1.
Berglund, Helene, 1957, et al.
(författare)
Older people's views of quality of care: a randomised controlled study of continuum of care
2013
Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell. - 0962-1067 .- 1365-2702. ; 22:19-20, s. 2934-2944
Tidskriftsartikel (refereegranskat) abstract
Aims and objectives To analyse frail older peoples views of quality of care when receiving a comprehensive continuum of care intervention, compared with those of people receiving the usual care (control group). The intervention included early geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care-planning meetings in older peoples own homes. less thanbrgreater than less thanbrgreater thanBackground Prior studies indicate that tailored/individualised care planning conducted by a case manager/coordinator often led to greater satisfaction with care planning among older people. However, there is no obvious evidence of any effects of continuum of care interventions on older peoples views of quality of care. less thanbrgreater than less thanbrgreater thanDesign Randomised controlled study. less thanbrgreater than less thanbrgreater thanMethods Items based on a validated questionnaire were used in face-to-face interviews to assess older peoples views of quality of care at three, six and 12months after baseline. less thanbrgreater than less thanbrgreater thanResults Older people receiving a comprehensive continuum of care intervention perceived higher quality of care on items about care planning (p0005), compared with those receiving the usual care. In addition, they had increased knowledge of whom to contact about care/service, after three and 12months (pandlt;003). less thanbrgreater than less thanbrgreater thanConclusions The study gives evidence of the advantages of a combination of components such as organising care-planning meetings in older peoples own homes, case management and interprofessional teamwork. less thanbrgreater than less thanbrgreater thanRelevance to clinical practice The results have implications for policymakers, managers and professionals in the area of health and social care for older people to meet individual needs of frail older people.
2.
Augustsson, Hanna, et al.
(författare)
Determinants for the use and de-implementation of low-value care in health care : a scoping review.
2021
Ingår i: Implementation Science Communications. - : Springer Science and Business Media LLC. - 2662-2211. ; 2:1
Tidskriftsartikel (refereegranskat) abstract
BACKGROUND: A considerable proportion of interventions provided to patients lack evidence of their effectiveness. This implies that patients may receive ineffective, unnecessary or even harmful care. However, despite some empirical studies in the field, there has been no synthesis of determinants impacting the use of low-value care (LVC) and the process of de-implementing LVC.AIM: The aim was to identify determinants influencing the use of LVC, as well as determinants for de-implementation of LVC practices in health care.METHODS: A scoping review was performed based on the framework by Arksey and O'Malley. We searched four scientific databases, conducted snowball searches of relevant articles and hand searched the journal Implementation Science for peer-reviewed journal articles in English. Articles were included if they were empirical studies reporting on determinants for the use of LVC or de-implementation of LVC. The abstract review and the full-text review were conducted in duplicate and conflicting decisions were discussed until consensus was reached. Data were charted using a piloted data charting form and the determinants were inductively coded and categorised in an iterative process conducted by the project group.RESULTS: In total, 101 citations were included in the review. Of these, 92 reported on determinants for the use of LVC and nine on determinants for de-implementation. The studies were conducted in a range of health care settings and investigated a variety of LVC practices with LVC medication prescriptions, imaging and screening procedures being the most common. The identified determinants for the use of LVC as well as for de-implementation of LVC practices broadly concerned: patients, professionals, outer context, inner context, process and evidence and LVC practice. The results were discussed in relation to the Consolidated Framework for Implementation Research.CONCLUSION: The identified determinants largely overlap with existing implementation frameworks, although patient expectations and professionals' fear of malpractice appear to be more prominent determinants for the use and de-implementation of LVC. Thus, existing implementation determinant frameworks may require adaptation to be transferable to de-implementation. Strategies to reduce the use of LVC should specifically consider determinants for the use and de-implementation of LVC.REGISTRATION: The review has not been registered.
3.
Mazzocato, Pamela, et al.
(författare)
Kaizen practice in healthcare : a qualitative analysis of hospital employees' suggestions for improvement
2016
Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 6:7
Tidskriftsartikel (refereegranskat) abstract
OBJECTIVES: Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare.METHODS: We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated.RESULTS: 72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions.CONCLUSIONS: There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results.
4.
Thomas, Kristin, 1978-
(författare)
Implementation of coordinated healthy lifestyle promotion in primary care : Process and outcomes
2015
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Background: Implementation of healthy lifestyle promotion in routine primary has been suboptimal. There is emerging evidence that coordinating care can improve the efficiency and quality of care. However, more research is needed on the implementation of coordinated care in healthy lifestyle promotion, the role of patients in implementation and the long-term outcomes of implementation efforts.Overall aim: To investigate the implementation of coordinated healthy lifestyle promotion in primary care in terms of process and outcomes, from the perspectives of both staff and patients.Methods: In 2008, Östergötland county council commissioned primary care centres to implement a coordinated care initiative, lifestyle teams, to improve healthy lifestyle promotion routines. A lifestyle team protocol stipulated centres to: (1) create multi-professional teams, (2) appoint team managers, (3) hold team meetings, and (4) create in-house referral routines for at-risk patients. Paper I investigated the implementation process of three lifestyle teams during a two year period using a mixed method, convergent parallel design. A proposed theory of implementation process was used to analyse data from manager interviews, documents and questionnaires. Paper II explored patients’ role in implementation using grounded theory. Interview data from patients with varied experience of promotion was used. Paper III investigated implementation outcomes using a quasi-experimental, cross-sectional design that compared three intervention centres (lifestyle teams) with three control centres (no teams). Data were collected by staff and patient questionnaires and manager interviews at 3 and 5 years after commissioning. The RE-AIM framework was modified and used to define outcome variables: Reach of patients, Effectiveness (attitudes and competency among staff), Adoption among staff, Implementation fidelity to the lifestyle team protocol, and Maintenance of the results at 5-year follow-up.Results: Paper I: The implementation process was complex including multiple innovation components and groups of adopters. The conditions for implementation, e.g. resources varied between staff and team members which challenged the embedding of the teams and new routines. The lifestyle teams were continuously redefined by team members to accommodate contextual factors, features of the protocol and patients. The lifestyle team protocol presented an infrastructure for practice at the centres. Paper II: A grounded theory about being healthy with three interconnected subcategories emerged from data: (1) conditions, (2) managing, and (3) interactions regarding being healthy. Being healthy represented a process of approaching a health ideal which occurred simultaneously with, and could contradict, a process of maximizing well-being. A typology of four patient types (resigned, receivers, co-workers, and leaders) illustrated how processes before, during and after healthy lifestyle promotion were interconnected. Paper III: Reach: significantly more patients at control centres received promotion compared to intervention centres at 3-year (48% and 41% respectively) and 5-year followups (44% and 36% respectively). Effectiveness: At 3-year follow-up, after controlling for clustering by centres, intervention staff were significantly more positive concerning perceived need for lifestyle teams; that healthy lifestyle promotion was prioritized at their centre and that there was adequate competency at individual and centre level regarding lifestyle promotion. At 5-year follow-up, significant differences remained regarding prioritization of lifestyle promotion at centre level. The majority of both intervention and control staff were positive towards lifestyle promotion. Adoption: No significant differences were found between control and intervention centres at 3 years (59% and 47% respectively) or at 5 years (45% and 36% respectively). Implementation fidelity: all components of the lifestyle team protocol had been implemented at all the intervention centres and at none of the control centres.Conclusions: The implementation process was challenged by a complex interaction between groups of staff, innovation components and contextual factors. Although coordinated care are used for other conditions in primary care, the findings suggest that it is difficult to adopt similar routines for healthy lifestyle promotion. Findings suggest that the lifestyle team protocol did not fully consider social components of coordinated care or the varied conditions for change exhibited by adopters. Patients can be seen as coproducing implementation of healthy lifestyle promotion.
5.
Richter, Anne, et al.
(författare)
Evaluation of iLead, a generic implementation leadership intervention : mixed-method preintervention-postintervention design
2020
Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 10:1
Tidskriftsartikel (refereegranskat) abstract
OBJECTIVES: The present study aimed to evaluate the iLead intervention and to investigate whether or not transfer of training can be supported by contextualising the intervention (recruiting all managers from one branch of the organisation while focusing on one implementation case, as well as training senior management).DESIGN: A pre-evaluation-postevaluation design was applied using mixed methods with process and effect surveys and interviews to measure the effects on three levels.SETTING: Healthcare managers from Stockholm's regional healthcare organisation were invited to the training.PARTICIPANTS: 52 managers participated in the iLead intervention. Group 1 consisted of 21 managers from different organisations and with different implementation cases. Group 2, representing the contextualised group, consisted of 31 managers from the same organisation, working on the same implementation case, where senior management also received training.INTERVENTION: iLead is an intervention where healthcare managers are trained in implementation leadership based on the full-range leadership model.PRIMARY OUTCOME MEASURES: Reactions, knowledge and implementation leadership are measured.RESULTS: Quantitative and qualitative analyses indicate that iLead was perceived to be of high quality and capable of increasing participants' knowledge. Mixed effects were found regarding changes in behaviours. The contextualisation did not have a boosting effect on behaviour change. Hence, group 2 did not increase its active implementation leadership in comparison with group 1.CONCLUSIONS: iLead introduces a new approach to how implementation leadership can be trained when knowledge of effective leadership for implementations is combined with findings on the importance of environmental factors for the transfer of training. Even though managers reported general positive effects, transfer was not facilitated through the contextualisation of the intervention. There is a need to further develop approaches to help participants subsequently apply the learnt skills in their work environment.
6.
Augustsson, Hanna, et al.
(författare)
National governance of de-implementation of low-value care : a qualitative study in Sweden
2022
Ingår i: Health Research Policy and Systems. - : BMC. - 1478-4505. ; 20:1
Tidskriftsartikel (refereegranskat) abstract
Background The de-implementation of low-value care (LVC) is important to improving patient and population health, minimizing patient harm and reducing resource waste. However, there is limited knowledge about how the de-implementation of LVC is governed and what challenges might be involved. In this study, we aimed to (1) identify key stakeholders' activities in relation to de-implementing LVC in Sweden at the national governance level and (2) identify challenges involved in the national governance of the de-implementation of LVC. Methods We used a purposeful sampling strategy to identify stakeholders in Sweden having a potential role in governing the de-implementation of LVC at a national level. Twelve informants from nine stakeholder agencies/organizations were recruited using snowball sampling. Semi-structured interviews were conducted, transcribed and analysed using inductive thematic analysis. Results Four potential activities for governing the de-implementation of LVC at a national level were identified: recommendations, health technology assessment, control over pharmaceutical products and a national system for knowledge management. Challenges involved included various vested interests that result in the maintenance of LVC and a low overall priority of working with the de-implementation of LVC compared with the implementation of new evidence. Ambiguous evidence made it difficult to clearly determine whether a practice was LVC. Unclear roles, where none of the stakeholders perceived that they had a formal mandate to govern the de-implementation of LVC, further contributed to the challenges involved in governing that de-implementation. Conclusions Various activities were performed to govern the de-implementation of LVC at a national level in Sweden; however, these were limited and had a lower priority relative to the implementation of new methods. Challenges involved relate to unfavourable change incentives, ambiguous evidence, and unclear roles to govern the de-implementation of LVC. Addressing these challenges could make the national-level governance of de-implementation more systematic and thereby help create favourable conditions for reducing LVC in healthcare.
7.
Dunér, Anna, 1962, et al.
(författare)
Implementing a continuum of care model for older people - results from a Swedish case study
2011
Ingår i: International Journal of Integrated Care. - : Ubiquity Press, Ltd.. - 1568-4156. ; 11:October-December
Tidskriftsartikel (refereegranskat) abstract
Introduction: There is a need for integrated care and smooth collaboration between care-providing organisations and professions to create a continuum of care for frail older people. However, collaboration between organisations and professions is often problematic. The aim of this study was to examine the process of implementing a new continuum of care model in a complex organisational context, and illuminate some of the challenges involved. The introduced model strived to connect three organisations responsible for delivering health and social care to older people: the regional hospital, primary health care and municipal eldercare. Methods: The actions of the actors involved in the process of implementing the model were understood to be shaped by the actors' understanding, commitment and ability. This article is based on 44 qualitative interviews performed on four occasions with 26 key actors at three organisational levels within these three organisations. Results and conclusions: The results point to the importance of paying regard to the different cultures of the organisations when implementing a new model. The role of upper management emerged as very important. Furthermore, to be accepted, the model has to be experienced as effectively dealing with real problems in the everyday practice of the actors in the organisations, from the bottom to the top.
8.
Frykman, Mandus, et al.
(författare)
The work is never ending : uncovering teamwork sustainability using realistic evaluation
2017
Ingår i: Journal of Health Organization & Management. - 1477-7266 .- 1758-7247. ; 31:1, s. 64-81
Tidskriftsartikel (refereegranskat) abstract
PurposeThe purpose of this paper is to uncover the mechanisms influencing the sustainability of behavior changes following the implementation of teamwork.Design/methodology/approachRealistic evaluation was combined with a framework (DCOM®) based on applied behavior analysis to study the sustainability of behavior changes two and a half years after the initial implementation of teamwork at an emergency department. The DCOM® framework was used to categorize the mechanisms of behavior change interventions (BCIs) into the four categories of direction, competence, opportunity, and motivation. Non-participant observation and interview data were used.FindingsThe teamwork behaviors were not sustained. A substantial fallback in managerial activities in combination with a complex context contributed to reduced direction, opportunity, and motivation. Reduced direction made staff members unclear about how and why they should work in teams. Deterioration of opportunity was evident from the lack of problem-solving resources resulting in accumulated barriers to teamwork. Motivation in terms of management support and feedback was reduced.Practical implicationsThe implementation of complex organizational changes in complex healthcare contexts requires continuous adaption and managerial activities well beyond the initial implementation period.Originality/valueBy integrating the DCOM® framework with realistic evaluation, this study responds to the call for theoretically based research on behavioral mechanisms that can explain how BCIs interact with context and how this interaction influences sustainability.
9.
Hasson, Henna, et al.
(författare)
Empirical and conceptual investigation of de-implementation of low-value care from professional and health care system perspectives : a study protocol
2018
Ingår i: Implementation Science. - : BIOMED CENTRAL LTD. - 1748-5908. ; 13
Tidskriftsartikel (refereegranskat) abstract
Background: A considerable proportion of interventions provided to patients lacks evidence of their effectiveness This implies that patients may receive ineffective, unnecessary, or even harmful care Thus, in addition to implementing evidence based practices, there is also a need to abandon interventions that are not based on best evidence, i e, low value care However, research on de implementation is limited, and there is a lack of knowledge about how effective de implementation processes should be earned out The aim of this project is to explore the phenomenon of the de implementation of low value health care practices from the perspective of professionals and the health care system. Methods: Theories of habits and developmental learning in combination with theories of organizational alignment will be used The project's work will be conducted in five steps Step 1 is a scoping review of the literature, and Step 2 has an explorative design involving interviews with health care stakeholders Step 3 has a prospective design in which workplaces and professionals are shadowed during an ongoing de implementation In Step 4, a conceptual framework for de implementation will be developed based on the previous steps In Step 5, strategies for de implementation are identified using a co design approach. Discussion: This project contributes new knowledge to implementation science consisting of empirical data, a conceptual framework, and strategy suggestions on de implementation of low value care The professionals' perspectives will be highlighted, including insights into how they make decisions, handle de implementation in daily practice, and what consequences it has on their work Furthermore, the health care system perspective will be considered and new knowledge on how de implementation can be understood across health care system levels will be obtained The theories of habits and developmental learning can also offer insights into how context triggers and reinforces certain behaviors and how factors at the individual and the organizational levels interact The project employs a solution oriented perspective by developing a framework for de implementation of low value practices and suggesting practical strategies to improve de implementation processes at all levels of the health care system The framework and the strategies can thereafter be evaluated for their validity and impact in future studies.
10.
Ingvarsson, Sara, et al.
(författare)
Management strategies to de-implement low-value care-an applied behavior analysis.
2022
Ingår i: Implementation Science Communications. - : BioMed Central (BMC). - 2662-2211. ; 3:1
Tidskriftsartikel (refereegranskat) abstract
BACKGROUND: There is a lack of knowledge about management strategies being used to de-implement low-value care (LVC). Furthermore, it is not clear from the current literature what mechanisms are involved in such strategies and how they can change physicians' behaviors. Understanding the mechanisms is important for determining a strategy's potential impact. Applied behavior analysis focuses on processes involved in increasing and decreasing behaviors. Therefore, the aim of this study is to understand what management strategies are being used to de-implement LVC and the possible mechanisms involved in those strategies, using concepts from applied behavior analysis.METHOD: We applied a qualitative study design using an inductive approach to understand what management strategies are in use and then employed applied behavior analysis concepts to deductively analyze the mechanisms involved in them.RESULTS: We identified eight different management strategies intended to influence LVC. Five of the strategies were developed at a regional level and had the potential to influence physicians' LVC-related behaviors either by functioning as rules on which LVC to de-implement or by initiating local strategies in each health care center that in turn could influence LVC practices. The local strategies had a stronger potential for influencing de-implementation.CONCLUSION: Both strategies at a systemic level (regional) and on a local level (health care centers) must be considered to influence LVC-related behaviors. Strategies at the center level have a specific opportunity to impact LVC-related behaviors because they can be tailored to specific circumstances, even though some of them probably were initiated as an effect of strategies on a regional level. Using applied behavior analysis to understand these circumstances can be helpful for tailoring strategies to reduce LVC use.
