient safety.
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| 11. |
- Fredriksson, Mio, 1976-, et al.
(författare)
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Are data from national quality registries used in quality improvement at Swedish hospital clinics?
- 2017
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 29:7, s. 909-915
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the use of data from national quality registries (NQRs) in local quality improvement as well as purported key factors for effective clinical use in Sweden. Comparative descriptive: a web survey of all Swedish hospitals participating in three NQRs with different levels of development (certification level). Heads of the clinics and physician(s) at clinics participating in the Swedish Stroke Register (Riksstroke), the Swedish National Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Lung Cancer Registry (NLCR). Individual and unit level use of NQRs in local quality improvement, and perceptions on data quality, organizational conditions and user motivation. Riksstroke data were reported as most extensively used at individual and unit levels ((x) over bar 17.97 of 24 and (x) over bar 27.06 of 35). Data quality and usefulness was considered high for the two most developed NQRs ((x) over bar 19.86 for Riksstroke and (x) over bar 19.89 for GallRiks of 25). Organizational conditions were estimated at the same level for Riksstroke and GallRiks ((x) over bar 12.90 and (x) over bar 13.28 of 20) while the least developed registry, the NLCR, had lower estimates (x 10.32). In Riksstroke, the managers requested registry data more often ((x) over bar 15.17 of 20). While there were significant differences between registries in key factors such as management interest, use of NQR data in local quality improvement seems rather prevalent, at least for Riksstroke. The link between the registry's level of development and factors important for routinization of innovations such as NQRs needs investigation.
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| 12. |
- Fredriksson, Mio, 1976-, et al.
(författare)
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Cuts without conflict : The use of political strategy in local health system retrenchment in Sweden
- 2019
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 237
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Tidskriftsartikel (refereegranskat)abstract
- Disinvestment in health services is seen as challenging by decision-makers as the public usually reacts strongly to rationing and retrenchments. Drawing on the literature on welfare state retrenchment - the reduction of public expenditure by cutting costs or spending - this article explores the development and implementation of a comprehensive retrenchment programme in one local health system in Sweden (a so-called region). According to theory, retrenchments are both electorally risky and institutionally difficult. Nonetheless, they take place and in the local health system we investigate, without too extensive public protest and without decision-makers having to resign. The main question in this qualitative study is: why and how was it possible to make such comprehensive retrenchments despite being unpopular and facing many political and institutional barriers? Interviews with 18 local politicians and public servants were carried out between January 18 and April 3, 2017, and analysed from the perspective of political strategy. They showed that the serious budget deficit, and a shared understanding of what the region's problems were, are important explanations for why the retrenchment programme was possible to develop and implement. Based on a thorough internal review of the health system, a crisis discourse developed which partly depoliticized the retrenchment programme. Justification and framing are keys to how it was possible. The retrenchment programme was justified by arguing that current service provision exceeded that in comparable regions, and framed as necessary saving the local health system and enhancing quality. Important strategies were thus to redefine the retrenchments and to blame-share, the latter through politicians and public servants claiming responsibility together after involving the clinic managers. In sum, our study shows that the retrenchment literature and theories on political strategy may be fruitfully applied to the health-care sector as well. By studying the local level, our findings contribute to the retrenchment literature, indicating that political strategy at the local level is more about justification and blame sharing, than blame avoidance.
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| 13. |
- Gadbois, Emily A, et al.
(författare)
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Lost in Transition: a Qualitative Study of Patients Discharged from Hospital to Skilled Nursing Facility
- 2019
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Ingår i: Journal of general internal medicine. - : Springer Science and Business Media LLC. - 0884-8734 .- 1525-1497. ; 34:1, s. 102-109
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThis research aimed to understand the experiences of patients transitioning from hospitals to skilled nursing facilities (SNFs) by eliciting views from patients and hospital and skilled nursing facility staff.DesignWe conducted semi-structured interviews with hospital and skilled nursing facility staff and skilled nursing facility patients and their family members in an attempt to understand transitions between hospital and SNF. These interviews focused on all aspects of the discharge planning and nursing facility placement processes including who is involved, how decisions are made, patients' experiences, hospital-SNF communication, and the presence of programs to improve the transition process.ParticipantsParticipants were 138 staff in 16 hospitals and 25 SNFs in 8 markets across the country, and 98 newly admitted, previously community-dwelling SNF patients and/or their family members in five of those markets.ApproachInterviews were qualitatively analyzed to identify overarching themes.Key ResultsPatients reported they felt rushed in making their SNF decisions, did not feel they were appropriately prepared for the hospital-SNF transition or educated about their post-acute needs, and experienced transitions that felt chaotic, with complications they associated with timing and medications. Hospital and SNF staff expressed similar opinions, stating that transitions were rushed, there were problems with the timing of the discharge, with information transfer and medication reconciliation, and that patients were not appropriately prepared for the transition. Staff at some facilities reported programs designed to address these problems, but the efficacy of these programs is unknown.ConclusionsResults indicate problematic transitions stemming from insufficient care coordination and failure to appropriately prepare patients and their family members. Previous research suggests that problematic or hurried transitions from hospital to SNF are associated with medication errors and unnecessary rehospitalizations. Interventions to improve transitions from hospital to SNF that include a focus on patients and families are needed.
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| 14. |
- Gadbois, Emily A., et al.
(författare)
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Medicare Advantage Control of Postacute Costs : Perspectives From Stakeholders
- 2018
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Ingår i: American Journal of Managed Care. - 1088-0224 .- 1936-2692. ; 24:12, s. E386-E392
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Medicare Advantage (MA) plans have strong incentives to control costs, including postacute spending; however, to our knowledge, no research has examined the methods that MA plans use to control or reduce postacute costs. This study aimed to understand such MA plan efforts and the possible unintended consequences. STUDY DESIGN: A multiple case study method was used. METHODS: We conducted 154 interviews with administrative and clinical staff working in 10 MA plans, 16 hospitals, and 25 skilled nursing facilities (SNFs) in 8 geographically diverse markets across the United States. RESULTS: Participants discussed how MA plans attempted to reduce postacute care spending by controlling the SNF to which patients are discharged and SNF length of stay (LOS). Plans typically influenced SNF selection by providing patients with a list of facilities in which their care would be covered. To influence LOS, MA plans most commonly authorized patient stays in SNFs for a certain number of days and required that SNFs adhere to this limitation, but they did not provide guidance or assistance in ensuring that the LOS goals were met. Hospital and SNF responses to the largely authorization-based system were frequently negative, and participants expressed concerns about potential unintended consequences. CONCLUSIONS: In their interactions with hospitals and SNFs, MA plans attempted to influence the choice of SNF and LOS to control postacute spending. However, exerting too much influence over hospitals and SNFs, as these results seem to indicate, may have the negative consequences of delayed hospital discharge and SNFs' avoidance of burdensome plans.
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| 15. |
- Gofen, Anat, et al.
(författare)
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Negotiated compliance at the street level : Personalizing immunization in England, Israel and Sweden
- 2019
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Ingår i: Public Administration. - : Wiley. - 0033-3298 .- 1467-9299. ; 97:1, s. 195-209
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Tidskriftsartikel (refereegranskat)abstract
- Often portrayed as behaviour that is inconsistent with policy goals, public noncompliance poses a significant challenge for government. To explore what compliance efforts entail on the ground, this study focuses on childhood immunization as a paradigmatic case where a failure to ensure compliance poses a public health risk. The analysis draws on 48 semi‐structured interviews with frontline nurses and regional/national public health officials in England (N = 15), Sweden (N = 17) and Israel (N = 16), all of which have experienced periodic noncompliance spikes, but differ in direct delivery of vaccination provision. Compliance efforts emerged as a joint decision‐making process in which improvisatory practices of personalized appeals are deployed to accommodate parents’ concerns, termed here ‘street‐level negotiation’. Whereas compliance is suggestive of compelling citizens’ adherence to standardized rules, compliance negotiation draws attention to the limited resources street‐level workers have when encountering noncompliance and to policy‐clients’ influence on delivery arrangements when holding discretionary power over whether or not to comply.
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| 16. |
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| 17. |
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| 18. |
- Isaksson, David, et al.
(författare)
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Free establishment of primary health care providers : effects on geographical equity
- 2016
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundA reform in 2010 in Swedish primary care made it possible for private primary care providers to establish themselves freely in the country. In the former, publicly planned system, location was strictly regulated by local authorities. The goal of the new reform was to increase access and quality of health care. Critical arguments were raised that the reform could have detrimental effects on equity if the new primary health care providers chose to establish foremost in socioeconomically prosperous areas.The aim of this study is to examine how the primary care choice reform has affected geographical equity by analysing patterns of establishment on the part of new private providers.MethodsThe basis of the design was to analyse socio-economic data on individuals who reside in the same electoral areas in which the 1411 primary health care centres in Sweden are established. Since the primary health care centres are located within 21 different county councils with different reimbursement schemes, we controlled for possible cluster effects utilizing generalized estimating equations modelling. The empirical material used in the analysis is a cross-sectional data set containing socio-economic data of the geographical areas in which all primary health care centres are established.ResultsWhen controlling for the effects of the county council regulation, primary health care centres established after the primary care choice reform were found to be located in areas with significantly fewer older adults living alone as well as fewer single parents – groups which generally have lower socio-economic status and high health care needs. However, no significant effects were observed for other socio-economic variables such as mean income, percentage of immigrants, education, unemployment, and children <5 years.ConclusionsThe primary care choice reform seems to have had some negative effects on geographical equity, even though these seem relatively minor.
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| 19. |
- Isaksson, David, 1982-, et al.
(författare)
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Privatization of social care delivery : how can contracts be specified?
- 2018
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Ingår i: Public Management Review. - : Informa UK Limited. - 1471-9037 .- 1471-9045. ; 20:11, s. 1643-1662
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Tidskriftsartikel (refereegranskat)abstract
- When contracting out services to private actors, public authorities must be able to ensure that the quality of services provided is satisfactory. Therefore, it is important to formulate precise quality requirements, thus making them possible to monitor. In the study, 1,005 quality requirements from public procurements of nursing homes were categorized, and their degree of monitorability assessed. The analysis showed that quality requirements related to soft' areas such as social activities typically were non-monitorable. The requirements were written in an imprecise, vague manner, thus making it difficult for the local governments to determine whether or not they were met.
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| 20. |
- Isaksson, David, 1982-, et al.
(författare)
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Risk selection in primary care : a cross-sectional fixed effect analysis of Swedish individual data
- 2018
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 8:10
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Tidskriftsartikel (refereegranskat)abstract
- Objective To assess socioeconomic differences between patients registered with private and public primary healthcare centres.Design Population-based cross-sectional study controlling for municipality and household.Setting Swedish population-based socioeconomic data collected from Statistics Sweden linked with individual registration data from all 21 Swedish regions.Participants All individuals residing in Sweden on 31 December 2015 (n=9 851 017) were included in the study.Primary outcome measures Registration with private versus public primary healthcare centres.Results After controlling for municipality and household, individuals with higher socioeconomic status were more likely to be registered with a private primary healthcare provider. Individuals in the highest income quantile were 4.9 percentage points (13.7%) more likely to be registered with a private primary healthcare provider compared with individuals in the lowest income quantile. Individuals with 1–3 years of higher education were 4.7 percentage points more likely to be registered with a private primary healthcare provider compared with those with an incomplete primary education.Conclusions The results show that there are notable differences in registration patterns, indicating a skewed distribution of patients and health risks between private and public primary healthcare providers. This suggests that risk selection behaviour occurs in the reformed Swedish primary healthcare system, foremost through location patterns.
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| 21. |
- Isaksson, David, 1982-
(författare)
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Steering health and social care through quasi-markets
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Municipalities and county councils try a multitude of different strategies when they design and steer health and social care markets to ensure that goals such as quality and equity are met. Depending on the strategies used, different problems arise. The aim of this thesis is to examine how local authorities can design quasi-markets in a way that achieves public goals such as equity and high quality. To answer the aim, four empirical studies were carried out.The studies show that when designing a market by contracting-out through public procurement, the issues lay primarily at specifying and defining what is meant by quality before a service is privatized. This is especially difficult to do concerning soft areas such as elder- and healthcare. If this is not done properly, it can lead to crucial issues for monitoring quality since the contracting authority cannot hold the provider responsible for delivering an aspect of a service if that aspect is not specified in the contract.When a market is designed as in the patient choice systems in primary care, it creates a whole other set of difficulties for the local governments. Here, it is not as important to specify quality beforehand in the contracts since quality monitoring is done retrospectively by both the counties themselves as well as the patients who with their choices can monitor quality by punishing providers with poor quality by registering with another provider. Instead, the crucial problem is how to design reimbursement system that will lead to an equal access to health care. In this respect, the county councils utilize different methods. However, despite these measures, the primary care choice reform have led to inequity, both geographical inequity in regards to where new private primary health care centres are located but also, to a larger degree, socio-economic inequity relating to what kind of socio-economic groups of individuals are registered with private PHCCs. In other words, county councils do not manage to fully counteract risk selection behaviour by the design of their reimbursement system which could imply issues with unequal access to health care.
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| 22. |
- Kullberg, Linn, et al.
(författare)
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Health insurance for the healthy? : Voluntary health insurance in Sweden
- 2019
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Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 123:8, s. 737-746
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Tidskriftsartikel (refereegranskat)abstract
- Background: In Sweden, voluntary health insurance is held only by a very small part of the population, but uptake has grown rapidly since 2000. So far, little is known about who purchases this insurance and what the insurance plans contain.Aim: To provide a comprehensive description of the coverage and content of voluntary health insurance in Sweden.Methods: Data from a national survey (Riks-SOM 2016) were used to estimate insurance coverage in different population groups. Additionally, a qualitative content analysis of the voluntary health insurance plans from seven of the largest insurance companies in Sweden was conducted.Results: Voluntary health insurance was found to be more common among high income-earners, individuals employed in the private sector, business owners, and white-collar workers. Insurance benefits varied from visiting a general practitioner to more specialised treatments like knee or hip surgery. Pre-existing medical conditions, emergency medicine, highly specialised care and ongoing chronic care was excluded from the insurance plans.Conclusion: Work-related factors such as employment sector, occupation and income appeared to be key determinants for VHI uptake in Sweden. Since the insurance plans included several restrictions, individuals with high care needs are excluded. Taken together, the results indicate that voluntary health insurance in Sweden provide benefits foremost for the healthy and wealthy.
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| 23. |
- Kullberg, Linn, et al.
(författare)
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Market-orienting reforms in rural health care in Sweden : how can equity in access be preserved?
- 2018
-
Ingår i: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 17
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Health care provision in rural and urban areas faces different challenges. In Sweden, health care provision has been predominantly public and equitable access to care has been pursued mainly through public planning and coordination. This is to ensure that health needs are met in the same manner in all parts of the country, including rural or less affluent areas. However, a marketization of the health care system has taken place during recent decades and the publicly planned system has been partially replaced by a new market logic, where private providers guided by financial concerns can decide independently where to establish their practices. In this paper, we explore the effects of marketization policies on rural health care provision by asking how policy makers in rural counties have managed to combine two seemingly contradictory health policy goals: to create conditions for market competition among health care providers and to ensure equal access to health care for all patients, including those living in rural and remote areas. Methods: A qualitative case study within three counties in the northern part of Sweden, characterized by vast rural areas, was carried out. Legal documents, the "accreditation documents" regulating the health care quasi-markets in the three counties were analyzed. In addition, interviews with policy makers in the three county councils, representing the political majority, the opposition, and the political administration were conducted in April and May 2013. Results: The findings demonstrate the difficulties involved in introducing market dynamics in health care provision in rural areas, as these reforms not only undermined existing resource allocation systems based on health needs but also undercut attempts by local policy makers to arrange for care provision in remote locations through planning and coordination. Conclusion: Provision of health care in rural areas is not well suited for market reforms introducing competition, as this may undermine the goal of equity in access to health care, even in a publicly financed health care system.
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| 24. |
- Lehto, Juhani, et al.
(författare)
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The reactions to macro-economic crisis in Nordic health system policies : Denmark, Finland and Sweden, 1980-2013
- 2015
-
Ingår i: Health Economics, Policy and Law. - 1744-1331 .- 1744-134X. ; 10:1, s. 61-81
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Tidskriftsartikel (refereegranskat)abstract
- Denmark, Finland and Sweden have experienced two major recessions during the last 25 years. The adjustments to the earlier crisis in the late 1980s (Denmark) and early 1990s (Finland and Sweden) resembled the policies in many other European countries during the present crisis. The analysis of relationship of deep economic crises and growth period between them to the health system policies and institutions in the three countries from the 1980s to 2013 is based on a categorisation of reactions to external shocks as path conforming or path breaking. The results of the empirical long-term trends show that the reactions to deep recessions have been mainly temporary adjustments and acceleration of changes already prepared before economic crisis. The economic crisis in the three countries has not been ‘good enough’ to enable paradigmatic changes in the Nordic public, decentralised and equity-oriented health systems. Changes such as the slow privatisation in care funding and production and the adoption of new management practices indicate an ongoing paradigmatic change related to longer-term societal, ideological and political developments rather than directly to economic crises or growth.
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| 25. |
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| 26. |
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| 27. |
- Moberg, Linda
(författare)
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Marketization in Swedish Eldercare : Implications for Users, Professionals, and the State
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During the last decades, Swedish policy makers have implemented various marketization reforms into the public welfare sector in order to make it more cost-efficient and to improve its quality. The aim of this dissertation is to investigate what implications this marketization trend has had for the organization of Swedish eldercare. In particular, the research question addressed is how marketization reforms such as privatized provision, increased competition, and user choice have transformed the relationship between the service users, the professionals, and the state. To answer the research question, four articles are presented in the dissertation, each corresponding to a separate empirical investigation. Together, the articles demonstrate that the increased reliance on marketization in Swedish eldercare has made it more difficult for the local authorities to directly control the quality of the services, since it reduces their ability to allocate public resources and expects them to govern the provision of eldercare through the entering of contracts. This development has also implied that service users themselves become increasingly responsible for ensuring that the quality of their care is high. Moreover, the articles show that the increased reliance on audit by the national government and its agencies has tended to undermine the professionalization of eldercare staff, thereby limiting their autonomy and ability to ensure service quality. As a whole, the dissertation contributes with a more comprehensive understanding of how marketization has altered the organization of Swedish eldercare and under what conditions it might undermine the goals of social equality and ensuring that all citizens have equal access to good quality care.
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| 28. |
- Moberg, Linda, et al.
(författare)
-
Professionalized through audit? : Care workers and the new audit regime in Sweden
- 2018
-
Ingår i: Social Policy & Administration. - : John Wiley & Sons. - 0144-5596 .- 1467-9515. ; 52:3, s. 631-645
-
Tidskriftsartikel (refereegranskat)abstract
- The professionalization of social care workers is a policy goal in many welfare states. At the same time, professionalization risks being undermined by enhanced audit. The objective of this article is to analyze whether the audit processes adopted in Swedish eldercare and childcare support or undermine the professionalization of the occupations working there, i.e., nurses, nursing assistants, preschool teachers, and preschool assistants. In particular, we investigate whether the three main forms of auditstandard-setting, inspections, and quality measurementssupport or undermine the occupations' ability to achieve professional closure and enhance their external and internal autonomy. The findings suggest that audit processes in eldercare risk undermining professionalization, while in childcare the pattern is reversed: audit appears supportive of professionalization, at least for preschool teachers. This finding suggests that audit processes do not have to be detrimental to professionalization.
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| 29. |
- Moberg, Linda, et al.
(författare)
-
User choice in Swedish eldercare : conditions for informed choice and enhanced service quality
- 2016
-
Ingår i: Journal of European Social Policy. - : SAGE Publications. - 0958-9287 .- 1461-7269. ; 26:3, s. 281-295
-
Tidskriftsartikel (refereegranskat)abstract
- Proponents of user choice argue that this type of policy arrangement improves the quality of public social services since users are expected to select the most highly performing providers. In order for users to make informed choices, however, they need quality information about the services offered by different providers. In this article, we carry out a case study, investigating whether information about service quality was presented to users of home-based elderly care in Sweden. The analysis is based on unique data regarding the information of 223 providers in 10 municipalities. The results suggest that the information was poor and lacking in important quality dimensions. This indicates a lack of real user power since it is virtually impossible for users to make informed choices without relevant information. It also makes it less likely that the general quality level of home-based services will increase as a result of the user choice.
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| 30. |
- Nordlöf, Hasse, et al.
(författare)
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Safety culture and reasons for risk-taking at a large steel-manufacturing company : Investigating the worker perspective
- 2015
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Ingår i: Safety Science. - : Elsevier BV. - 0925-7535 .- 1879-1042. ; 73, s. 126-135
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Tidskriftsartikel (refereegranskat)abstract
- Workers in the steel-manufacturing industry face many safety risks due to the nature of the job. How well safety procedures and regulations are followed within an organization is considered to be influenced by the reigning culture of the organization. The aim of this study was to investigate and describe safety culture and risk-taking at a large steel-manufacturing company in Sweden by exploring workers’ experiences and perceptions of safety and risks. Ten focus group interviews were conducted with a total of 66 workers. In the interviews, the situation of safety at work was discussed in a semi-structured manner. The material was analyzed inductively using qualitative content analysis. The analysis resulted in a thorough description of safety culture and risk-taking at the company, based on the following five main categories: 1. Acceptance of risks, one simply has to accept the safety risks of the work environment, 2. Individual responsibility for safety, the responsibility for safe procedures rests to the largest extent on the individual, 3. Trade-off between productivity and safety, these are conflicting entities, wanting to produce as well as wanting to work safely, 4. Importance of communication, it is needed for safety actions to be effective, and 5. State-of-the-day and external conditions, an interplay between these factors affect risk-taking. In sociotechnical systems theory it is acknowledged that there are interactions between social and technical factors in organizations. The findings of this study are interpreted to be in line with a sociotechnical understanding of safety culture and risk-taking.
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| 31. |
- Shield, Renée, et al.
(författare)
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Choosing the Best and Scrambling for the Rest: Hospital–Nursing Home Relationships and Admissions to Post-Acute Care
- 2019
-
Ingår i: Journal of Applied Gerontology. - : SAGE Publications. - 0733-4648 .- 1552-4523. ; 38:4, s. 479-498
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: We explored post-Affordable Care Act hospital and skilled nursing facility (SNF) perspectives in discharge and admission practices. Method: Interviews were conducted with 138 administrative personnel in 16 hospitals and 25 SNFs in eight U.S. markets and qualitatively analyzed. Results: Hospitals may use prior referral rates and patients' geographic proximity to SNFs to guide discharges. SNFs with higher hospital referral rates often use licensed nurses to screen patients to admit more preferred patients. While SNFs with lower hospital referral rates use marketing strategies to increase admissions, these patients are often less preferred due to lower reimbursement or complex care needs. Conclusion: An unintended consequence of increased hospital-SNF integration may be greater disparity. SNFs with high hospital referral rates may admit well-reimbursed or less medically complex patients than SNFs with lower referral rates. Without policy remediation, SNFs with lower referral rates may thus care for more medically complex long-term care patients.
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| 32. |
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| 33. |
- Spangler, Douglas, et al.
(författare)
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Small is beautiful? : Explaining resident satisfaction in Swedish nursing home care
- 2019
-
Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 19:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Resident satisfaction is an important aspect of nursing home quality. Despite this, few studies have systematically investigated what aspects of nursing home care are most strongly associated with satisfaction. In Sweden, a large number of processual and structural measures are collected to describe the quality of nursing home care, though the impact of these measures on outcomes including resident satisfaction is poorly understood.METHODS: A cross-sectional analysis of data collected in two nationally representative surveys of Swedish eldercare quality using multi-level models to account for geographic differences.RESULTS: Of the factors examined, nursing home size was found to be the most important predictor of resident satisfaction, followed by the amount of exercise and activities offered by the nursing home. Measures of individualized care processes, ownership status, staffing ratios, and staff education levels were also weakly associated with resident satisfaction. Contrary to previous research, we found no clear differences between processual and structural variables in terms of their association with resident satisfaction.CONCLUSIONS: The results suggest that of the investigated aspects of nursing home care, the size of the nursing home and the amount activities offered to residents were the strongest predictors of satisfaction. Investigation of the mechanisms behind the higher levels of satisfaction found at smaller nursing homes may be a fruitful avenue for further research.
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| 34. |
- Tyler, Denise A, et al.
(författare)
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Challenges and Consequences of Reduced Skilled Nursing Facility Lengths of Stay
- 2018
-
Ingår i: Health Services Research. - : Wiley. - 0017-9124 .- 1475-6773. ; 53:6, s. 4848-4862
-
Tidskriftsartikel (refereegranskat)abstract
- Length of stay (LOS) among postacute care patients in skilled nursing facilities (SNFs) has been steadily decreasing for the past several years. Empirical studies on overall SNF LOS are scant because most studies focus on LOS for certain conditions or procedures (e.g., Haghverdian, Wright, and Schwarzkopf 2017). However, analysis of LOS data available at Brown University's LTCFocus website (www.ltcfocus.org) illustrates that SNF LOS has been dropping in recent years. These reductions have been due, in part, to Medicare policy changes and market based pressures, including the emergence of accountable care organizations (ACOs) and bundled payment and shared savings programs, as well as the growth of Medicare Advantage. However, little is known about how shorter LOS is affecting SNFs or their postacute care patients.Implementation of the Affordable Care Act (ACA) included several programs to improve care quality, increase efficiency, and reduce costs through value‐based payment models. In these programs, participating providers, including doctors, hospitals, and other health care organizations, join together voluntarily to provide coordinated care to their Medicare patients. These groups are reimbursed for episodes of care, payments are capitated and risk‐adjusted, and participating organizations share savings they achieve from their Medicare population (Centers for Medicare and Medicaid Services 2017). Because over 20% of Medicare patients who are hospitalized each year are discharged to postacute care (PAC; Tian 2016), many of the patients covered by these programs are cared for in SNFs. However, research has shown that a minority of ACOs, for example, actually include SNFs as full participants (Colla et al. 2016). This means that ACOs are relying on SNFs to provide better care at lower costs without including those SNFs in the shared savings or through contractual or other formal relationships.In the last several years, there has also been extraordinary growth in the Medicare Advantage program, which now covers one‐third of all Medicare beneficiaries (Jacobson et al. 2017). Medicare Advantage is the managed care version of Medicare where private insurers are paid by Medicare on a per beneficiary per month basis for the care of all their enrolled beneficiaries. Unlike traditional Medicare where patients have choice among all available providers, Medicare Advantage managed care organizations (MCOs) are free to form networks of preferred providers. This affords MCOs some control over the care delivered by providers in their networks, including increased control over LOS.Decreases in LOS due to these market and policy pressures are likely having an effect on SNFs. Therefore, the purpose of this research was to identify the key challenges that reductions in LOS pose for SNFs, the unintended consequences of reduced LOS for SNFs and SNF patients, SNF responses to these, and suggestions for modifications to current policy.
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| 35. |
- Tyler, Denise A., et al.
(författare)
-
Patients Are Not Given Quality-Of-Care Data About Skilled Nursing Facilities When Discharged From Hospitals
- 2017
-
Ingår i: Health Affairs. - : Health Affairs (Project Hope). - 0278-2715 .- 1544-5208. ; 36:8, s. 1385-1391
-
Tidskriftsartikel (refereegranskat)abstract
- Hospitals are now being held at least partly accountable for Medicare patients' care after discharge, as a result of regulations and incentives imposed by the Affordable Care Act. However, little is known about how patients select a postacute care facility. We used a multiple case study approach to explore both how patients requiring postacute care decide which skilled nursing facility to select and the role of hospital staff members in this decision. We interviewed 138 staff members of sixteen hospitals and twenty-five skilled nursing facilities and 98 patients in fourteen of the skilled nursing facilities. Most patients described receiving only lists of skilled nursing facilities from hospital staff members, while staff members reported not sharing data about facilities' quality with patients because they believed that patient choice regulations precluded them from doing so. Consequently, patients' choices were rarely based on readily available quality data. Proposed changes to the Medicare conditions of participation for hospitals that pertain to discharge planning could rectify this problem. In addition, less strict interpretations of choice requirements would give hospitals flexibility in the discharge planning process and allow them to refer patients to higher-quality facilities.
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| 36. |
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| 37. |
- Törmä, Johanna, 1981-
(författare)
-
Implementation strategies for nutritional guidelines in nursing homes : Effects on care staff and residents
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: The number of older adults (≥ 65 years) is increasing in Sweden. At the same time, the elderly care system is being restructured with an increased care burden in nursing homes (NHs). Several studies report a high prevalence of malnutrition among older adults. In recent years public awareness about malnutrition has increased and collective initiatives have been undertaken. However, we lack knowledge regarding how to implement these initiatives to achieve real improvements in practice.Aims: The overall aims of the thesis are to update our knowledge of the nutritional situation in municipal elderly care and to evaluate different implementation strategies (external facilitation and educational outreach visits) for implementing nutritional guidelines in the NH setting.Methods: Residents and staff of altogether eight NH units participated in the studies. The two implementation strategies were external facilitation (EF) and educational outreach visits (EOV). The EF strategy was a one-year, multifaceted intervention that included support, guidance, practice audits and feedback in four NH units. The EOV strategy comprised one three-hour lecture about the nutritional guidelines in four other NH units. Both strategies were targeted to selected NH teams, which consisted of a unit manager, a nurse and 5-10 care staff.Results: In paper I, the prevalence of malnutrition in the NH setting remained high, i.e., 30% were malnourished and 63% at risk of malnutrition, and malnutrition was associated with deterioration in function and cognition and one-year mortality. However, possible improvements in nutritional status among NH residents over time (from 1996 to 2010) were observed. In paper II, the EF strategy improved mealtime ambience compared to the EOV strategy with respect to arranging the table, offering a choice of beverage and more to drink, serving the meal, increasing social interactions between staff and residents, decreasing social interactions among staff and reducing noise from the kitchen. In paper III, the EF strategy may have been related to a delay in cognitive deterioration in a sub-sample of communicative NH residents. In paper IV, the EF strategy improved, on average, the ability and willingness of the staff to implement the guidelines, i.e., the staff experienced a clearer assignment of responsibilities regarding nutritional procedures and that they had more time, tools and support from leadership. Moreover, the staff felt that they experienced less resistance from work colleagues, that their knowledge and experience were valued, that the guidelines worked in practice and that the implementation of guidelines was not labourious. Conclusions: Malnutrition is prevalent in Swedish nursing homes. Implementation of nutritional guidelines by an external facilitator, as compared to traditional methods, may be more effective on mealtime ambience, provide better preconditions for change among the staff, and may have positive effects on cognition among residents.
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| 38. |
- Törmä, Johanna, et al.
(författare)
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Strategies to implement community guidelines on nutrition and their long-term clinical effects in nursing home residents
- 2015
-
Ingår i: The Journal of Nutrition, Health & Aging. - : Springer Science and Business Media LLC. - 1279-7707 .- 1760-4788. ; 19:1, s. 70-76
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: Studies on implementation techniques that focus on nutrition in the setting of elderly care are scarce. The aims of this study were to compare two implementation strategies i.e., external facilitation ( EF) and educational outreach visits ( EOVs), in order to introduce nutritional guidelines ( e.g. screening, food quality and mealtime ambience), into a nursing home ( NH) setting and to evaluate the clinical outcomes. Design: A controlled study with baseline and follow-up measurements. Setting: Four NHs. Participants: A total of 101 NH residents. Intervention: The EF was a one-year, multifaceted intervention that included support, guidance, practice audits, and feedback that were provided to two NHs. The EOVs performed at the other NHs consisted of one session of three hours of lectures about the guidelines. Both interventions targeted a team of the unit manager, the head nurse, and 5-10 of the care staff. Measurements: The outcomes were nutritional status ( Mini Nutritional Assessment-Short Form, MNA-SF), body mass index ( BMI), functional ability ( Barthel Index, BI), cognitive function ( Short Portable Mental Status Questionnaire, SPMSQ, performed in a subgroup of communicative NH residents), health-related quality of life ( EQ-5D), and the levels of certain biochemical markers like for example vitamin D, albumin and insulin-like growth factor 1. Results: After a median of 18 months, nutritional parameters ( MNA-SF and BMI) remained unchanged in both groups. While there were no differences in most outcomes between the two groups, the cognitive ability of those in the EOV group deteriorated more than in individuals in the EF group ( p=0.008). Multiple linear regression analyses indicated that the intervention group assignment ( EF) was independently from other potentially related factors associated with less cognitive decline. Conclusion: An extended model of implementation of nutritional guidelines, including guidance and feedback to NH staff, did not affect nutritional status but may be associated with a delayed cognitive decline in communicative NH residents.
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| 39. |
- Törmä, Johanna, et al.
(författare)
-
The effects of nutritional guideline implementation on nursing home staff performance : a controlled trial
- 2018
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 32:2, s. 622-633
-
Tidskriftsartikel (refereegranskat)abstract
- Rationale: Suboptimal nutritional practices in elderly caresettings may be resolved by an efficient introduction ofnutritional guidelines.Aims: To compare two different implementation strate-gies, external facilitation (EF) and educational outreachvisits (EOVs), when introducing nutritional guidelines innursing homes (NHs), and study the impact on staffperformance.Methodological design: A quasi-experimental study withbaseline and follow-up measurements.Outcome measures: The primary outcome was staff perfor-mance as a function of mealtime ambience and food ser-vice routines.Interventions/research methods: The EF strategy was a 1-year,multifaceted intervention that included support, guidance,practice audit and feedback in two NH units. The EOVstrategy comprised one-three-hour lecture about nutri-tional guidelines in two other NH units. Both strategieswere targeted to selected NH teams, which consisted of aunit manager, a nurse and 5–10 care staff. Mealtime ambi-ence was evaluated by 47 observations using a structuredmealtime instrument. Food service routines were evalu-ated by 109 food records performed by the staff.Results: Mealtime ambience was more strongly improvedin the EF group than in the EOV group after the imple-mentation. Factors improved were laying a table(p = 0.03), offering a choice of beverage (p = 0.02), theserving of the meal (p = 0.02), interactions between staffand residents (p = 0.02) and less noise from the kitchen(p = 0.01). Food service routines remained unchanged inboth groups.Conclusions: An EF strategy that included guidance, auditand feedback improved mealtime ambience when nutri-tional guidelines were introduced in a nursing home set-ting, whereas food service routines were unchanged bythe EF strategy.
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| 40. |
- Vengberg, Sofie, et al.
(författare)
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Patient choice and provider competition : Quality enhancing drivers in primary care?
- 2019
-
Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 226, s. 217-224
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Tidskriftsartikel (refereegranskat)abstract
- Patient choice of provider and provider competition have been introduced with the claim that they would lead to improved quality. For this to occur, certain conditions must be fulfilled on both the demand and the supply side. However, supply side-mechanisms – with provider behaviour as central – have been largely neglected in the literature, especially in primary care markets. In this article, we focus on provider behaviour and explore if and how choice and competition function as quality enhancing drivers in Swedish primary care. We explore this through semi-structured interviews with 24 managers and physicians at 13 Swedish primary healthcare centres, conducted from May 2016 to February 2017. The analysis draws on assumptions that for enhanced quality, providers must receive information on patients' choices, analyse it and respond accordingly. One conclusion is that Swedish primary care providers lack information on patients' choices and "exits", which makes it difficult for providers to respond to patients' choices. Furthermore, it is questionable whether choice and competition stimulate enhanced clinical quality. At the same time, choice and competition seems to make providers more aware of accessibility concerns and of their reputation, which they may be stimulated to improve. The article contributes evidence on supply side-mechanisms, and encourages clarification of "quality" in this respect, both on the political arena as well as in theoretical models.
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| 41. |
- von Granitz, Heléne, 1969-, et al.
(författare)
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Do personal assistance activities promote participation for persons with disabilities in Sweden?
- 2017
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 39:24, s. 2512-2521
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACTPurpose: To examine how the right to participation according to Article 19 of the United Nations’ Convention on the Rights of Persons with Disabilities (UNCRPD) is promoted by personal assistance use in Sweden across age, gender and eligible person categories.Method: Register data and data from a questionnaire were used (N¼15,289). Principal component analysis was performed and the internal consistency was tested. Descriptive statistics (v2 test) were used across age, gender and eligible person categories and components.Results: An uneven distribution of personal assistance across the components Health and Care; Home, Leisure and Social Interaction; and Daily Occupation was found. Significant differences in personal assistance reported were found between children and adults, men and women and between the three eligible person categories.Conclusions: The discrepancy between reported and expected outcome of personal assistance indicates that Article 19 of the UNCRPD has not been met. The unequal access to participation across age, gender and eligible person categories would seem to further signify that the Act concerning Support and Service for Persons with Certain Functional Impairments is promoting activities of a caring nature rather than fulfilling Article 19 of the UNCRPD, i.e. ensuring full participation in society.
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| 42. |
- Winblad, Ulrika, 1968-, et al.
(författare)
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ACO-Affiliated Hospitals Reduced Rehospitalizations From Skilled Nursing Facilities Faster Than Other Hospitals
- 2017
-
Ingår i: Health Affairs. - : PROJECT HOPE. - 0278-2715 .- 1544-5208. ; 36:1, s. 67-73
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Tidskriftsartikel (refereegranskat)abstract
- Medicare's more than 420 accountable care organizations (ACOs) provide care for a considerable percentage of the elderly in the United States. One goal of ACOs is to improve care coordination and thereby decrease rates of rehospitalization. We examined whether ACO-affiliated hospitals were more effective than other hospitals in reducing rehospitalizations from skilled nursing facilities. We found a general reduction in rehospitalizations from 2007 to 2013, which suggests that all hospitals made efforts to reduce rehospitalizations. The ACO-affiliated hospitals, however, were able to reduce rehospitalizations more quickly than other hospitals. The reductions suggest that ACO-affiliated hospitals are either discharging to the nursing facilities more effectively compared to other hospitals or targeting at-risk patients better, or enhancing information sharing and communication between hospitals and skilled nursing facilities. Policy makers expect that reducing readmissions to hospitals will generate major savings and improve the quality of life for the frail elderly. However, further work is needed to investigate the precise mechanisms that underlie the reduction of readmissions among ACO-affiliated hospitals.
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| 43. |
- Winblad, Ulrika, 1967-, et al.
(författare)
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Do public nursing home care providers deliver higher quality than private providers? : Evidence from Sweden
- 2017
-
Ingår i: BMC Health Services Research. - : BIOMED CENTRAL LTD. - 1472-6963. ; 17
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies.Methods: The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures.Results: The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes.Conclusions: Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier findings. The fact that privately operated homes, including those operated by for-profit companies, had higher processual quality is more unexpected, given previous research. Finally, no significant quality differences were found between private ownership types, i.e. for-profit, non-profit, and private equity companies, which indicates that profit motives are less important for determining quality in Swedish nursing home care than in other countries where similar studies have been carried out.
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| 44. |
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| 45. |
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| 46. |
- Winblad, Ulrika, et al.
(författare)
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Privatisering av välfärdstjänster: hur garanteras kvalitet i vård och omsorg?
- 2015
-
Ingår i: Statsvetenskaplig Tidskrift. - 0039-0747. ; 117:4, s. 531-554
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Tidskriftsartikel (refereegranskat)abstract
- In recent decades, the Swedish welfare system has come to involve more privateactors. Swedish law, however, is still clear that health and social care should be characterizedby good quality regardless of its mode of operation. A central concern hasbeen how to politically ensure quality as welfare providers become more numerousand of different types. To what extent are politicians still able to monitor qualitywithin private health- and social care? The article reviews several quality assurancemechanisms that are built into the privatization reforms: how contracts are specifiedand monitored and how patients use their choices to send signals about carequality. A review of the literature illustrates the difficulty for politicians to formulategood contracts and follow them up. Also, patients’ choices are not a reliablesource of information about care quality since they rarely make informed choices.Not being able to monitor quality in a proper way risks creating a legitimacy gapfor the entire welfare system.
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| 47. |
- Winblad, Ulrika, 1968-, et al.
(författare)
-
Uppföljning och tillsyn av privata aktörer
- 2019
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Ingår i: Perspektiv på granskning inom offentlig sektor. - Stockholm : Gleerups Utbildning AB. - 9789151100654
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 48. |
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- Wisell, Kristin, 1980-, et al.
(författare)
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Diversity as salvation? : A comparison of the diversity rationale in the Swedish pharmacy ownership liberalization reform and the primary care choice reform
- 2019
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Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 123:5, s. 457-461
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Tidskriftsartikel (refereegranskat)abstract
- Widespread liberalizing reform of the Swedish community pharmacy and primary care sectors took place in 2009–2010, including opening the market to private providers. One important rationale for the reforms was to increase diversity in the health-care system by providing more choices for individuals. The aim of this study was to increase the understanding how policy makers understood and defined diversity as a concept, and as a rationale for the reforms. The method used was document analysis of preparatory work and plenary parliament debate protocols. The results show that policy makers held vague and unclear definitions of diversity, which complicated its implementation. Diversity was sometimes seen as an effect of competition–a goal–while in other cases it was seen as a condition to be met in order to achieve competition–a means. Thus, policy makers viewed diversity both as a goal and as a means, making the underlying mechanisms unclear. The findings also revealed that policy makers failed to consistently demonstrate how the introduction of competition would lead to diversity.
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