| 1. |
- Andersson, Ann-Christine, et al.
(författare)
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Evaluating a Breakthrough Series Collaborative in a Swedish Health Care Context
- 2014
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Ingår i: Journal of Nursing Care Quality. - : Lippincott Williams & Wilkins. - 1057-3631 .- 1550-5065. ; 29:2, s. E1-E10
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Tidskriftsartikel (refereegranskat)abstract
- This study evaluated the use of the Breakthrough Series Collaborative methodology in a Swedish county council improvement program, comparing measurements at the beginning and after 6 months. A questionnaire was used, and improvement processes and outcomes were analyzed. The results showed an overall large engagement in improvements, although the methodology and facilitators were seen as only moderately supportive.
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| 2. |
- Andersson, Ann-Christine, et al.
(författare)
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Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare
- 2013
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Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 13:48
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Tidskriftsartikel (refereegranskat)abstract
- Background: Quality improvement initiatives have expanded recently within the healthcare sector. Studies have shown that less than 40% of these initiatives are successful, indicating the need for an instrument that can measure the progress and results of quality improvement initiatives and answer questions about how quality initiatives are conducted. The aim of the present study was to develop and test an instrument to measure improvement process and outcome in Swedish healthcare. Methods: A questionnaire, founded on the Minnesota Innovation Survey (MIS), was developed in several steps. Items were merged and answer alternatives were revised. Employees participating in a county council improvement program received the web-based questionnaire. Data was analysed by descriptive statistics and correlation analysis. The questionnaire psychometric properties were investigated and an exploratory factor analysis was conducted. Results: The Swedish Improvement Measurement Questionnaire consists of 27 items. The Improvement Effectiveness Outcome dimension consists of three items and has a Cronbach’s alpha coefficient of 0.67. The Internal Improvement Processes dimension consists of eight sub-dimensions with a total of 24 items. Cronbach’s alpha coefficient for the complete dimension was 0.72. Three significant item correlations were found. A large involvement in the improvement initiative was shown and the majority of the respondents were satisfied with their work. Conclusions: The psychometric property tests suggest initial support for the questionnaire to study and evaluate quality improvement initiatives in Swedish healthcare settings. The overall satisfaction with the quality improvement initiative correlates positively to the awareness of individual responsibilities.
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| 3. |
- Andersson, Ann-Christine, et al.
(författare)
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Five Types of Practice-Based ImprovementIdeas in Health Care Services: An EmpiricallyDefined Typology
- 2011
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Ingår i: Quality Management in Health Care. - : Lippincott Williams & Wilkins. - 1063-8628 .- 1550-5154. ; 20:2, s. 122-130
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to empirically identify and present different kinds of practice-based improvement ideas developed in health care services. The focus is on individual placement needs, problems/issues, and the ability to organize work on the development, implementation, and institutionalization of ideas for the health care sector. This study is based on a Swedish county council improvement program. Health care departments and primary health care centers in the Kalmar County Council were invited to apply for money to accomplish improvement projects. A qualitative content analysis was done of 183 proposed applications from various health care departments and primary health care centers. The following 5 types of improvement projects were identified: organizational process, evidence and quality, competence development, process technology, and proactive patient work. This illustrates the range of strategies that encourage letting individual units define their own improvement needs. These projects point to the various problems and experiences health care professionals encounter in their day-to-day work. To generalize beyond this improvement program and to validate the typology, we applied it to all articles found when searching for quality improvement projects in the journal Quality Management in Health Care during the last 2 years and found that all of them could be fitted into at least 1 of those 5 categories. This article provides valuable insights into the current state of improvemen work in Swedish health care, and will serve as a foundation for further investigations in this quality improvement program.
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| 4. |
- Andersson, Ann-Christine, et al.
(författare)
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Practice-based improvement ideas in healthcare services
- 2010
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective. The present study will contribute to knowledge of how practitioners in a healthcare region engage in quality improvement initiatives. The focus is on individual placement needs, problems/issues and the ability to organize work on the development, implementation and institutionalization of ideas for the healthcare sector. Design and settings. This study is based on the Kalmar county council Improvement Program. Healthcare departments and primary healthcare centers in the county council were invited to apply for money to accomplish improvement projects. The aim is to empirically identify and present the different kinds of practice-based improvement ideas developed in healthcare services. The 202 applications received from various healthcare departments and primary healthcare centers are analyzed using qualitative content analysis. Outcome and Results. Five types of improvement projects were identified: Organizational Process; Evidence and Quality; Competence Development; Process Technology; and Proactive Patient Work. This illustrates the range of strategies that encourage letting individual units define their own improvement needs. In addition, a common characteristic among the studied project applications is to increase patient safety, effectiveness and availability of care, and education/training. Those intentions are found in many of the applications and therefore give the impression of being most important to caregivers today. Conclusions. These projects point to the various problems and experiences healthcare professionals encounter in their day-to-day work. This paper provides valuable insights into the current state of improvement work in Swedish healthcare, and will serve as a foundation for further investigations in this quality program.
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| 5. |
- Andersson, Ann-Christine, et al.
(författare)
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Sustainable outcomes of an improvement programme: do financial incentives matter?
- 2013
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Ingår i: Total Quality Management and Business Excellence. - : Taylor and Francis (Routledge): SSH Titles. - 1478-3363 .- 1478-3371. ; 24:7-8, s. 959-969
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to evaluate whether an improvement programme can contribute to positive sustainable improvements in an organisation, and whether financial incentives are driving forces for improvements. The material was all projects (n=232) that applied for funding in a county council improvement programme between 2007 and 2010. The projects were analysed as to whether they received funding (n=98) or were rejected (n=95). In addition, a categorisation of the projects intentions was analysed. Some projects were still ongoing, but 50 projects were implemented and sustained two or more years after being finalised. Implemented improvements were on different levels, from (micro-level) units up to the entire (macro-level) organisation. In addition, 27 rejected projects were finalised without funding. Eighteen of those 27 were sustainably implemented. This study indicates that there are incentives other than financial at work if an improvement programme contributes to sustainable improvements in the organisation. To encourage practice-based improvements is one way of incentivising the intention and effort to become and perform better.
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| 6. |
- Andersson, Ann-Christine, et al.
(författare)
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Two Different Strategies to Facilitate Involvement in Healthcare Improvements : A Swedish County Council Initiative
- 2014
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Ingår i: Global Advances in Health and Medicine. - : SAGE Publications. - 2164-957X .- 2164-9561. ; 3:5, s. 22-28
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Tidskriftsartikel (refereegranskat)abstract
- Background: From a management point of view, there are many different approaches from which to choose to engage staff members in initiatives to improve performance.Objective: The present study evaluated how two different types of improvement strategies facilitate and encourage involvement of different professional groups in health-care organizations.Methods/Design: Empirical data of two different types of strategies were collected within an improvement project in a County Council in Sweden. The data analysis was carried out through classifying the participants' profession, position, gender, and the organizational administration of which they were a part, in relation to their participation.Setting: An improvement project in a County Council in Sweden.Participants: Designed Improvement Processes consisted of n=105 teams and Intrapreneurship Projects of n=202 projects.Intervention: Two different types of improvement strategies, Designed Improvement Processes and Intrapreneurship Projects.Main Outcome Measures: How two different types of improvement strategies facilitate and encourage involvement of different professional groups in healthcare organizations.Results: Nurses were the largest group participating in both improvement initiatives. Physicians were also well represented, although they seemed to prefer the less structured Intrapreneurship Projects approach. Assistant nurses, being the second largest staff group, were poorly represented in both initiatives. This indicates that the benefits and support for one group may push another group aside.Conclusions: Managers need to give prerequisites and incentives for staff who do not participate in improvements to do so. Comparisons of different types of improvement initiatives are an underused research strategy that yields interesting and thoughtful results.
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| 7. |
- Andersson, Ann-Christine, et al.
(författare)
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Who conducts quality improvement initiatives in healthcare services? An evaluation of an improvement program in acounty council in Sweden
- 2010
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Purpose – The aim of this paper is to contribute to the knowledge of who engages in quality improvement initiatives and to describe whether staff professions or gender are relevant variables. Design/methodology/approach – This paper contains an evaluation of the participants in a specific defined strategic improvement initiative program in one county council in southeast Sweden. The improvement program was initiated by county council politicians to encourage improvement initiatives and to spread improvement skills and knowledge in the organization. The program is driven both “top down” (teaching/convincing line managers to demand improvements) and “bottom up” through improvement programs using methodology to help teams identify, plan and adopt improvements in their daily work. Data was collected from special applications (called Free Applications, FA) and from participants in the education program (called Improvement Program, IP), both of which include information about profession and 2 gender. A content analysis was made. After the first categorization of which types of improvement projects practitioners engage in, further analysis of staff disciplines, professions (hierarchy) and gender was done. The results were compared to the overall structure of staff presence in the county council. Findings – Changes in participation occurred over time. The FA (Free Applications) part (n=202) shows a higher share of leaders and managers (35%), but their participation in the IP (Improvement Program) (n=477) fluctuated (8-26%). Physicians were more represented in the FA than in the IP. The largest single group was nurses. Overall the gender perspective reflects the conditions of the county council, but in FA the representation of women was lower. Five types of improvement projects were identified: 1) Organizational process focus; 2) Evidence and quality; 3) Competence development; 4) Process Technology; and 5) Proactive patient work. Managers were most represented in the category “Organizational process”. The largest difference was seen in the category “Proactive patient work” with the highest occurrence among women (86%) and less among men (17%) and managers (21%). The patient as a contributor taking active part was not found in either the FA or the IP. Research limitations/implications – This study shows differences in participation between free applications and methodology-guided programs when it comes to professions and gender in the country council improvement drive. It may be useful for further research regarding how to successfully work for and implement improvements and change in healthcare environments. Practical implications – The study will discuss and contribute to further knowledge of whether profession, hierarchy and gender have an impact (obstructive or as an asset) in performing improvement work in healthcare settings. Originality/value - Not much has been written about who is accomplishing quality improvements in terms of profession and gender. This paper provides some valuable insights into the differences between staff categories (professions) and gender in the improvement work in Swedish healthcare.
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| 8. |
- Arman, M., et al.
(författare)
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Women's Perceptions and Beliefs About the Genesis of Their Breast Cancer
- 2006
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Ingår i: Cancer Nursing. - : Ovid Technologies (Wolters Kluwer Health). - 0162-220X .- 1538-9804. ; 29:2, s. 142-148
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Tidskriftsartikel (refereegranskat)abstract
- A person's belief is seen as a set of assumptions, depending on perceptions, and formed with the influence of experiences and social culture. With the aim of understanding the beliefs about the genesis of their illness, 118 (59 + 59) women with different stages of breast cancer were interviewed. Half of the sample had chosen complementary care in an anthroposophical hospital, and the other half was a matched group. Qualitative content analysis was used. Three themes emerged: (1) belief in a link to life lived (71%), (2) heredity as the sole genesis (4%), and (3) rejection of the question (25%). Under beliefs in a link to life lived, external aspects to the patient's own life (eg, diet and lifestyle) were cited, as well as inner aspects such as psychosocial problems and stress. The findings show that women are well informed about medical facts, although their beliefs reveal a holistic approach. The women's beliefs, where inner psychosocial factors are uppermost, point to a reverse of the causal ranking of medical advisors. The difference between the groups was that the matching sample was more likely to reject the influence of possible causes from life lived. In a caring perspective, women's perceptions of the genesis of their illness are in some cases turned to creative health activities that may increase well-being.
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| 9. |
- Bygren, Lars Olov, 1936-, et al.
(författare)
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Change in paternal grandmothers' early food supply influenced cardiovascular mortality of the female grandchildren
- 2014
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Ingår i: BMC Genetics. - : BioMed Central. - 1471-2156. ; 15, s. 12-
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study investigated whether large fluctuations in food availability during grandparents' early development influenced grandchildren's cardiovascular mortality. We reported earlier that changes in availability of food - from good to poor or from poor to good - during intrauterine development was followed by a double risk of sudden death as an adult, and that mortality rate can be associated with ancestors' childhood availability of food. We have now studied transgenerational responses (TGR) to sharp differences of harvest between two consecutive years' for ancestors of 317 people in Overkalix, Sweden. Results: The confidence intervals were very wide but we found a striking TGR. There was no response in cardiovascular mortality in the grandchild from sharp changes of early exposure, experienced by three of the four grandparents (maternal grandparents and paternal grandfathers). If, however, the paternal grandmother up to puberty lived through a sharp change in food supply from one year to next, her sons' daughters had an excess risk for cardiovascular mortality (HR 2.69, 95% confidence interval 1.05-6.92). Selection or learning and imitation are unlikely explanations. X-linked epigenetic inheritance via spermatozoa seemed to be plausible, with the transmission, limited to being through the father, possibly explained by the sex differences in meiosis. Conclusion: The shock of change in food availability seems to give specific transgenerational responses.
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| 10. |
- Carlsson, Marianne, et al.
(författare)
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A five-year follow-up of quality of life in women with breast cancer in anthroposophic and conventional care
- 2006
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Ingår i: Evidence-based Complementary and Alternative Medicine. - : Hindawi Limited. - 1741-427X .- 1741-4288. ; 3:4, s. 523-531
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Tidskriftsartikel (refereegranskat)abstract
- Complementary and alternative medicine is used by many cancer patients in most parts of the world, and its use is increasing. The aim of the present study was to examine, over 5 years, the perceived quality of life/life satisfaction in two samples of women with breast cancer who were treated with anthroposophic care or conventional medical treatment only. Data from admission, after I year and after 5 years are used for the comparisons. On admission to the study the women in anthroposophic care perceived their quality of life to be lower than that of the women in the conventional treatment group, especially for emotional, cognitive and social functioning and overall quality of life. Sixty women who actively chose treatment with anthroposophic medicine and 60 individually matched women treated with conventional medicine participated. Quality of life was measured by the EORTC QLQ-C30 and the Life Satisfaction Questionnaire. Twenty-six women within anthroposophic care and 31 women within conventional medicine survived the 5 years. Effect size (ES) estimation favored the anthroposophic group in seven of the subscales mostly measuring emotional functioning. The ES for four of the subscales favored the conventional treatment group, mostly concerning physical functioning. After 5 years there were improvements in overall quality of life and in emotional and social functioning compared to admission for the women in anthroposophic care. The improvements took place between admission and 1 year, but not further on. Only minor improvements were found in the matching group.
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