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- Augustsson, Hanna, et al.
(författare)
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National governance of de-implementation of low-value care : a qualitative study in Sweden
- 2022
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Ingår i: Health Research Policy and Systems. - : BMC. - 1478-4505. ; 20:1
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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.
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- Astnell, Sandra, et al.
(författare)
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Integrating health promotion with quality improvement in a Swedish hospital
- 2015
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Ingår i: Health Promotion International. - : Oxford University Press (OUP). - 0957-4824 .- 1460-2245. ; 31:3, s. 495-504
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Tidskriftsartikel (refereegranskat)abstract
- Integration of workplace employee health promotion (HP) and occupational health and safety (OHS) work into organizational quality improvement systems is suggested as a way to strengthen HP and OHS activities in an organization. The aim of this article was to study what consequences integration of HP, OHS and a quality improvement system called kaizen has on the frequency and type of HP and OHS activities. A quasi-experimental study design was used where an integration of the three systems for HP, OHS respectively kaizen, was performed at six intervention units at a Swedish hospital. The remaining six units served as controls. Document analysis of all employees' written improvement suggestions (kaizen notes) during 2013 was conducted. The findings show that the intervention group had more suggestions concerning HP and OHS (n = 114) when compared with the control group (n = 78) and a greater variety of HP and OHS suggestions. In addition, only the intervention group had included HP aspects. In both groups, most kaizen notes with health consideration had a preventive focus rather than rehabilitative. The intervention, i.e. the integration of HP, OHS and kaizen work, had a favourable effect on HP and OHS work when compared with the controls. The results of the study support that this system can work in practice at hospitals.
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- Augustsson, Hanna, et al.
(författare)
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Determinants for the use and de-implementation of low-value care in health care : a scoping review.
- 2021
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Ingår i: Implementation Science Communications. - : Springer Science and Business Media LLC. - 2662-2211. ; 2:1
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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.
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- Augustsson, Hanna
(författare)
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Inside the black box of workplace interventions : investigating the influence of context and process on outcomes
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Staff working in healthcare and residential care for older people are continuously required to learn and develop competencies to keep up with medical, technological and social developments. At the same time, they experience a work situation generally characterized by high demands. Workplace interventions aiming to improve competence and work environment have been highlighted as a way to improve working conditions for staff. However, these interventions are complex and challenging to implement, difficult to evaluate and have resulted in mixed effects. Not only the intervention content but also the context and process factors may influence the outcomes of workplace interventions. Yet, although several factors that may influence implementation have been identified, these factors have rarely been linked to the outcomes of such interventions. Aim: The aim of this thesis was to investigate how factors related to the context and implementation process of workplace interventions in healthcare and residential care for older people influenced the implementation and intervention outcomes. Methods: This thesis is based on the evaluation of three workplace interventions. Both qualitative and quantitative methods were used to study the context, process and outcomes. Study I was a workplace learning intervention conducted in three residential care facilities for older people. Six facilities served as a comparison group. The intervention’s effect on organizational learning was evaluated using questionnaires at baseline and at 6- and 12-month follow-up. Context and process factors influencing outcomes were investigated using semi-structured interviews with line managers on two occasions (6- and 14-month follow-up) and with staff on one occasion (6-month follow-up). Study II was an organizational-level occupational health intervention conducted at a hospital with six departments included in the intervention group and six in a comparison group. Implementation fidelity regarding the two core components in the intervention was evaluated using questionnaires administered to all employees in the intervention departments at 6-month follow-up as well as with an analysis of organizational documents. Context and process factors influencing implementation fidelity were assessed with semi-structured interviews with line managers and key individuals, as well as with questionnaires administered to employees at baseline and at 6-month follow-up. Study III was a workplace learning intervention conducted in 78 primary healthcare centers. Employees’ openness to change, concerning both the process and the content of the change, and the work group’s openness to the content of change were measured with questionnaires at baseline. These were used to predict two types of outcomes, improvements in competence regarding information and communication technologies (ICT) and the use of acquired competence, which were evaluated using questionnaires administered to all staff at baseline and at18-month follow-up. Results: Both context and process factors influenced the implementation and intervention outcomes. More specifically, stakeholders’ low ownership of the intervention, an insufficient learning climate, insufficient prerequisites for change and managers’ attitudes and actions were found to hinder the creation of organizational learning in study I. In study II, implementation fidelity varied between the departments that participated in the intervention. Factors related to the omnibus context (i.e., having a well-established quality improvement system, group collaboration), the discrete context (i.e., changes in management), the intervention and implementation (i.e., line managers’ attitudes and actions, perception of information and communication, level of participation, the roles of the drivers of change), and participants’ mental models (i.e., outcome expectancy, perceptions of the intervention activities) were found to explain the differences in implementation fidelity. In study III, baseline individual-level openness to both change process and change content as well as group-level openness to change content predicted intervention outcomes at the time of the follow-up. Conclusions: Overall, the findings suggest that successful workplace interventions are shaped by several factors related to the intervention’s content, the context in which the intervention takes place and the process by which the intervention is implemented. Thus, rather than waiting until after an intervention to evaluate why it succeeded or not, context and process factors should be taken into account already when planning and implementing an intervention. Workplace interventions in which context and process factors, as well as implementation outcomes, are continuously monitored and used to tailor the intervention may have greater potential to improve employees’ work conditions.
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