1.
Fredriksson, Mio, et al.
(författare)
Local politico-administrative perspectives on quality improvement based on national registry data in Sweden : a qualitative study using the Consolidated Framework for Implementation Research.
2014
Ingår i: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 9
Tidskriftsartikel (refereegranskat) abstract
Background. Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement¿s intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data.Methods. Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed.Results. The politicians and administrators perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians¿ role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations.Conclusions. The Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.
2.
Björkman, Annica, et al.
(författare)
Malpractice claimed calls within the Swedish Healthcare Direct: a descriptive – comparative case study
2021
Ingår i: BMC Nursing. - : Springer. - 1472-6955. ; 20
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.
3.
Blomqvist, Paula, 1968-, et al.
(författare)
Sweden
2021
Ingår i: Health Politics in Europe. - Oxford : Oxford University Press. - 9780198860525 ; , s. 164-204
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.
4.
Egholm, Cecilie Lindström, et al.
(författare)
Facilitators for using data from a quality registry in local quality improvement work : a cross-sectional survey of the Danish Cardiac Rehabilitation Database
2019
Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:6
Tidskriftsartikel (refereegranskat) abstract
Objectives To investigate use of data from a clinical quality registry for cardiac rehabilitation in Denmark, considering the extent to which data are used for local quality improvement and what facilitates the use of these data, with a particular focus on whether there are differences between frontline staff and managers. Design Cross-sectional nationwide survey study. Setting, methods and participants A previously validated, Swedish questionnaire regarding use of data from clinical quality registries was translated and emailed to frontline staff, mid-level managers and heads of departments (n=175) in all 30 hospital departments participating in the Danish Cardiac Rehabilitation Database. Data were analysed descriptively and through multiple linear regression. Results Survey response rate was 58% (101/175). Reports of registry use at department level (measured through an index comprising seven items; score min 0, max 7, where a low score indicates less use of data) varied significantly between groups of respondents: frontline staff mean score 1.3 (SD=2.0), mid-level management mean 2.4 (SD=2.3) and heads of departments mean 3.0 (SD=2.5), p=0.006. Overall, department level use of data was positively associated with higher perceived data quality and usefulness (regression coefficient=0.22, p=0.019), management request for data (regression coefficient=0.40, p=0.008) and personal motivation of the respondent (regression coefficient=1.63, p<0.001). Among managers, use of registry data was associated with data quality and usefulness (regression coefficient=0.43, p=0.027), and among frontline staff, reported data use was associated with management involvement in quality improvement work (regression coefficient=0.90, p=0.017) and personal motivation (regression coefficient=1.66, p<0.001). Conclusions The findings suggest relatively sparse use of data in local quality improvement work. A complex interplay of factors seem to be associated with data use with varying aspects being of importance for frontline staff and managers.
5.
Hallberg, Anna, 1989-, et al.
(författare)
Balancing Pragmatism and Sustainability : A Case Study of an Interorganisational Network to Improve Integrated Care for the Elderly
2021
Ingår i: International Journal of Integrated Care. - : Ubiquity Press. - 1568-4156. ; 21:3
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.
6.
Hoffstedt, Caroline, et al.
(författare)
Choosing not to choose-Patients' justification of a disengaged choice of primary care provider
2023
Ingår i: Social Policy & Administration. - : John Wiley and Sons Inc. - 0144-5596 .- 1467-9515. ; 57:7, s. 1014-1031
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.
7.
Hoffstedt, Caroline, 1984-
(författare)
Informed patient choice – chimera or reality? : Understanding how patients engage in information-seeking when choosing a provider in Swedish primary care
2022
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.
8.
9.
Hoffstedt, Caroline, et al.
(författare)
When do people choose to be informed? : Predictors of information-seeking in the choice of primary care provider in Sweden
2020
Ingår i: Health Economics, Policy and Law. - Cambridge : Cambridge University Press. - 1744-1331 .- 1744-134X. ; 15:2, s. 210-224
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.
10.
Holmström, Inger, 1960-, et al.
(författare)
Registered Nurses' experiences of using a clinical decision support system for triage of emergency calls : A qualitative interview study
2020
Ingår i: Journal of Advanced Nursing. - : WILEY. - 0309-2402 .- 1365-2648. ; 76:11, s. 3104-3112
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.
