| 1. |
- Andersson, Ann-Christine
(author)
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Quality Improvement in Healthcare : Experiences from a Swedish County Council Initiative
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Quality improvement (QI) has become an important issue in healthcare settings. A central question for many healthcare systems is how to manage improvement initiatives adequately. All county councils and regions managing healthcare in Sweden have started to work with QI at an organizational system level, to varied extents. The Kalmar county council improvement initiative constitutes the empirical basis of this thesis. The aim of the thesis is to provide knowledge about different aspects of a county-wide improvement initiative, and a broader understanding of factors and strategies that affect participation, management and outcomes. The overall study design is based on a case study.The first two studies illuminate the practice-based (micro level), bottom-up perspective. Inductively five different areas (categories) were identified. Factors influencing participation in improvement initiatives provided the basis for the next study. The result showed that different staff categories were attracted by different initiatives. The next two studies illuminate the top-down (macro/meso) management perspective. Managers’ views of how patients can participate were investigated and a content analysis of the written answers was made. Four main areas (categories) were identified. A survey study investigated all of the county council managers’ experiences of the whole improvement initiative. Overall the managers thought that the improvement work was worth the effort. To evaluate the Breakthrough Collaborative program, a survey was developed and tested. This survey was used to investigate process and outcome of the BC program. The majority of the respondents were satisfied with their work, but wanted more time for teams to meet and work. To find out if an improvement program can affect outcome and contribute to sustainable changes, interviews were made with project applicants (n=202). Almost half (48%) of the projects were funded, and of those 51% were sustained. Of the rejected (not funded) projects, 28% were accomplished and sustained anyway. The results in this thesis cannot show that the “golden mean” exists, or that a single best way to manage changes and improvements in a healthcare organization has been found, but the way QI initiatives are organized does affect participation and outcomes. The intention, from the management topdown system level, encouraging staff and units and letting practice-based ideas develop at all system levels, can stimulate and facilitate improvement work.
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| 2. |
- Navarro, Priscilla, 1989-
(author)
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THE STRATEGIC ROLE OF PROCESS MANAGEMENT IN SMEs
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Literature indicates a greater use of process management in large companies than in small and medium-sized enterprises (SMEs). SMEs are a major contributor to the global economy, and just like large companies, SMEs face challenges such as a need to respond promptly and effectively to their business environment, despite having limited resources. Practitioners and researchers within process management refer to a trade-off between the operative support that process management provides and the strategic ability of organisations to be flexible in response to their environment and customer requests. The strategic role of process management has not been highlighted in depth in the literature. Hence, the use of process management and its strategic role in SMEs is a research gap which needs to be investigated. This research should include approaches to process management that support the fulfilment of strategic goals without compromising flexibility. The purpose of this dissertation is to enhance the understanding of the strategic role of process management in SMEs. To address this purpose, two research questions were designed. The first research question explores how the fundamentals of process management contribute to the understanding of the strategic role of process management. The second research question explores and analyses the conditions of SMEs and suggests how process management could be adapted to be used in SMEs. This dissertation includes a longitudinal study, with an action research approach, conducted at two companies. This approach provided a deep understanding of the companies and a strong connection between research and managerial usefulness. The results of the dissertation suggest a need for a contingent approach to process management where the activities that lead to competitive advantage are identified. This identification, together with a connection to the strategic goals of the organisations can then be the basis for determining the need for process development of the organisation. In this way, process management efforts can be focused on processes that lead the organisations to gain competitive advantage. Hence, with the connection to competitive advantage, the strategic goals of the organisations and the continuous improvement principle of process management enhance the understanding of the strategic role of process management. The contribution of this dissertation is primarily in the field of process management, by providing results and analyses that support its strategic relevancy in general and specifically for SMEs. A dynamic capabilities lens has been used to enhance the connection between competitive advantage and the strategic role of process management. This dissertation also contributes to research into dynamic capabilities, by providing concrete examples of the interpretation of dynamic capabilities and a connection between dynamic capabilities and a managerial approach such as process management. The context of this dissertation includes environmental sustainability as a societal need to be addressed by the road freight transport (RFT) business sector, constituted mostly by SMEs. RFT companies, in particular SMEs, have limited resources and simultaneously need to be responsive to various and challenging customer demands. The use of this context enabled the inclusion of examples and analysis with a managerial contribution for, but not limited to, RFTs.
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| 3. |
- Westerlund, Anna, 1978-
(author)
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The role of implementation science in healthcare improvement efforts : investigating three complex interventions
- 2018
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Doctoral thesis (other academic/artistic)abstract
- For decades, scholars have found significant gaps between the knowledge available and the knowledge applied in healthcare. Many potential benefits of adequate knowledge based interventions are therefore never achieved. A considerable body of knowledge has evolved on how to promote a better uptake of evidence-based knowledge into routine use. Even so, the actual impact and usefulness of implementation research findings among healthcare practitioners have not been extensively studied.Accordingly, the overall aim of this thesis is to contribute to the understanding of how the implementation of complex interventions into healthcare can be improved. This is done by investigating whether some of these efforts do correspond with available scientific knowledge on implementation.The thesis is based on three cases contributing to four studies. The cases studied are: the National Perinatal Patient Safety program (NPPS), the Dynamic and Viable Organisation initiative (DVO), and the International Child Development Program (ICDP). All studies focuses on the early stages of implementation.A mixed methods approach was adopted, involving both qualitative and quantitative methods. Data collection consisted of interviews, questionnaires, observations, and process diaries. Qualitative content analysis (conventional and directed), descriptive and non-parametric statistics were used. The focus was on implementation strategies used by healthcare actors in relation to factors influencing implementation processes and outcomes. More specifically, healthcare actors perspectives on such factors and whether they were addressed by the strategies used, was investigated. A process evaluation of implementation outcomes was also part of the thesis.The healthcare actors in focus were the adopters, i.e. practitioners expected to change their work practices, and implementation facilitators. The latter refer to actors with a more or less explicit responsibility to implement new practices or interventions aimed at improving the quality and effectiveness of the provided health services.Variation was found regarding how the implementation strategies used in the three cases corresponded with available scientific knowledge on implementation. In Case NPPS, the implementation facilitators planned, designed, and ensured that the core interventions of the implementation strategy were executed in a rational manner. Several important implementation factors were addressed by the strategy. The process evaluation of effects on readiness for change by the development of a team mental model among adopters showed positive results.In Case DVO a strategy was used that evolved over time, partly based on raised questions and feedback from staff and managers involved. The strategy can be described as an intuitive ‘socially accomplished activity’. This strategy involved addressing ‘Implementation Process-related factors’ in order to affect motivation and increase the tension for change among adopters.In Case ICDP, the results reflected a shortage of strategies during the early stage of implementation. The main intervention was the stepwise ICDP-education. A more comprehensive implementation strategy covering implementation factors highlighted as important among adopters was not developed. The process evaluation revealed vague directives on what was expected regarding the use and adaptation of ICDP to current practice versus preservation of fidelity to the original ICDP. This situation resulted in a rather large variation in how the changes in work practices were perceived among the health centres involved. No health centre practiced ICDP in its original form.A new knowledge-practice gap is discussed based on the findings in this thesis: a gap between the scientific knowledge on implementation and the actual implementation strategies used in practice during improvement efforts initiated by healthcare actors. The findings show that correspondence between scientific knowledge on implementation and what is actually done in order to accomplish change in practice might be more random (or implicit) than systematic. The question of how to transfer scientific knowledge on implementation into user-friendly resources for practitioners is discussed. A tentative model is suggested, which contributes to existing determinant frameworks by focusing on relations among factors. The model may be used in healthcare practice, to guide the design of an implementation strategy (or as a pathway for tailored implementation interventions) and aid the assignment of responsibilities in relation to factors that are known to affect implementation processes and outcomes.The question of how to transfer models and frameworks into user-friendly resources needs further attention. It is suggested that action oriented research aiming at further developing and establishing the concept of ‘practical implementation science’ should be conducted. This could be a way of bridging the knowledge-practice gap in healthcare.
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| 4. |
- Edvardsson, Kristina, 1973-
(author)
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Health promotion in pregnancy and early parenthood : the challenge of innovation, implementation and change within the Salut Programme
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Background: In 2005, the Västerbotten County Council launched a child health promotion programme, “the Salut Programme”, in response to an alarming prevalence of overweight and obesity, and trends of increased dental caries, among young county citizens. The programme, initially developed in four pilot areas, is built on multidisciplinary and cross-sectoral collaboration and aims to support and strengthen health promotion activities in health care, social services and school settings. It targets children and adolescents (0-18 years of age) and their parents, and starts during pregnancy. This thesis focuses on interventions provided by antenatal care, child health care, dental services, and open pre-schools, directed to expectant parents and families with children aged 0-1 ½ years. Within the programme context, the aim was to explore socio-demographic patterns of overweight and obesity in expectant parents (Paper I), firsttime parents’ experiences of health promotion and lifestyle change during pregnancy and early parenthood (Paper II), professionals’ experiences of factors influencing programme implementation and sustainability (Paper III and IV), and early programme outcomes on professionals’ health promotion practices and collaboration following countywide dissemination and implementation (Paper IV). Methods and results: A population based cross-sectional study among expectant parents showed overweight and obesity in 29% of women (pre-pregnancy) and in 53% of men (n=4,352♀, 3,949♂). The likelihood for obesity was higher in expectant parents with lower levels of education, among those unemployed or on sick leave, and those living in rural areas. In 62% of couples, at least one of the partners was overweight or obese; a positive partner correlation was also found for BMI (I). An interview study with 24 first-time parents (n=12♀, 12♂) revealed that they primarily undertook lifestyle changes to secure the health of the fetus in pregnancy, and to provide a healthy environment in childhood. Parents described themselves as highly receptive to information about how their lifestyle could influence fetal health, and they frequently discussed pregnancy risks related to tobacco and alcohol, as well as toxins and infectious agents in foods. However, parents did not seem inclined to make lifestyle changes primarily to promote their own health. The antenatal and child health care services were perceived as being mainly directed towards women, and parents described a lack of a holistic view of the family which included experiences of fathers being treated as less important (II). An interview study undertaken with professionals (n=23) in the Salut Programme pilot areas indicated programme sustainability at most sites, two years after implementation, although less adherence was described within child health care. Factors influencing programme sustainability, as described by professionals, were identified at multiple organisational levels (III). A before-and-after survey among professionals (n=144) measured outcomes of the county-wide implementation of the Salut Programme in 13 out of 15 county municipalities. Results showed significant improvements in professionals’ health promotion practices and collaboration across sectors. A number of important implementation facilitators and barriers, acting at different organizational levels, were also identified via a survey comprised of open-ended questions (IV). Conclusion: The Salut Programme, developed with high involvement of professionals, and strongly integrated in existing organisational structures and practices, shows potential for improving health promotion practices and cross-sectoral collaboration. The findings can inform further development of the Salut Programme.as well as new health promotion initiatives, and inform policy practice and future research. These aspects include approaches in health promotion and prevention, father involvement during pregnancy and early parenthood, and factors influencing implementation and sustainability of cross-sectoral health promotion programmes.
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| 5. |
- Eriksson, Maria, 1976-
(author)
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Creating customer value in commercial experiences
- 2009
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Licentiate thesis (other academic/artistic)abstract
- There is a type of business offering gaining much attention, both in the media and in financial figures, which provides the customer with something extra, something to be remembered. This offering is a commercial experience. It is claimed that commercial experiences are different from traditional industry and mass-production and even separated from goods and services. The possibility of creating something extraordinary in order to gain profit is of increasing interest in today’s business world. Consumers are seeking for experiences to reach a higher level of personal growth, an experience that create personal identity and lead to long-lasting memories. This is something an increasing amount of consumers are willing to pay money for - the commercial experience market. The purpose of this thesis is to contribute knowledge about and a deeper understanding of commercial experiences, both in general and especially with regard to how customer value is created. The focus of the research was also to strengthen and support organizations that offer commercial experiences. In order to fulfill the purpose, two case studies were conducted with different focal points. The first aimed to find best practice and explore excellent ways of working when providing commercial experiences. The second study aimed to identify the needs for improvement to strengthen organizations offering commercial experiences. According to my findings, there seems to be several distinctions between commercial experiences and goods and services. These include; the level of price, the time spent by the customer, the customer affect as strongly emotional and maybe most importantly, the finding that commercial experiences create a higher level of customer value than goods and services. All this proves that the commercial experience is to be considered an offering on its own, a refined customer offer of higher value. Since commercial experiences are said to engage customers in an inherently memorable way, reaching a higher level of customer value than goods and services, is seen as a critical factor. Understanding what the customer really wants, needs and what builds customer value when offering commercial experiences then become particularly important as drivers of success. When studying a particular organization for best practice, several similarities between providing commercial experiences and working according to the core values of TQM were found and established as a factor of business excellence. Further when it comes to providing commercial experiences storytelling, theming and a creative environment stood out as additional factors of business excellence. Moreover, selecting the right co-workers based on their values rather than merely their skills and academic qualifications was seen as an important factor of success. The co-worker is often the co-creator of the experience together with the customer and therefore has an important part to play in the organization. Creating a corporate culture with co-workers sharing the values is seen as essential in order to run a successful business. It appears that any type of organization can provide an experience for the customer, the key is adding on the extra value to reach the level of attractive quality. The commercial experience is described as deeply affecting both the feelings and senses of the customer, resulting in new memories; it is a memorable event the customer is willing to pay for. The commercial experience contains elements of engagement, personal relevance, novelty, surprise and learning and is not limited to certain types of businesses. The fact that this is an area of increasing business interest but as yet a poorly explored one indicates that there is a need to develop improved ways of working, tools and methods, tailor-made for providing commercial experiences. Improved tools for identifying customer expectations and measuring customer satisfaction are clearly needed, especially since this is a growing industry that cannot be ignored. Welcome to further explore the experience economy where new memories are so highly valued that people are prepared to pay for them!
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| 6. |
- Karlsson, Margareta
(author)
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Att styra mot uthållig organisatorisk samverkan i hälso- och sjukvårdsprocesser : Främjande och motverkande faktorer
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Svensk hälso- och sjukvård står inför utmaningar att möta ändrade behov, nya behandlingsmetoder och ny teknik. Genom samordning och samverkan antas kvaliteten för patienten kunna förbättras samtidigt som kostnader reduceras. Organisatorisk samverkan innebär att aktörer, över organisatoriska gränser, tillsammans försöker uppnå syftet med samverkan, t.ex. att underlätta vården av en patient eller patientgrupp i en vårdkedja. Reformer av styrningen har dock påverkat förutsättningarna för organisatorisk samverkan.Avhandlingen beskriver hur ökad förmåga att styra mot uthållig organisatorisk samverkan kan främja effektivare hälso- och sjukvårdsprocesser. I fyra studier utforskas hur några styrprinciper påverkat organisatorisk samverkan, vilka arbetssätt som kan motverka negativa konsekvenser av dessa styrprinciper och hur systematiskt förbättringsarbete ur ett systemperspektiv kan främja initiering, genomförande och utveckling av organisatorisk samverkan. Studierna utforskar olika former av samverkan; (I) intra-organisatorisk samverkan mellan en servicefunktion och vårdverksamheter, (II) inter-organisatorisk samverkan i en försörjningsprocess, (III) kunskapsutbyte i ett förbättringsarbete och (IV) hur ett marknadsbaserat begrepp som intern kund kan inverka på samverkan i en vårdprocess. Kvalitativa metoder har använts för insamling och analys av data, förutom olika typer av intervjuer även granskning av officiella dokument samt en strukturerad litteraturgenomgång och en konceptuell diskussion.Avhandlingen utforskar några styrprinciper som studierna indikerat kunna påverka organisatorisk samverkan. Strävan mot en sömlös vårdkedja kan motverkas av betoningen av gränser inom och mellan organisationer. Strävan efter ökad kvalitet baserat på bevis kan motverka ambitioner av ökad takt i förbättringsarbetet. Strävan efter ett gemensamt ansvarstagande i värdeskapande för patienten kan motverkas av interna marknader och en marknadsbaserad diskurs. Krav på kostnadskontroll kan motverka strävan mot systemövergripande kostnadseffektivitet och måleffektivitet. Arbetssätt som främjar uthållig organisatorisk samverkan baserad på tillit och ömsesidighet kan dock motverka de negativa konsekvenserna. Strukturerad kommunikation, incitament genom gemensamma mål och indikatorer, uppföljning av dem och utvärdering av samverkan kan främja pågående, nya och förnyade samverkansaktiviteter. Nedtoning av en marknadsbaserad diskurs och betoning av det ömsesidiga ansvaret kan synliggöra servicefunktionernas roll i värdeskapande för patienten. Avhandlingen visar också att organisatorisk samverkan kan främja förbättringsarbete och lärande i processer genom delande av kunskap inom och mellan funktioner och organisationer. Arbetssätt baserade på teorier om organisering, kvalitetsledning, systemtänkande och processledning kan stödja organisationerna vid initiering, genomförande och utveckling av samverkan inom och mellan organisationer.
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