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- Gäre, Klas, 1948-, et al.
(author)
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Evidence informed healthcare improvement : Design and evaluation
- 2023
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Reports (other academic/artistic)abstract
- Healthcare is in constant change with fast development in knowledge, new technology and varying needs and expectations from patients, citizens, management, and politicians. There is a challenge in balancing the involved actors´ focus, needs, preferences, and resources for healthcare improvement. Improvement of healthcare is an ongoing activity, sometimes managed and controlled, often not. A key ingredient for success is competence where the need for competence varies with perspectives of the improving actors. Actors in healthcare improvement are professionals, patients, politicians, management, citizens, researchers, research foundations and others. In this report a review of frameworks in healthcare improvement are presented together with management myths and questions around needs for healthcare improvement competence and capabilities currently on the agenda.Most improvement initiatives of some size have substantial parts of IT and have had so for a considerable time. This rather long experience of more and less successful IT implementation and use is transparent and useful in all kinds of healthcare improvement. One important issue in this report is what has real impact is the actual understanding and use of innovations and artefacts by healthcare actors in a broad sense for healthcare improvement (e.g., new clinical evidence, clinical guidelines, process changes, information systems and more). The aim in this report is to review frameworks which can be useful in healthcare improvement as well as in the study of healthcare improvement.Conclusions concern what is found to be important to study and understand healthcare improvement, considering the presented frameworks. Improvement of healthcare is present in all the frameworks but in different ways and what is emphasized concerning scope and focus. Improving healthcare take place in the interaction of at least two parts, one of which is healthcare professionals, and another is the patient/next-of-kin. Professionals and patient populations interact in processes of social networks and structures. Actors and context are useful concepts for understanding action (use) and its social contexts. The actual use of innovations is best understood in terms of integration into clinical activities and processes – actors’ interaction, coordination and communication activities and processes.Theoretical implications are that there is a need for more research concerning meso and macro perspectives on methods for healthcare improvement, and the interplay of perspectives regarding the understanding of improvement in healthcare. Of course, a challenge is that the objects of improvement are complex adaptive systems of healthcare is not easily to catch in simple rules. They are genuinely difficult both to change and evaluate changes. Practical implications of the report support design and contents of education programs in improvement of healthcare, in better understanding usefulness, practice, use, and experience base. To help the understanding of the need and usefulness of integrating different perspectives for successful healthcare improvement, e.g., micro, meso, and macro perspectives, use of mixed methods and more.
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- Askenäs, Linda, et al.
(author)
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Establishing new consulting services in health care organizations : an ANT analysis of patient-centred care
- 2013
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In: ACIS 2013: Information systems: Transforming the Future. - Melbourne : RMIT University. ; , s. 1-12
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Conference paper (peer-reviewed)abstract
- A recent trend in health care is patient-centred health, but are health care organizations ready to cope with that change? Changes at the patient level are one aspect but there is a need for reshaping the organization of health care. There is a need to focus much more on prevention care, helping patients to cope and become better self-managers, focusing on the patient process, working together and empowering patients. The aim of this paper is to gain a better understanding of the lack of sustainability over time in two patient-centred care (PCC) projects by using actor network theory (ANT) as an analytical framework. We use case studies from heart fibrillation and heart failure care organizations in a Swedish county council. The cases concern initiatives to achieve better interactions for these patients and organize care to become more patient-centred. Both initiatives have now been partly abandoned in the organization, although research and guidelines recommend such care organizations. The analysis of the different actors dominating the translation process towards a PCC network and of the way they get together in networks reveals that this is a time-consuming process, taking place long after the initial training and PCC implementation activities. We discuss the temporality of stability, the reversible process with chimerical enrolments, and how a complex and changing environment demands constant re-problematization of PCC. We also include how the understanding of the translation and negotiation process can influence decisions on allocating sufficient time and resources to the process. We shed light on the importance of understanding and managing the organizational change in a PCC project and thus also of when to implement patient-centred e-health solutions.
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