| 1. |
- Björkman, Annica, et al.
(författare)
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Malpractice claimed calls within the Swedish Healthcare Direct: a descriptive – comparative case study
- 2021
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Ingår i: BMC Nursing. - : Springer. - 1472-6955. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMedical errors are reported as a malpractice claim, and it is of uttermost importance to learn from the errors to enhance patient safety. The Swedish national telephone helpline SHD is staffed by registered nurses; its aim is to provide qualified healthcare advice for all residents of Sweden; it handles normally about 5 million calls annually. The ongoing Covid-19 pandemic have increased call volume with approximate 30%. The aim of the present study was twofold: to describe all malpractice claims and healthcare providers’ reported measures regarding calls to Swedish Healthcare Direct (SHD) during the period January 2011–December 2018 and to compare these findings with results from a previous study covering the period January 2003–December 2010.MethodsThe study used a descriptive, retrospective and comparative design. A total sample of all reported malpractice claims regarding calls to SHD (n = 35) made during the period 2011–2018 was retrieved. Data were analysed and compared with all reported medical errors during the period 2003–2010 (n = 33).ResultsTelephone nurses’ failure to follow the computerized decision support system (CDSS) (n = 18) was identified as the main reason for error during the period 2011–2018, while failure to listen to the caller (n = 12) was the main reason during the period 2003–2010. Staff education (n = 21) and listening to one’s own calls (n = 16) were the most common measures taken within the organization during the period 2011–2018, compared to discussion in work groups (n = 13) during the period 2003–2010.ConclusionThe proportion of malpractice claims in relation to all patient contacts to SHD is still very low; it seems that only the most severe patient injuries are reported. The fact that telephone nurses’ failure to follow the CDSS is the most common reason for error is notable, as SHD and healthcare organizations stress the importance of using the CDSS to enhance patient safety. The healthcare organizations seem to have adopted a more systematic approach to handling malpractice claims regarding calls, e.g., allowing telephone nurses to listen to their own calls instead of having discussions in work groups in response to events. This enables nurses to understand the latent factors contributing to error and provides a learning opportunity.
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| 2. |
- Blomqvist, Paula, 1968-, et al.
(författare)
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Contracting out welfare services : how are private contractors held accountable?
- 2022
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Ingår i: Public Management Review. - : Taylor & Francis. - 1471-9037 .- 1471-9045. ; 24:2, s. 233-254
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Tidskriftsartikel (refereegranskat)abstract
- A challenge for governments contracting out public services is holding accountable contractors who fail to meet agreed-upon standards. In social services, contract monitoring is complicated by the fact that contracts tend to be incomplete and performance hard to assess. In this study, we examine how local governments in Sweden hold private contractors accountable in nursing home care. The main finding is that a mixture of accountability mechanisms was used, but that social accountability was seen as most effective. Marketaccountability measures like contract termination and financial sanctions could not be applied as local governments lacked the capacity to enforce them
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| 3. |
- Blomqvist, Paula, 1968-, et al.
(författare)
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Have the Welfare Professions Lost Autonomy? : A Comparative Study of Doctors and Teachers
- 2024
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Ingår i: Journal of Social Policy. - : Cambridge University Press. - 0047-2794 .- 1469-7823. ; 53:1, s. 64-85
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Tidskriftsartikel (refereegranskat)abstract
- This article investigates the impact of NPM reforms on two prominent welfare state professions; medical doctors and teachers. The case study context is Sweden, where the impact of NPM led to a series of reforms in health care and education after 1990. The focus in the paper is on professional autonomy, which can be seen as a core trait in professional work. The findings in the article point to both medical doctors and teachers having lost professional autonomy as a result of NPM-reforms, particularly with regards to the dimensions of work organization and evaluation. Autonomy in individual decision-making seems to have been least affected, even if there are indications of this being infringed upon as well. Despite these broad similarities, the loss of autonomy is found to be more pronounced in the case of teachers. One reason behind this difference, which manifests itself in teachers having become subject to higher level of direct administrative control by school managers while at the same time experiencing a more distinct loss of autonomy to evaluate their work, appears to be that medical doctors have been more successful in establishing themselves as experts in relation to new public audit agencies.
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| 4. |
- Blomqvist, Paula, 1968-, et al.
(författare)
-
Sweden
- 2021
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Ingår i: Health Politics in Europe. - Oxford : Oxford University Press. - 9780198860525 ; , s. 164-204
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Bokkapitel (refereegranskat)abstract
- This chapter provides an extended look at health politics and the tax-financed, universal health system in Sweden. It traces the historical development of the Swedish healthcare system, characterized by a shifting relationship between a powerful, interventionist state and self-governing county-level governing institutions. Starting in the late 1980s, despite broad political agreement about the need to adapt the system and make it more patient-centered, there has been debate over most health reforms, particularly over the role of markets and private actors, with legislative votes largely following the left–right political party divide. Nevertheless, reforms like the introduction of private actors, mostly publicly financed and regulated, the enhancement of patient choice, measures to reduce waiting times, and other changes in the formerly nearly all-public system have taken place without seriously undermining the health system’s fundamentally solidaristic character.
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| 5. |
- Ewert, Benjamin, et al.
(författare)
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Any lessons to learn? : Pathways and impasses towards health system resilience in post-pandemic times
- 2023
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Ingår i: Health Economics, Policy and Law. - : CAMBRIDGE UNIV PRESS. - 1744-1331 .- 1744-134X. ; 18:1, s. 66-81
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Tidskriftsartikel (refereegranskat)abstract
- The COVID-19 pandemic has been an ultimate challenge for health systems as a whole rather than just single sectors (e.g. hospital care). Particularly, interface management between health system sectors and cooperation among stakeholders turned out to be crucial for an adequate crisis response. Dealing with such interfaces, it is argued in the literature, demands from health care systems to become resilient. One way to analyse this is to focus on the ways in which bottlenecks in health systems are dealt with during the pandemic. This paper investigates six bottlenecks, including overburdened public health agencies, neglected nursing homes and insufficient testing capacities that have been encountered in the health systems of Germany, Sweden and the Netherlands during the pandemic. Based on empirical findings we identify and critically discuss preliminary lessons in terms of health system resilience, an increasingly popular theoretical concept that frames crises as an opportunity for health system renewal. We argue that in practice health system resilience is hindered by path dependencies of national health systems and, owed to the crisis, interim policies that lack ambition for broader reforms.
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| 6. |
- Fredriksson, Mio, 1976-, et al.
(författare)
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A New Way of Thinking and Talking About Economy : Clinic Managers' Perspectives on the Sustainable Implementation of a Decommissioning Programme in Sweden
- 2023
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Ingår i: HEALTH SERVICES INSIGHTS. - : SAGE Publications. - 1178-6329. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Healthcare systems may run into economic problems that may require 'active' decommissioning by policy-makers and managers. The aim of this study was to investigate, from a sustainability perspective, the implementation of an extensive decommissioning programme in one of the Swedish regions. Interviews were performed with 26 clinic managers 3 years after initial implementation. Those were analysed inductively, and then discussed based on a model of potential influences on sustainability. Although the programme was only 'partly sustained', the result point to a sustained attention to the health system's poor economy, visible in a great effort by the clinics to maintain their budgets. The most important influences were intervention fit and modifications made at the clinic level (i. innovation characteristics), clinic and health system leadership (ii. context), champions (iii. capacity) and shared decision-making and relationship building (iv. processes and interactions). When implementing decommissioning, it is particularly important to engage managers responsible for the care of patients and clinic budgets from an early stage and to allow them to design approaches based on the staff's and managers' detailed knowledge of the situation at their clinics and of the disease area, that is, to achieve fit at the clinics. In this way, the decommissioning approaches can more likely get the character of quality improvement efforts, which increases sustainability and may lead to positive quality outcomes. Despite being unpopular, the study suggests that decommissioning can have positive effects as well, such as creating opportunities to make difficult but necessary changes and fostering increased collegial support during the centralisation of services.
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| 7. |
- Gustafsson, Inga-Britt, et al.
(författare)
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Factors that shape the successful implementation of decommissioning programmes : an interview study with clinic managers
- 2021
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: As a response to many years of repetitive budget deficits, Region Dalarna in Sweden started a restructuring process in 2015, and implemented a decommissioning programme to achieve a balanced budget until 2019. Leading politicians and public servants took the overall decisions about the decommissioning programme, but the clinical decision-making and implementation was largely run by the clinic managers and their staff. As the decommissioning programme improved the finances, met relatively little resistance from the clinical departments, and neither patient safety nor quality of care were perceived to be negatively affected, the initial implementation could be considered successful. The aim of this study was to investigate clinic managers' experience of important factors enabling the successful implementation of a decommissioning programme in a local healthcare organization.METHODS: Drawing on a framework of factors and processes that shape successful implementation of decommissioning decisions, this study highlights the most important factors that enabled the clinic managers to successfully implement the decommissioning programme. During 2018, an interview study was conducted with 26 clinic managers, strategically selected to represent psychiatry, primary care, surgery and medicine. A deductive content analysis was used to analyze the interviews. By applying a framework to the data, the most important factors were illuminated.RESULTS: The findings highlighted factors and processes crucial to implementing the decommissioning programme: 1) create a story to get a shared image of the rationale for change, 2) secure an executive leadership team represented by clinical champions, 3) involve clinic managers at an early stage to ensure a fair decision-making process, 4) base the decommissioning decisions on evidence, without compromising quality and patient safety, 5) prepare the organisation to handle a process characterised by tensions and strong emotions, 6) communicate demonstrable benefits, 7) pay attention to the need of cultural and behavioral change and 8) transparently evaluate the outcome of the process.CONCLUSIONS: From these findings, we conclude that in order to successfully implement a decommissioning programme, clinic managers and healthcare professions must be given and take responsibility, for both the process and outcome.
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| 8. |
- Gustafsson, Inga-Britt, et al.
(författare)
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Putting a decommissioning programme into action : an interview study with politicians and public servants in a local healthcare organisation
- 2024
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Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 38:9, s. 258-279
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: A local healthcare organisation providing healthcare to 288,000 residents in Sweden struggled with a longstanding budget deficit. Several attempts to overcome the demanding financial situation have failed. A decommissioning programme was launched, and two years later, an evaluation indicated positive outcomes. The aim of this study was to explore factors politicians and public servants perceived as enablers to the successful implementation of the programme.Design/methodology/approach: A deductive content analysis approach using a framework of factors facilitating successful implementation of decommissioning decisions was applied to analyse interviews with 18 informants.FindingsImportant factors were: (1) a review report contributing to the clarity of evidence, which (2) made the clarity of the rationale for change undeniable and (3) strengthened the political support for change. Additional factors were: (4) the strength of executive leadership, (5) the strength of clinical leadership supported by (6) the quality of project management and (7) a cultural and behavioural change seen as an important outcome for the path forward. A way to maximise the potential for a successful implementation of a large-scale decommissioning programme is to build a shared vision and a collaboration grounded in convincing evidence. Include public servants with a clinical background in the executive leadership team to contribute with legitimacy, competence, and trust in the decommissioning programme's intention.Originality/value: The paper addresses the limited knowledge of best practices in decommissioning processes and contributes empirical knowledge from a successful case.
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| 9. |
- Hallberg, Anna, 1989-, et al.
(författare)
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Balancing Pragmatism and Sustainability : A Case Study of an Interorganisational Network to Improve Integrated Care for the Elderly
- 2021
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Ingår i: International Journal of Integrated Care. - : Ubiquity Press. - 1568-4156. ; 21:3
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Networks constitute a promising strategy for interorganisational collaboration, but may fail due to network tensions. By investigating the activities and internal dynamics of a voluntary meso-level network operating in the intersection of health and social care, this study aims to enhance the understanding of the relationship between pragmatism and sustainability and the role network governance plays in this respect.Methods: In this descriptive case study, 2–3 researchers observed 3 three-hour long network meetings during the course of a year, and four complementary interviews were performed. Data were analysed based on the literature on network functioning and effectiveness.Results: Pragmatism (a focus on ‘getting things done’) was more emphasised than sustainability although the network meetings also contained elements of relationship- and trust-building. The network leadership (a Network Administrative Organisation, NAO) created structure and concretized the participants’ ideas while remaining flexible and perceptive, and also carried out tasks which would otherwise not have been performed.Discussion: The emphasis on pragmatism did not seem to influence sustainability negatively which has been pointed out as a potential risk in previous literature. Rather, the focus on pragmatism reinforced sustainability in a way that is similar to what has been described in prior research as a “trust-building loop” and discussed further in terms of a “perception of progress” mechanism. However, it was unclear what future the voluntary network would have without the NAO.Conclusion: Network governance is instrumental to success, and should be carefully considered when initiating interorganisational network initiatives for integrated care.
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| 10. |
- Hallberg, Anna, 1989-, et al.
(författare)
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Vertical policy coordination of COVID-19 testing in Sweden : an analysis of policy-specific demands and institutional barriers
- 2024
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Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 38:9, s. 106-124
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe build-up of large-scale COVID-19 testing required an unprecedented effort of coordination within decentralized healthcare systems around the world. The aim of the study was to elucidate the challenges of vertical policy coordination between non-political actors at the national and regional levels regarding this policy issue, using Sweden as our case.Design/methodology/approachInterviews with key actors at the national and regional levels were analyzed using an adapted version of a conceptualization by Adam et al. (2019), depicting barriers to vertical policy coordination.FindingsOur results show that the main issues in the Swedish context were related to parallel sovereignty and a vagueness regarding responsibilities and mandates as well as complex governmental structures and that this was exacerbated by the unfamiliarity and uncertainty of the policy issue. We conclude that understanding the interaction between the comprehensiveness and complexity of the policy issue and the institutional context is crucial to achieving effective vertical policy coordination.Originality/valueMany studies have focused on countries’ overall pandemic responses, but in order to improve the outcome of future pandemics, it is also important to learn from more specific response measures.
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| 11. |
- Hoffstedt, Caroline, et al.
(författare)
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Choosing not to choose-Patients' justification of a disengaged choice of primary care provider
- 2023
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Ingår i: Social Policy & Administration. - : John Wiley and Sons Inc. - 0144-5596 .- 1467-9515. ; 57:7, s. 1014-1031
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Tidskriftsartikel (refereegranskat)abstract
- A key underpinning of choice of health care provider is that patients make active and informed decisions which stimulate quality competition. By imitating the principles of a market in the steering of health care, patients thus assume the role of consumers. Few patients however neither consider alternative providers nor seek information about quality. The aim of this study was to investigate if and how patients engage in the role of being active and informed consumers in the setting of primary care, and how they argue for their choice. The study was based on semi-structured interviews with 18 respondents in a municipality in mid-Sweden. Respondents were purposefully sampled and interviews were analysed using an inductive thematic approach. Findings demonstrated that patients disengaged from choice by arguing, for instance, that they were satisfied with their current provider or because they perceived no differences in quality. Overall, results were in line with previous studies performed in US and European hospital settings, indicating that patients present some similar arguments regarding disengagement from choice irrespective of level of care or geographical setting. Arguments specifically related to the primary care level were that patients found it more important to achieve continuity in the patient-doctor relationship than 'shopping around' for the best provider, or that they desired more profiled services to actively make a choice. In contrast to previous literature, patients refuted the 'patient-consumer' role by referring to, for instance, the belief that care should be of equal quality independent of what choice they made.
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| 12. |
- Hoffstedt, Caroline, et al.
(författare)
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How do people choose to be informed? A survey of the information searched for in the choice of primary care provider in Sweden
- 2021
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- To stimulate quality through choice of provider, patients need to seek and base their decisions on both relevant and reliable information describing providers’ clinical quality. The purpose of this study was first to investigate what types of information and information sources patients turned to in the active choice of primary care provider. Second, it investigated whether a sub-group of patients considered more likely to actively seek information, also sought more advanced information about the clinical quality of providers.
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| 13. |
- Hoffstedt, Caroline, 1984-
(författare)
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Informed patient choice – chimera or reality? : Understanding how patients engage in information-seeking when choosing a provider in Swedish primary care
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The steering of health care through patient choice has become an integral part of several health systems. In Sweden, the government introduced a legal right for patients to choose their own primary care provider in 2010. The reform was built on the principles of a quasi-market, meaning that public reimbursement follows patients’ choices to stimulate both public and private providers to compete for patients. Through this the government hoped to achieve higher quality and efficiency of services as large groups of patients were assumed to seek care from the best performing providers. An important precondition of a functioning quasi-market such as the patient choice is that patients make informed choices. By this is implied that they consider the service quality of different providers by actively seeking and using relevant and reliable information. Otherwise, the mechanism behind patient choice might be lost as providers will not be exposed of the risk of being outcompeted due to inferior quality. The specific aim of this thesis was to investigate how patients engage with the assumptions of the informed choice of a primary care provider and the conditions that influence them in this regard. This aim was achieved by conducting four empirical studies. The main findings of the studies demonstrated that not even patients in active choice situations, as they had switched or considered switching primary care provider, searched for information which could underpin a judgment of the quality of different providers. Findings indicated that patients’ overall lack of engagement in making informed choices was the result of how they experienced the conditions of choice, such as a lack of promoted differences in the range and quality of services and a general trust in that they would receive health care of equal quality regardless of choice. Patients also actively resisted the very premises of an informed choice by arguing that the convenience of being geographically close to services was more important than opting for the clinically best provider, or that access to primary care services of high quality should not be dependent on making an informed choice. The results implicate that patients’ choices have poor prospects of function as drivers of quality, and that public authorities must continue to safeguard quality to ensure that all patients receive an acceptable standard of primary care services.
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| 14. |
- Hoffstedt, Caroline, et al.
(författare)
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When do people choose to be informed? : Predictors of information-seeking in the choice of primary care provider in Sweden
- 2020
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Ingår i: Health Economics, Policy and Law. - Cambridge : Cambridge University Press. - 1744-1331 .- 1744-134X. ; 15:2, s. 210-224
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Tidskriftsartikel (refereegranskat)abstract
- Improving the ability of patients to make informed choices of health care provider can give providers more incentive to compete based on quality. Still, it is not evident to what extent and when people search for information when choosing a provider. The aim of this study is to identify under what circumstances individuals seek information when choosing a primary care provider. Research to date has mostly focused on individuals’ demographic and socio-economic characteristics and the poor availability of information as barriers to information-seeking and use. Our results highlight the importance of taking individuals’ personal motivations and situational context into account when studying information-seeking behavior. Overall, these results suggest that not even individuals who are likely to search for information since they switched or considered switching primary care provider, do so to any greater extent. However, those motivated to change providers by internal factors such as dissatisfaction or a belief that other providers may provide superior services actively sought out information to a greater extent than those motivated by external factors such as the closure of their current provider, or by moving house. Gender, employment status, place of residence and education level was also significantly associated with information-seeking.
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| 15. |
- Holmström, Inger, 1960-, et al.
(författare)
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Better safe than sorry : Registered nurses' strategies for handling difficult calls to emergency medical dispatch centres - An interview study
- 2022
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Ingår i: Journal of Clinical Nursing. - : WILEY. - 0962-1067 .- 1365-2702. ; 31:17-18, s. 2486-2494
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives To describe strategies employed by registered nurses for handling difficult calls to emergency medical dispatch centres. Background At emergency medical dispatch centres, registered nurses encounter a range of difficult calls in their clinical practice. They often use clinical decision support systems, but these may be of limited help if the caller is for instance abusive or has limited language proficiency. Much can be learnt from strategies developed by registered nurses for handling difficult calls. Design A descriptive qualitative study was conducted. Methods A purposeful sample of 24 registered nurses from three different emergency medical dispatch centres were interviewed. The transcribed interviews were analysed using qualitative content analysis. The COREQ checklist was applied. Results An overarching theme was established: "Using one's nursing competence and available resources for a safe outcome", based on three sub-themes: Use one's own professional and personal resources, Use resources within the organisation and Use external resources. The themes in turn consist of ten categories. Conclusions Registered nurses employed a range of strategies to deal with difficult calls, often in combination. They used their personal resources, resources within their own organisation, and collaboration partners to make safe triage decisions and use resources wisely. The effectiveness of these strategies, however, remains unknown. When registered nurses were unable to rule out a high-acuity condition, they used safety-netting and sent an ambulance. Evaluating current strategies and making strategies explicit could further improve the ability of nurses to handle difficult calls. Relevance to clinical practice The strategies described by registered nurses for handling difficult calls to EMDCs included using a consecutive set of strategies. Some of the strategies seemed to be used deliberately, while others seemed tacit and applied in a routinised way. These strategies could potentially be useful for RNs working with telephone triage in different contexts.
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| 16. |
- Holmström, Inger, 1960-, et al.
(författare)
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Registered Nurses' experiences of using a clinical decision support system for triage of emergency calls : A qualitative interview study
- 2020
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Ingår i: Journal of Advanced Nursing. - : WILEY. - 0309-2402 .- 1365-2648. ; 76:11, s. 3104-3112
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To describe how Registered Nurses make use of a Clinical Decision Support System to triage calls to emergency medical dispatch centres, from the perspective of professional autonomy. Design The study had a descriptive design with a qualitative inductive approach. Methods Interviews were done with 24 Registered Nurses during 2018-2019. Thematic analysis was conducted. Results Five themes and 16 subthemes were established: (a) Using the CDSS as a general support to professional competence in emergency calls, including subthemes:Support for professional competence,an aid to reflection,a compulsory support; (b) A specific support useful in difficult situations and calls, with subthemes:RN being tired or stressed out;vague and unclear symptoms,rare situations,aggressive and agitated callers; (c) Using the CDSS but changing triage recommendations/priority, including subthemes:Recommending a higher priority than the CDSSandrecommending a lower priority than the CDSS; (d) Development areas for better use of the CDSS in collaboration with other services, with subthemes:Request for common documentation system with ambulancesandcloser collaboration with the national telephone nursing helpline; and (e) Possible technical development areas in the CDSS for optimal use, including subthemes:image transfer,medical records,development of certain areas in the CDSS,update of maps,a need for more knowledge. Conclusion The CDSS was not perceived as a restriction on professional autonomy. It was particularly useful in rare situations. Technical improvements as well as education and training should be done in close collaboration with registered nurses. Impact The study contributes with knowledge about how registered nurses triaging emergency calls use a decision support system. The system was a support for professional competence and did not seem to restrict them. The findings could be useful for clinicians and researchers in development of telephone triage and decision support systems.
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| 17. |
- Holmström, Inger, 1960-, et al.
(författare)
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The perspectives of Swedish registered nurses about managing difficult calls to emergency medical dispatch centres : a qualitative descriptive study
- 2021
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Ingår i: BMC Nursing. - : BMC. - 1472-6955. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Telephone triage at emergency medical dispatch centres is often challenging for registered nurses due to lack of visual cues, lack of knowledge about the patient, and time pressure - and making the right decision can be a matter of life and death. Some calls may be more difficult to handle, and more knowledge is needed about these calls to develop education and coping strategies. Therefore, the aim of this study was to describe the perspectives of registered nurses' views about managing difficult calls to emergency medical dispatch centres. Methods A descriptive design with a qualitative inductive approach was used. Three dispatch centers in mid-Sweden were investigated, covering about 950,000 inhabitants and handling around 114,000 calls per year. Individual interviews were carried out with a purposeful sample of 24 registered nurses. Systematic text condensation was conducted. Results Seven themes were generated: calls with communication barriers, calls from agitated or rude callers, calls about psychiatric illness, calls from third parties, calls about rare or unclear situations, calls with unknown addresses and calls regarding immediate life-threatening conditions. There was a strong consensus among the registered nurses about which calls were experienced as difficult, with the exception of calls about immediate life-threatening conditions. Some registered nurses thought calls about immediate life-threatening conditions were easy to handle as they simply adhered to protocol, while others described these calls as difficult and were emotionally affected. Conclusion The registered nurses' descriptions of difficult calls focused on the callers, while their own role, the organisational framework, and leadership were not mentioned. Many types of calls included difficulties, which could be related to the caller, their symptoms, or different circumstances. The registered nurses pointed to language barriers and rude, agitated callers as increasing problems. An investigation of actual emergency calls is warranted to examine the extent and nature of such calls.
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| 18. |
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| 19. |
- Kaminsky, Elenor, et al.
(författare)
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Registered nurses' understandings of emergency medical dispatch center work : A qualitative phenomenographic interview study
- 2021
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Ingår i: Nursing and Health Sciences. - : John Wiley & Sons. - 1441-0745 .- 1442-2018. ; 23:2, s. 430-438
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Tidskriftsartikel (refereegranskat)abstract
- Non-urgent and urgent telephone nursing services are increasing globally, and phenomenographic research has shown that how work is understood may influence work performance. This descriptive study makes a qualitative inductive investigation of understandings of emergency medical dispatch center work among registered nurses. Twenty-four registered nurses at three mid Swedish emergency medical dispatch centers were interviewed. Analysis based on phenomenographic principles identified five categories in the interviews: (i) Assess, prioritize, direct, or refer; (ii) Facilitate ambulance nursing work; (iii) Perform nursing care; (iv) Always be available for the public; and (v) Have the person behind the patient in mind. The first constitutes the basis of the work. The second emphasizes cooperation with and support for the ambulance staff. The third entails remotely providing nursing care, whilst the fourth stresses serving the entire population. The fifth and most comprehensive way of understanding work involves having a holistic view of the person in need, including person-centered care. Provision of high-quality emergency medical dispatch center work involves all categories. Combined, they constitute a "work map," valuable for reflection, competence development, and introduction of new staff.
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| 20. |
- Kullberg, Linn, et al.
(författare)
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Does voluntary health insurance reduce the use of and the willingness to finance public health care in Sweden?
- 2022
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Ingår i: Health Economics, Policy and Law. - : Cambridge University Press. - 1744-1331 .- 1744-134X. ; 17:4, s. 380-397
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Tidskriftsartikel (refereegranskat)abstract
- Voluntary private health insurance (VHI) has generally been of limited importance in national health service-type health care systems, especially in the Nordic countries. During the last decades however, an increase in VHI uptake has taken place in the region. Critics of this development argue that voluntary health insurance can undermine support for public health care, while proponents contend that increased private funding for health services could relieve strained public health care systems. Using data from Sweden, this study investigates empirically how voluntary health insurance affects the public health care system. The results of the study indicate that the public Swedish health care system is fairly resilient to the impact of voluntary health insurance with regards to support for the tax-based funding. No difference between insurance holders and non-holders was found in willingness to finance public health care through taxes. A slight unburdening effect on public health care use was observed as VHI holders appeared to use public health care to a lesser extent than those without an insurance. However, a majority of the insurance holders continued to use the public health care system, indicating only a modest substitution effect.
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| 21. |
- Kullberg, Linn
(författare)
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Private Health Insurance in Sweden : Implications for the legitimacy of the public health care system
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The market for private health insurance (PHI) is growing in many countries with public, tax-funded health care systems. In Sweden, this development has generated an at times intense and polarised debate, exposing that the principles on which the public health care system rests in many aspects collide with the construction of PHI. Two dimensions have been suggested as being important for maintaining the legitimacy of public health care systems. The first is that citizens support the normative principles underpinning the system, including solidaristic funding through general taxation. With this comes the willingness of the population, and in particular the middle classes as net contributors, to pay tax to support the system. The second dimension is related to how the population perceives the performance of public services, as it has been suggested that public services need to be of sufficiently high quality for private alternative to be considered redundant. The growing market for PHI, where people can duplicate the public health care coverage with private health care services, raises concerns regarding the legitimacy of public health care. The aim of this thesis was, therefore, to investigate how PHI affects the legitimacy of the public health care system in Sweden. Three research questions were raised, addressing the prevalence and scope of PHI in Sweden, whether the experience of having PHI affects willingness to pay tax towards public health care, and satisfaction with public services. Four studies consisting of two quantitative cross-sectional studies and two qualitative interview-based studies were conducted to answer these questions. The results indicate that PHI in Sweden provides benefits foremost for the healthy and wealthy. The findings furthermore suggest that the first dimension of health care legitimacy (willingness to pay tax towards public health care) does not seem to be reduced by the experience of having PHI. Regarding the second dimension of legitimacy (satisfaction with the public services), the results are mixed. PHI-funded services were preferred over publicly funded services in terms of access and service quality within the primary care sector, while the medical quality of the public sector was considered high. In conclusion, the legitimacy of the public health care system in Sweden appears fairly resilient to the impact of PHI, although decreasing satisfaction might, in the long run, challenge the stability of the system.
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| 22. |
- McHugh, John P, et al.
(författare)
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Readmission Reduction Strategies for Patients Discharged to Skilled Nursing Facilities : A Case Study From 2 Hospital Systems in 1 City
- 2021
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Ingår i: Journal of Nursing Care Quality. - : Lippincott Williams & Wilkins. - 1057-3631 .- 1550-5065. ; 36:1, s. 91-98
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Some hospitals seek integration with skilled nursing facilities (SNFs) to reduce readmissions while others focus more on patients discharged home.PURPOSE: Our objective was to understand different approaches for readmission reduction for patients discharged to SNFs based on contrasting strategies from 2 competing hospital systems.METHODS: Employing a case study methodology, we compared 1 hospital system that integrated with SNFs to a competing system that did not. We compared interview data from clinical and administrative staff and publicly reported rehospitalization rate changes from the 2 systems.RESULTS: Analysis of integrating hospital system interviews noted providing patients detailed discharge information and educating SNF staff regarding care protocols. Integrated hospital system all-cause readmission rates declined by nearly 1 percentage point more than the nonintegrated hospital system (coefficient, -0.008; 95% confidence interval, -0.003 to -0.012) between 2014 and 2017.CONCLUSION: As hospitals explore care transition improvements to SNFs, developing more embedded relationships highlights one approach to improve value.
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| 23. |
- Ohlsson, Anna, 1975-
(författare)
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Equity in Treatment and Outcomes among Heart Failure Patients in Sweden : The role of gender, age and socioeconomic factors in access to treatment and mortality
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is extensive empirical evidence for inequity in health and health care between and within countries across all economic levels worldwide. In Sweden, the Health and Medical Services Act states that health care should provide good health and equal health care for the entire population, but this goal has yet to be fulfilled. Equity has been defined as “differences which are unnecessary and avoidable, but in addition are considered unfair and unjust”. Equity in health is closely linked with the so-called social determinants of health, or the conditions in which people are born, grow, live, work, and age.Heart failure (HF) is a common disease globally, carrying high morbidity and mortality, and is one of the major causes of hospitalisations in Sweden. There is a strong evidence base for renin angiotensin system blockers (RASb) as well as beta-blockers (BB) reducing mortality in HF, and long-standing recommendations for these medications in treatment guidelines. However, not all eligible patients receive this first-line treatment. There has been some evidence of inequity by gender and age in treatment of HF, but evidence regarding socioeconomic risk factors has been scarce.In this thesis, differences in access to pharmacological therapy by demographic and socioeconomic factors were investigated.Observational studies with cohort designs were performed. In Study I–III large national population-level interlinked register materials were investigated, and in Study IV a well characterised cohort including clinical and prescription data from the SwedeHF, a Swedish HF quality register, was analysed.In Study I, we investigated differences in access to angiotensin-converting enzyme inhibitors (a type of RASb) by gender, age, educational level, employment status, income and immigration status among hospitalised HF patients in Sweden. In Study II we aimed to investigate effectiveness, i.e., the association between RASb exposure and mortality, among hospitalised HF patients in Sweden, and whether effectiveness varied with gender and age. In Study III, RASb access and mortality by employment status and educational level among hospitalised HF patients in Sweden of working age was analysed, along with possible excess mortality among non-employed patients without access to RASb. In Study IV, medication adherence to mortality-reducing HF medications, i.e., RASb and BB, was examined by age, gender, educational level, marital status and income.In conclusion, the studies in the thesis showed that access to RASb treatment appeared inequitable for women, the non-employed, and the elderly among hospitalised HF patients, although this treatment was associated with lower mortality for all these groups. Furthermore, RASb treatment was associated with similar reductions in mortality for women and men, but the association was somewhat weaker among older compared with younger hospitalised HF patients. In addition, non-employment and lower educational level were associated with higher mortality in hospitalised HF patients, and non-employment was associated with less access to RASb treatment. Finally, lower income and single status were associated with lower adherence to mortality-reducing treatment with BB and RASb in a quality register HF cohort, while associations were more unclear regarding gender and age.
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| 24. |
- Spangler, Douglas, et al.
(författare)
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The Impact of the Swedish Care Coordination Act on Hospital Readmission and Length-of-Stay among Multi-Morbid Elderly Patients : A Controlled Interrupted Time Series Analysis
- 2023
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Ingår i: International Journal of Integrated Care. - : Ubiquity Press. - 1568-4156. ; 23:2
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Tidskriftsartikel (refereegranskat)abstract
- Coordinating follow-up care after discharge from hospital is critical to ensuring good outcomes for patients, but is difficult when multiple care providers are involved. In 2018, Sweden adopted the Care Coordination Act, which modified economic incentives to reduce discharge delays and mandated a discharge planning process for patients requiring post-discharge social-or primary care services. This study evaluates the impact of this reform on hospital length-of-stay and unplanned readmissions among multi-morbid elderly patients. Interrupted time series analysis of all in-patient care episodes involving multi-morbid elderly patients in Sweden from 2015 - 2019 (n = 2 386 039) was performed. Secondary analyses using case-mix adjustment and controlled interrupted time series analysis were employed to assess for bias. Average length of stay decreased during the post-reform period, corresponding to 248 521 saved care days. Unplanned readmissions meanwhile increased, corresponding to 7 572 excess unplanned readmissions. While reductions in length-of-stay were concentrated among patients targeted by the reform, increases in readmission rates were similar in patients not targeted by the reform, indicating potential confounding. The reform thus appears to have achieved its goal of decreasing in-patient length of stay, but a robust effect on readmissions, outpatient visits, or mortality was not found. This may be due to lackluster implementation or an ineffective mandated intervention.
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| 25. |
- Spangler, Douglas, et al.
(författare)
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Using trigger tools to identify triage errors by ambulance dispatch nurses in Sweden : an observational study
- 2020
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Ingår i: BMJ Open. - : BMJ PUBLISHING GROUP. - 2044-6055. ; 10:3
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study aimed to assess whether trigger tools were useful identifying triage errors among patients referred to non-emergency care by emergency medical dispatch nurses, and to describe the characteristics of these patients.Design: An observational study of patients referred by dispatch nurses to non-emergency care.Setting: Dispatch centres in two Swedish regions.Participants: A total of 1089 adult patients directed to non-emergency care by dispatch nurses between October 2016 and February 2017. 53% were female and the median age was 61 years.Primary and secondary outcome measures: The primary outcome was a visit to an emergency department within 7 days of contact with the dispatch centre. Secondary outcomes were (1) visits related to the primary contact with the dispatch centre, (2) provision of care above the primary level (ie, interventions not available at a typical local primary care centre) and (3) admission to hospital in-patient care.Results: Of 1089 included patients, 260 (24%) visited an emergency department within 7 days. Of these, 209 (80%) were related to the dispatch centre contact, 143 (55%) received interventions above the primary care level and 99 (38%) were admitted to in-patient care. Elderly (65+) patients (OR 1.45, 95% CI 1.05 to 1.98) and patients referred onwards to other healthcare providers (OR 1.58, 95% CI 1.15 to 2.19) had higher likelihoods of visiting an emergency department. Six avoidable patient harms were identified, none of which were captured by existing incident reporting systems, and all of which would have received an ambulance if the decision support system had been strictly adhered to.Conclusion: The use of these patient outcomes in the framework of a Global Trigger Tool-based review can identify patient harms missed by incident reporting systems in the context of emergency medical dispatching. Increased compliance with the decision support system has the potential to improve patient safety.
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| 26. |
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| 27. |
- Törmä, Johanna, et al.
(författare)
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Is it possible to influence ability, willingness and understanding among nursing home care staff to implement nutritional guidelines? : A comparison of a facilitated and an educational strategy
- 2021
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Ingår i: International Journal of Older People Nursing. - : John Wiley & Sons. - 1748-3735 .- 1748-3743. ; 16:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Translating nutrition knowledge into care practice is challenging since multiple factors can affect the implementation process. This study examined the impact of two implementation strategies, that is external facilitation (EF) and educational outreach visits (EOVs), on the organisational context and individual factors when implementing nutritional guidelines in a nursing home (NH) setting.Methods: The EF strategy was a one-year, multifaceted (including support, guidance, a practice audit and feedback) intervention given to four NH units. The EOV strategy was a three-hour lecture about the nutritional guidelines given to four other NH units. Both strategies were directed at selected NH teams, consisting of a unit manager, a nurse and 5-10 care staff. A questionnaire was distributed, before and after the interventions, to evaluate the prerequisites for the staff to use the guidelines. Three conditions were used to examine the organisational context and the individual factors: the staff's ability and willingness to implement the nutritional guidelines and their understanding of them. Confirmatory factor analysis and structural equation models were used for the data analysis.Results: The results indicated that on average, there was a significant increase in the staff's ability to implement the nutritional guidelines in the EF group. The staff exposed to the EF strategy experienced better resources to implement the guidelines in terms of time, tools and support from leadership and a clearer assignment of responsibility regarding nutrition procedures. There was no change in staff's willingness and understanding of the guidelines in the EF group. On average, no significant changes were observed for the staff's ability, willingness or understanding in the EOV group.Conclusions: A long-term, active and flexible implementation strategy (i.e. EF) affected the care staff's ability to implement the nutritional guidelines in an NH setting. No such impact was observed for the more passive, educational approach (i.e. EOV).
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| 28. |
- Vengberg, Sofie
(författare)
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Marketisation of Swedish Primary Care : Patient Choice, Provider Competition and Payment Incentives
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the last decades, market elements—such as patient choice, provider competition and payment incentives—have been introduced in Swedish primary care, the Patient Choice reform in 2010 being pivotal for the marketisation of the sector. The political intentions with the reform were to empower patients and increase provider diversity, thereby stimulating competition and improving quality and access. The reform embedded a more market-based governance of the sector; resource allocation and accountability being achieved on the basis of patient choices, and policy goals being attained through provider competition. For this to occur, several conditions on both the demand-side and supply-side must be fulfilled. Empirical evidence on market conditions are, however, especially lacking on the supply-side. The aim of this dissertation is therefore to investigate whether and how the Swedish primary care sector and its providers have adapted to the market elements of the Patient Choice reform. Three research questions are raised, addressing how providers perceive and respond to the different market elements, how competitive the sector is, and in what way the market elements promote achievement of central policy goals: quality, access and equity. To answer these questions, four studies are presented: two qualitative interview studies and two quantitative cross-sectional studies. Together, the studies demonstrate that providers are, in general, not very sensitive to patients’ choices and to competition. In the government bill preceding the Patient Choice reform, provider reimbursements were described as a way for money to follow patients’ choices, thereby sharpening the demand signals. Instead, findings indicate that reimbursements mainly are a tool for the regions to steer provider behaviours. The primary care market is also diverse in terms of competition. A large share of the primary healthcare centres is located in local monopoly markets, whereas those located in competitive markets often face rather stiff competition. Moreover, findings show a mixed picture on how market elements promote goals on quality, access and equity. Higher levels of competition are found in more urban local markets and in local markets with a population of higher socioeconomic status. Because competition is unequally distributed, so are conditions for competition to improve performance. Furthermore, providers describe how equity in access has been negatively affected by fee-for-service reimbursements. In summary, there are several obstacles on the supply-side of the Swedish primary care market for the market elements to function as intended in the Patient Choice reform, but also for promoting central policy goals.
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| 29. |
- Vengberg, Sofie, et al.
(författare)
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Measuring competition in primary care : Evidence from Sweden
- 2024
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 19:7
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionIn many tax-based healthcare systems, policymakers have introduced reforms that promote provider competition with the intention of improving the quality and efficiency. Healthcare competition is usually defined spatially, with local markets often being identified as a circle around each provider. We argue that existing local market definitions can be improved to better capture actual local markets. For pro-competition reforms to potentially lead to the gains envisioned by policymakers, a crucial condition is the actual emergence of competitive markets. However, limited research has been conducted on competition in primary care markets, despite primary care constituting a vital part of a healthcare system.AimThe study aims to contribute to the debate on how to define local markets geographically and to examine provider competition in Swedish primary care.MethodsA cross-sectional study was conducted using data on all individuals and all primary care providers in Sweden. Local markets were defined as: fixed radius (1 km and 3 km); variable radius; and variable shape—our new local market definition that allows markets to vary in both size and shape. Competition was measured using the Herfindahl-Hirschman index and a count of the number of competitors within the local market.ResultsFixed radius markets fail to capture variation within and across geographical areas. The variable radius and variable shape markets are similar but do not always identify the same competitors or level of competition. Furthermore, competition levels vary significantly in Swedish primary care. Many providers operate in monopoly markets, whereas others face high competition.ConclusionsWhile the variable shape approach has the potential to better capture actual markets and more accurately identify competitors, further analyses are needed. Moreover, Swedish policymakers are advised to decide whether to still pursue competition and if so, take measures to improve local market conditions in monopolies.
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| 30. |
- Vengberg, Sofie, et al.
(författare)
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Money matters : primary care providers' perceptions of payment incentives
- 2021
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Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 35:4, s. 458-474
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Payments to healthcare providers create incentives that can influence provider behaviour. Research on unit-level incentives in primary care is, however, scarce. This paper examines how managers and salaried physicians at Swedish primary healthcare centres perceive that payment incentives directed towards the healthcare centre affect their work. Design/methodology/approach An interview study was conducted with 24 respondents at 13 primary healthcare centres in two cities, located in regions with different payment systems. One had a mixed system comprised of fee-for-service and risk-adjusted capitation payments, and the other a mainly risk-adjusted capitation system. Findings Findings suggested that both managers and salaried physicians were aware of and adapted to unit-level payment incentives, albeit the latter sometimes to a lesser extent. Respondents perceived fee-for-service payments to stimulate production of shorter visits, up-coding of visits and skimming of healthier patients. Results also suggested that differentiated rates for patient visits affected horizontal prioritisations between physician and nurse visits. Respondents perceived that risk-adjustments for diagnoses led to a focus on registering diagnosis codes, and to some extent, also up-coding of secondary diagnoses. Practical implications Policymakers and responsible authorities need to design payment systems carefully, balancing different incentives and considering how and from where data used to calculate payments are retrieved, not relying too heavily on data supplied by providers. Originality/value This study contributes evidence on unit-level payment incentives in primary care, a scarcely researched topic, especially using qualitative methods.
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| 31. |
- von Granitz, Heléne, 1969-, et al.
(författare)
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Do personal assistance activities promote participation in society for persons with disabilities in Sweden? : A five-year longitudinal study
- 2022
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 44:15, s. 3973-3981
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. To explore whether the personal assistance (PA) activities provided by the Swedish Act concerning Support and Service for Persons with Certain Functional Impairment in 2010 and 2015 promote participation in society according to Article 19 of the United Nations’ Convention on the Rights of Persons with Disabilities (UNCRPD).Methods. Register data and data from two questionnaires were used (N = 2565). Descriptive statistics and chi-square (McNemar’s test) were used to describe the basic features of the data. Mixed binominal logistic regression was used to examine correlation between gender and hours of PA between 2010 and 2015.Results. Despite an increase in the number of PA hours, more care activities and a reduction of most PA activities representing an active life were found. The result was especially evident for women, older people, and for a particular person category.Conclusions. The results offer evidence of a shift to a medical model and indicate a risk of social exclusion due to fewer activities representing an active life. An increase on average of 16 h of PA over the period studied does not guarantee access to an active life and may indicate a marginal utility. The noted decline of PA for participation in society enhances the importance of monitoring content aspects to fulfil Article 19 of the UNCRPD.
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| 32. |
- von Granitz, Heléne, 1969-
(författare)
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Enabling disability rights in practise : Understanding how the governance of state-funded personal assistance is fulfilling the Swedish LSS Act
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Personal assistance (PA) is stated in Article 19 of the UNCRPD as an internationally recognised disability right and is operationalised as a measure in the Swedish Act concerning Support and Service for Persons with Certain Functional Impairments (the LSS Act). The Act’s overall policy goal is to promote good living conditions for the eligible persons by enabling participation in society on equal terms with others. The governance of PA is a divided responsibility between the municipality and the Swedish Social Insurance Agency (SSIA), which assesses and grants PA-allowance if the PA applicant exceed 20 hours of certain needs per week. The overall aim of the thesis was to explore how the governance of PA-allowance enables to fulfil the LSS Act policy goals. The main findings of the thesis demonstrate a tilt in PA towards a medical model of disability, marked by a domination and an increase of healthcare activities over time. Less activities representing participation in society were found and unequal access to PA activities across age, gender and groups of persons with disabilities. The findings imply an increased risk to social and financial exclusion of PA users. Further, the LSS Act’s rationale and policy goals were shown to have a weakened impact on the SSIA instruction, the refined policy tool which outlines the PA-allowance granting process. A development towards a medicalised application of PA-allowance was found, characterised by healthcare measures to support medical conditions and a shift towards PA users with less ability to partake in the PA-allowance granting process. Factors shown to have influenced the governance of PA-allowance include: case law, changed policy priorities, weakened PA collaboration structures, inadequate monitoring of PA outcomes, strained working conditions at the SSIA and extensive complexities of the PA-allowance application. This thesis illustrates that the SSIA regime logic has thoroughly influenced the LSS policy outcome with time and emphasises the need for social reform policy tools to be continuously calibrated towards the original policy goals to uphold policy compliance. The regression of PA, by gradually resigning to a medical model of disability, demonstrates weakened conditions for Swedish disability policy through the LSS Act to fulfil Article 19 of the UNCRPD.
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| 33. |
- Wallenburg, Iris, et al.
(författare)
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'Nurses are seen as general cargo, not the smart TVs you ship carefully' : the politics of nurse staffing in England, Spain, Sweden, and the Netherlands
- 2023
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Ingår i: Health Economics, Policy and Law. - : Cambridge University Press. - 1744-1331 .- 1744-134X. ; 18:4, s. 411-425
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Tidskriftsartikel (refereegranskat)abstract
- Nurse workforce shortages put healthcare systems under pressure, moving the nursing profession into the core of healthcare policymaking. In this paper, we shift the focus from workforce policy to workforce politics and highlight the political role of nurses in healthcare systems in England, Spain, Sweden, and the Netherlands. Using a comparative discursive institutionalist approach, we study how nurses are organised and represented in these four countries. We show how nurse politics plays out at the levels of representation, working conditions, career building, and by breaking with the public healthcare system. Although there are differences between the countries - with nurses in England and Spain under more pressure than in the Netherlands and Sweden - nurses are often not represented in policy discourses; not just because of institutional ignorance but also because of fragmentation of the profession itself. This institutional ignorance and lack of collective representation, we argue, requires attention to foster the role and position of nurses in contemporary healthcare systems.
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| 34. |
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| 35. |
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| 36. |
- Winblad, Ulrika, 1968-, et al.
(författare)
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Preserving social equity in marketized primary care : strategies in Sweden
- 2021
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Ingår i: Health Economics, Policy and Law. - : Cambridge University Press. - 1744-1331 .- 1744-134X. ; 16:2, s. 216-231
-
Tidskriftsartikel (refereegranskat)abstract
- A primary care choice reform launched in Sweden in 2010 led to a rapid growth of private providers. Critics feared that the reform would lead to an increased tendency among new, profit-driven, providers, to select patients with lower health risks. Even if open risk selection is prohibited, providers can select patients in more subtle ways, such as establishing their practices in areas with higher health status. This paper investigates to what extent strategies were employed by local governments to avoid risk selection and whether there were any differences between left- and right-wing governments in this regard. Three main strategies were used: risk adjustment of the financial reimbursements on the basis of health and/or socio-economic status of listed patients; design of patient listing systems; and regulatory requirements regarding the scope and content of the services that had to be offered by all providers. Additionally, left-wing local governments were more prone than right-wing governments to adopt risk adjustment strategies at the onset of the reform but these differences diminished over time. The findings of the paper contribute to our understanding of how social inequalities may be avoided in tax-based health care systems when market-like steering models such as patient choice are introduced.
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| 37. |
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| 38. |
- Winblad, Ulrika, 1968-, et al.
(författare)
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Soft law and individual responsibility : a review of the Swedish policy response to COVID-19
- 2021
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Ingår i: Health Economics, Policy and Law. - : Cambridge University Press. - 1744-1331 .- 1744-134X. ; 17:1, s. 48-61
-
Tidskriftsartikel (refereegranskat)abstract
- Sweden's coronavirus disease 2019 (COVID-19) response, initially based largely on voluntary measures, has evoked strong reactions nationally and internationally. In this study, we describe Sweden's national policy response with regard to the general public, the community and the health care system, with a focus on how the response changed from March 2020 to June 2021. A number of factors contributed to Sweden's choice of policy response, including its existing legal framework, independent expert agencies and its decentralized, multi-level health care governance system. Challenges to the health- and elder care system during the pandemic, such as the need to increase intensive care- and testing capacity, and to ensure the safety of the elderly were addressed largely at the regional and local levels, with national authorities assuming a primarily coordinative role. Although the overall response based on voluntary compliance has persisted, the national government started to take a more prominent role in public messaging, and in enacting legally binding restrictions during subsequent waves of the pandemic. This study illustrates that not only policy responses, but also the fundamental structure of the health- and elder care system and its governance should be considered when evaluating the impact of the COVID-19 pandemic.
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| 39. |
- Åhlfeldt, Emanuel, et al.
(författare)
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Factors Explaining Program Sustainability : A Study of the Implementation of a Social Services Program in Sweden
- 2023
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Ingår i: Health & Social Care in the Community. - : Hindawi Publishing Corporation. - 0966-0410 .- 1365-2524. ; 2023
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Tidskriftsartikel (refereegranskat)abstract
- Even for successfully implemented programs, there is a great risk that new work practices are not sustained over time. Previous research has yielded a number of factors which influence program sustainability, but little is known about which factors are most important in different contexts or how these factors interact. This study tests a model of sustainability factors in a case where a program for structured needs assessment and documentation was implemented in the Swedish social services. In November 2020, a questionnaire was sent out to local implementing actors in the municipalities. The data include 135 municipal organizations with 1–3 respondents per organization. Descriptive statistics and multiple regression were used in the analysis. The outcome variable was routinization as one of the most central components of sustainability. The findings show that while the program was implemented at 21.5% of sites, it was both implemented and routinized at only 13.3% of sites. A key factor for successful routinization was an open project strategy, which entails coordination between the implementation process and other change initiatives, the identification of a long-term planning horizon, and development based on continuous feedback. Additional factors found to contribute to routinization were management commitment, user participation, first-line manager commitment, and available resources. Certain factors were identified as pertinent to the implementing actors themselves, such as effective project leadership and rationally planned projects. These latter factors, however, demonstrated less importance towards routinization. These findings are discussed in relation to the fragmented context of the implementation, whereby the recipient organizations were not single, unified organizations, but rather organizational clusters involving both purchaser and provider organizations. The findings have implications for the planning, management, and evaluation of social program implementation and the ability to sustain novel work practices.
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