| 1. |
- Alverbratt, Catrin, et al.
(författare)
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The process of implementing a new working method - a project towards change in a Swedish psychiatric clinic
- 2014
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Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 3:6, s. 174-189
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Tidskriftsartikel (refereegranskat)abstract
- The implementation of evidence-based methods in hospital settings is difficult and complex. The aim of the present study was to highlight the implementation process concerning a new working method, i.e. a new assessment tool, based on the International Classification of Functioning Disability and Health (ICF), among psychiatric nursing staff on five participating wards at a Swedish county hospital. Descriptive, qualitative data were collected through focus group interviews pre- and post-implementation. Data were analysed using directed content analysis, guided by Normalization Process Theory (NPT). The results revealed that just one of the five participating wards met the criteria for a successful implementation process. The results confirm previous studies showing the difficulty of implementation. Although participants agreed with the intention of the model, they were reluctant to apply it in practice. The implementation process seemed to be influenced by factors such as: time pressure; heavy workload; stress; lack of routines in using the tool; lack of nursing staff; as well as cultural characteristics and resistance to change.
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| 2. |
- Andreasson, Jörgen, et al.
(författare)
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The importance of healthcare managers’ organizational preconditions and support resources for their appraisal of planned change and its outcomes
- 2017
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Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 6:1, s. 25-33
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Tidskriftsartikel (refereegranskat)abstract
- Background: Healthcare managers are expected to lead and manage planned organizational change intended to improve healthcare process quality. However, their complex working conditions offer limited decision control, and healthcare managers often feel ill prepared and inadequately supported to perform their duties. Healthcare managers have previously described their need for organizational support, but we lack knowledge of the preconditions and resources that help managers implement planned change. Methods: This prospective cohort study examined healthcare managers at three Swedish hospitals implementing lean production and two Swedish hospitals implementing their own improvement model. Questionnaire data from 2012, 2103, and 2014 were used in following up. We used t-tests and a linear mixed model design in analysing the data. Results: Healthcare managers who perceived strong support from managers, employees, colleagues, and the organization and managers with the longest managerial experience had the least negative appraisal of change. Managers who perceived strong support from employees, management, and the organizational structure perceived higher levels of healthcare process quality. Conclusions: Long managerial experience and strong support from managers, employees, and the organization are important for managers’ appraisal of, work on, and successful implementation of planned change. Top management must therefore ensure that the healthcare managers have sufficient managerial experience and support before they delegate to them the responsibility to implement planned change.
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| 3. |
- Björngren Cuadra, Carin
(författare)
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Irregular migrants challenging policy hierarchies and health professions : the case of Sweden
- 2012
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Ingår i: Journal of Hospital Administration. - : Sciedu. - 1927-6990 .- 1927-7008. ; 1:2, s. 34-41
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Tidskriftsartikel (refereegranskat)abstract
- In a European comparative perspective Sweden, though upholding a universal welfare model is one of the most restrictive countries as regards irregular migrants’ right to access health care. They do not access care via the legal framework beyond emergency care upon payment of the full cost. This article presents findings from a study aiming at exploring and elucidating the Swedish policy answers as regards right to access health care for irregular migrants. The current policy is outlined besides a new governmental agreement and standpoints put forward by health and welfare professionals. The analysis suggests that migration policy has primacy over health policy. Further, it suggests, that by claiming that their jurisdiction is independent from the state’s interest of control of migration the hierarchy is renegotiated. The core involves the fundamental norms and principles underpinning the exclusion of irregular migrants from welfare services and their connection to controlled migration.
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| 4. |
- Bååthe, Fredrik, 1968, et al.
(författare)
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Physician experiences of patient-centered and team-based ward rounding – an interview based case-study
- 2014
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Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 3:6, s. 127-142
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Tidskriftsartikel (refereegranskat)abstract
- Background: Rounding has long traditions within hospital-based healthcare, as a way to organize the ward-based part of the care and cure process. Despite an increased emphasis on patient participation, there has been limited research exploring physician experiences of actually applying these principles to the ward round. Aim: To explore physician experiences after changing to a patient-centered and team-based ward round, in an internal medicine department at a Swedish mid-size hospital. Methods: Qualitative exploratory case-study. Semi-structured interviews with 13 physicians (six consultants, three residents, four interns) have been carried out. All interviews have been transcribed and analyzed by qualitative method. Results: The traditional relationship of superiority and subordination, embodied by the patient lying down in bed and the physician standing over the bed, was one essential change in the new ward round. Physicians experienced that less hierarchical relationships with patients, combined with working in a multi-professional team, contributed to betterinformed clinical decisions, fewer follow-up questions from patients, and increased professional fulfilment. However, physicians also experienced that their autonomy was being reduced, and there was uneasiness about exposing potential knowledge gaps in front of others. Conclusions: This qualitative study of physician experiences finds that patient-centered and team-based ward rounds is a fertile development journey forward. Also important to notice are the seemingly new and paradoxical findings that despite the introduction of the “right” ward round structure, negative experiences emerged as unwanted side effects to the positive experiences reported. It could be beneficial for leaders in healthcare (both managers and physicians) to consider these results to facilitate future ward round initiatives.
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| 5. |
- Dellve, Lotta, 1965, et al.
(författare)
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Open, transparent management and the media: The managers’ perspectives
- 2017
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Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 6:2, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Delivery of health care service (HCSs) is a public issue in Sweden. Managers’ decisions and strategies are expected to be open to debate, investigation and scrutiny by the media. There is, however, little knowledge about how managers at local level communicate with the media. The aim of this study is to present an empirically grounded conceptual model of how operative health care managers perceive and handle media communication in open, transparent management of public HCSs. Methods: A grounded theory approach was adopted including in-depth and follow-up interviews with 45 managers, and complemented with open-ended questions that were answered by the majority of municipal top managers of public HCSs in Sweden (n = 161). Results: Communicating with the media were interacting in spite of unequal logics and conditions regarding openness in communicating. In managers response to media misrepresentation (inaccurate, narrow and skewed reporting) of the often complex and value-laden issues of HCSs they put highlighted dignity, correctness regarding facts, and protection of integrity. Managers’ approaches were to mobilize individual and organizational resources in order to support openness and reduce uncertainties, through crafting managerial hardiness and organizational robustness, and over the longer term, by building authentic openness through awareness, control and acceptance of the conditions. Conclusions: In conclusion, handling the media can be challenging owing to different logics for reporting, but the media plays a vitally important role in the transparency of the management. Dealing with the pressure of media attention can either have negative consequences or contribute to more open and authentic internal and external communication.
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| 6. |
- Erichsen Andersson, Annette, 1966, et al.
(författare)
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Improving care in surgery – a qualitative study of managers’ experiences of implementing evidence-based practice in the operating room
- 2015
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Ingår i: Journal of Hospital Administration. - 1927-6990 .- 1927-7008. ; 4:4, s. 73-83
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Tidskriftsartikel (refereegranskat)abstract
- Background: More knowledge is needed on the preconditions and circumstances for leading implementation of evidence based practice in the operating room (OR). Effective leadership support is critical to enhance the provision of safer care. The aim of this study was to explore managers’ and clinical leaders’ experiences of implementing evidence-based practice to increase patient safety in the operating room. Methods: The study had a qualitative descriptive design. In all, 25 managers were interviewed, with different surgical specialities (orthopedics, general and pediatric surgery) and operating room suites, from eight hospitals and 15 departments. Results: The organizational structures were defined as key obstacles to implementation. Specifically, lack of a common platform for cooperation between managers from different departments, organizational levels and professional groups impeded the alignment of shared goals and directions. In cases where implementation was successful, well-functioning and supportive relationships between the managers from different professions and levels were crucial along with a strong sense of ownership and control over the implementation process. Whilst managers expressed the conviction that safety was an important issue that was supported by top management, the goal was usually to “get through” as many operations as possible. This created conflicts between either prioritizing implementation of safety measures or production goals, which sometimes led to decisions that were counter to evidence-based practice (EBP). While evidence was considered crucial in all implementation efforts, it might be neglected and mistrusted if hierarchical boundaries between professional subgroups were challenged, or if it concerned preventive innovations as opposed to technical innovations. Conclusions: The preconditions for implementing EBP in the OR are suboptimal; thus addressing leadership, organizational and interprofessional barriers are of vital importance.
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| 7. |
- Erichsen Andersson, Annette, 1966, et al.
(författare)
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Understanding value-based healthcare – an interview study with project team members at a Swedish university hospital
- 2015
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Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 4:4, s. 64-72
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study is to explore how representatives from four project teams understand the concept of value-based healthcare (VBHC), since each representative is responsible for one of the pilot projects implementing VBHC at a University hospital in Sweden. A qualitative design was used to gain understanding of VBHC. Open-ended interviews were used as the data-collection method and content analysis of the transcribed interviews was carried out. Participants’ understanding of VBHC focused on how value was created for the patient and on measuring medical outcomes and costs, although costs were to some extent put aside. To measure value for the patients, it was the health professionals’ perspective about what patient should value that dominated the understanding of the concept VBHC. VBHC was understood as a strategy to strengthen value innovations and to loosen the grip of economic control. Benchmarking was seen as a future possibility to develop value innovations. Changes in organizational culture were understood by participants as a need to change healthcare from being professional-centred to patient-centred. The way the concept was understood omits parts of the original concept. This has implications for whether or not the concept as it is described by the participants should be understood as VBHC according to the intentions of the strategy described. The development of outcome measures was predominantly based on the health professionals’ experiences, which is why the patients’ perspective needs to be strengthened. Further studies of the process of implementing VBHC are needed.
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| 8. |
- Karlsson, Susanne, et al.
(författare)
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Decisive situations influencing continuous positive airway pressure initiation in patients with obstructive sleep apnea syndrome – A critical incident technique analysis from the personnel’s perspective
- 2015
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Ingår i: Journal of Hospital Administration. - Richmond Hill, ON, Canada : Sciedu Press. - 1927-6990 .- 1927-7008. ; 4:1, s. 16-26
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Tidskriftsartikel (refereegranskat)abstract
- Background: Continuous positive airway pressure is an effective treatment of obstructive sleep apnea syndrome, but adherence to treatment is low. Interventions such as encouragement, education and cognitive behavioural therapy have affected adherence to continuous positive airway pressure treatment positively. Currently there are no studies regarding the situation for personnel during the initiation process of treatment.Purpose: The purpose was to describe situations influencing the initiation of continuous positive airway pressure in patients with obstructive sleep apnea syndrome from a personnel perspective.Materials and methods: A qualitative approach using critical incident technique was used. Data were collected through semi structured interviews. Thirty one informants were strategically selected from sixteen centres in Sweden.Results: Motivation, a prepared patient, communicational aspects and participation of family were described as pedagogical circumstances. External conditions, practical experience, the patient’s state of health and adaption to the mask were described as practical circumstances. The personnel handled the situations in a theoretical, practical and/or an emotional way.Conclusions: A better understanding of situations creating barriers or being facilitators, as well as ways to handle these situations, can be used to develop the role of personnel during the initiation process in order to increase continuous positive airway pressure adherence.
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| 9. |
- Lindskog, Pernilla, et al.
(författare)
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Lean in healthcare : Engagement in development, job satisfaction or exhaustion?
- 2016
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Ingår i: Journal of Hospital Administration. - : Sciedu press. - 1927-6990 .- 1927-7008. ; 5:5, s. 91-105
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Tidskriftsartikel (refereegranskat)abstract
- Conclusions about implementing the management concept lean in healthcare are contradictory and longitudinal studies are scarce. In particular, little is known of how working conditions contribute to the sustainability of lean in healthcare. The aim of this article is to identify to what extent lean tools (visual follow-up boards, standardised work, 5S [housekeeping], and value stream mapping [VSM]) promote working conditions for employees and managers in healthcare organisations (outcomes: engagement in development, job satisfaction and exhaustion), while considering the context (i.e., job resources and job demands) and aspects of the implementation process. A longitudinal quantitative study was conducted that involved employees and managers in two hospitals and one municipality (n = 448). Applying the job demands-resources model, multiple linear regression models were used. VSM, standardised work and 5S promoted employees and managers’ working conditions when supported by job resources. When no support was provided, visual follow-up boards were inhibiting employees and managers’ job satisfaction. VSM and standardised work were seen as central lean tools. In this sample, the application of lean cannot be considered sustainable as employees and managers’ working conditions deteriorated under the implementation of lean.
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| 10. |
- Mangafic, Samra, et al.
(författare)
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Communication in intensive care units and cardiac wards : A literature review and personal experiences
- 2019
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Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 8:1
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Forskningsöversikt (refereegranskat)abstract
- Background: Physicians are regularly confronted with a wide range of settings requiring good communication skills. Deficient communication is the main reason for patient complaints.Methods: A literature review and personal experiences of communication techniques used by physicians in intensive care units and cardiac wards.Results: Good communication can increase medical adherence and motivate patients to life-style changes and therefore improve outcomes, resolve or prevent conflicts, increase patients’ satisfaction with offered health care, decrease anxiety and depressive symptoms, instill hope and also make hospital staff feel better. Conclusions: In this article, different models aiming at achieving optimal results in diverse communication situations are described. Healthcare leaders and medical educators should encourage physicians to use the communication techniques presented in this review to optimize the interaction with patients, relatives and colleagues.
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| 11. |
- McGonagle, AK, et al.
(författare)
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Management Commitment to Safety, Teamwork, and Hospital Worker Injuries
- 2016
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Ingår i: Journal of hospital administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 5:6, s. 46-52
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Tidskriftsartikel (refereegranskat)abstract
- Although many studies link teamwork in health care settings to patient safety, evidence linking teamwork to hospital worker safety is lacking. This study addresses this gap by providing evidence linking teamwork perceptions in hospital workers to worker injuries, and further, finds a linkage between manager commitment to safety and teamwork. Organizational records of worker injuries and survey responses regarding management commitment to safety and teamwork from 446 hospital workers within 42 work units in a multi-site hospital system were examined. Results underscored the particular importance of teamwork on worker injuries as well as the importance of management commitment to safety as relating to teamwork. To improve worker safety, organizational leaders and unit managers should work to maintain environments wherein teamwork can thrive.
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| 12. |
- Nilsson, Kerstin, 1947, et al.
(författare)
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Leading implementation of the management innovation value-based healthcare at a Swedish University Hospital
- 2017
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Ingår i: Journal of Hospital Administration. - 1927-6990 .- 1927-7008. ; 6:1, s. 51-59
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study is to explore medical and care staff’s experiences of leading the implementation of the management innovation, named value-based healthcare (VBHC) at a large Swedish University Hospital. Methods: In this study an explorative design was used. Data was collected with individual open-ended repeated interviews with 20 members of four teams leading the implementation of VBHC. The interviews were transcribed verbatim and qualitatively analysed. Results: Findings from this interview study showed that not all participants were comfortable with being appointed as leaders for the VBHC implementation process. Some found it rather too challenging instead. Participants described characteristics such as openness, visibility, approachability, and the ability to be a role model as necessary when leading implementation work. Leadership strategies emphasized were participation and involvement but also the ability to control implementation processes. Anchoring was effectuated by means of a pedagogical approach including dialogues and feedback before making step-by-step changes in everyday work itself. Conclusions: This study shows that leadership is a challenging experience in the context of a team responsible for implementing VBHC, however commendable the management innovation in itself may be. The expectations connected to the leadership role in the context of VBHC implementation must be clarified. Awareness is needed of the extent of the mandates accorded to the care and medical staff appointed as leaders of VBHC teams, especially since care and medical staff are formally speaking not as managers.
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| 13. |
- Nyman, Tove, et al.
(författare)
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Workshifting – to manage shortage of nurses at a medical department in Western part of Sweden
- 2019
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Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-7008 .- 1927-6990. ; 8:2, s. 21-29
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Tidskriftsartikel (refereegranskat)abstract
- Background: Workshifting is a new model for redistributing tasks due to the shortage of health professionals such as registered nurses (RNs). Therefore, this study aim to describe registered nurses' experiences with workshifting in a medical ward at a university hospital in Sweden.Methods: Manifest qualitative content analysis with an inductive approach was used based on seven semi-structured interviews with RNs working in a medical ward at Sahlgrenska University Hospital in Gothenburg, Sweden.Results: One category, communication skills for increased cooperation, and three subcategories, Manage different skills, Changed work content and Lack of holistic nursing, were described. A healthy work environment (reasonable workload, interesting work tasks/content) is an important factor for attracting health professionals such as RNs.Conclusion: Workshifting redistributes tasks to added staff members such as pharmacists and assistant nurses, which decreases the RN workload; however, task-oriented work results in the lack of a holistic view of nursing. Moreover, enlarged teams need well-developed communication arenas to ensure patient safety and efficient work organization.
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| 14. |
- Parnell, Alan, et al.
(författare)
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COVID-19 a health reform catalyst? — Analyzing single-payer options in the U.S.: Considering economic values, recent proposals, and existing models from abroad
- 2020
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Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 9:4, s. 10-19
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Tidskriftsartikel (refereegranskat)abstract
- The United States has continued to face severe health coverage and spending challenges that have been attributed to a fragmented multi-payer and fee-for-service delivery system which has become even more exposed by the COVID-19 pandemic. Legislators and healthcare professionals have tried to answer the challenges faced by the U.S. health system through the introduction of several state and federal proposals for a “Medicare-for-all” like system, which have failed to be adopted likely due to the lack of consideration for free-market economic values. Looking to existing models abroad can provide the U.S. with different ways to understand how to achieve the benefits of single-payer models with universal coverage while maintaining the integrity of free-market values. The health systems in wealthy, industrialized countries are closely referenced in this article because of the variation of methods in which each achieves a single-payer/universal coverage model as well as the contrast in their health outcomes compared to that of the U.S. The biggest considerations for any reform effort to achieve an efficient single-payer system with universal coverage is the maintenance of private health insurers and the degree to which expanded government influence would be accepted. The future state of health care remains uncertain and unstable as a result of the COVID-19 pandemic, therefore a window of opportunity exists now for leveraging this uncertainty to achieve reform.
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| 15. |
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| 16. |
- Rosengren, Kristina, et al.
(författare)
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Characteristic of person-centered care as documented in medical records at a medical department – a mixed methods.
- 2019
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Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 8:2, s. 7-13
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Few studies describe characteristics of content of person-centrered care (PCC) in hospital care. Therefore, this study aim to describe and compare documentation in medical records regarding content of PCC for two diagnostic groups; Chronic Obstructive Pulmonary Disease (COPD) and Chronic Heart Failure (CHF) at a medical department in a hospital in Sweden.Methods: Documentation within medical records (n = 121) regarding content of PCC (patient resources, responsibility, i.e. partnership) were analysed by a mixed methods.Results: The results describe documented healthcare activities (medical records) among patients (COPD1 = 88; CHF2 = 33) treated at medical wards practicing PCC (n = 69, 391/302) and traditional medical wards (n = 52, 491/32). The study showed limited documentation in all medical records regardless of care; however, patients with CHF have higher documentation regarding content of PCC compare to COPD in 6 (symptoms, home situation, objectives, caring activities, patients resources, continuing care) out of 7 areas (planning processes).Conclusions: To improve healthcare with limited resources, there is need to switch mind-sets from what (diagnosis) to who (resources) using all evidence (expert=scientific to expert=lived experiences) by collecting narratives to facilitate mutual health plans (partnership). This change in healthcare organisation facilitates by transformative and shared leadership to improve teamwork (health professionals, patient, relative) in partnership with all involved.
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| 17. |
- Strömgren, Marcus
(författare)
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Intention to leave among health care professionals : The importance of working conditions and social capital
- 2017
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Ingår i: Journal of Hospital Administration. - : Sciedupress. - 1927-6990 .- 1927-7008. ; 6:3, s. 58-66
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Tidskriftsartikel (refereegranskat)abstract
- Hospitals in Sweden are redesigning their care processes to increase efficiency. However, related to these changes, there is a risk of increased staff intention to leave and turnover due to increased workload and work pace. The literature on work engagement and job demands and resources suggests that specific job resources can buffer negative effects; i.e., intention to leave because of job demands. Social capital is suggested to have the potential to be a resource associated with staff intention to leave. The aim of this study was to investigate the associations between social capital and intention to leave and to test if social capital moderates the relationship between job demands and intention to leave. A sample of five hospitals working under conditions of improvements of care processes were studied using a questionnaire administered to the healthcare clinicians (n = 849). High levels of social capital were associated with low levels of intention to leave. However, the moderating effect of social capital was not confirmed. Intention to leave among occupational groups was influenced differently by social capital, other job resources, and job demands.
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| 18. |
- Unnarsdottir, Magnea, et al.
(författare)
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Call me, later! Patients’ experiences of Swedish healthcare call-back services and access to healthcare
- 2018
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Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 7:5, s. 8-16
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Despite the wide use of telephone call-back services in Swedish healthcare, there has been little research on how it affects patients. This study explores individual experiences of a call-back service, concentrating on barriers to healthcare, and healthcare-seeking behavior. Methods: The study was conducted at Angered Hospital and Angered Primary Care Rehabilitation Center in Gothenburg, Sweden. Ten informants, 28-82 years old, who had used the call-back service participated in interviews about their experience of the call-back service. Thematic analysis was used to analyze data from the interviews. Results: Three themes were identified in the analysis: (1) features and functions of the call-back service; (2) the call-back service as a barrier to or facilitator of healthcare; and (3) adjustments to the call-back service. Most informants were content with the call-back function. Negative experiences were related to language difficulties and the length of time allowed during the phone call. Lack of available appointments and telephone access were problems reported. Informants suggested a longer time frame for calls, longer opening hours regarding telephone access, more language and voicemail options, and the possibility of speaking to a person. Conclusions: Informants in this study mostly had a positive impression of seeking healthcare using call-back services. Barriers related to language and time frame for calls could be explored in larger studies. The results from this explorative study suggests that a combination of approaches – with other options added to the call-back services - might increase equal access to health care. The use and effects of call-back services warrant further investigation.
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| 19. |
- Williamsson, Anna, 1981-, et al.
(författare)
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Organization of change agents during care process redesign in Swedish health care
- 2016
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Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 5:3, s. 20-32
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Tidskriftsartikel (refereegranskat)abstract
- Background: Swedish health care organizations (HCOs) are changing using management concepts such as Lean, in attempts of improving efficiency, quality of care and work environment. Since there are pre-conditional challenges for operative managers to engage in change, HCOs tend to assign supportive functions such as change agents (CAs) to facilitate change. Research on the use of CAs in HCOs is sparse, thus the aim of this study explores role assignments and conditions of formally appointed CAs contributing to care process redesign.Methods: A purposive sample of three Swedish hospitals initiating Lean-inspired care process redesign during 2010–2011 was done. In-depth interviews were held with fifty-one key functions during change. Focus group interviews were conducted with thirty-eight health care professionals. Data were analysed by content analysis.Results: Top managers’ goal was to have operative management responsible for change during care process redesign, with support from assigned CAs. Organizing of CAs varied concerning, e.g. their hierarchical positions, job descriptions and practices, and conditions to act as driving forces towards change. Being granted formal power, having earned legitimacy and credibility, clarity regarding roles and responsibilities in change; a good sense of timing and ability to build relationships and trust, were identified as beneficial for CAs to support change.Conclusions: Role assignment and organizing of CAs varies. A position closer to the operative levels, formalized and clarified responsibilities, earned legitimacy and timing support adaptation and alignment of planned change, such as Lean-inspired care process redesign.
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| 20. |
- Wrigstad, Jonas, et al.
(författare)
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Incident investigations by the regulatory authority of Swedish healthcare - a 20-year perspective
- 2015
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Ingår i: Journal of Hospital Administration. - : Sciedu Press. - 1927-6990 .- 1927-7008. ; 4:6, s. 68-76
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The purpose of this study was to describe procedural changes in hospital incident investigations and show the consequences of these changes over time. Methods: A two-stage method was used. First component of the study was a content analysis of 87 incident investigations conducted 1995-2014 by the regulatory authority after adverse events in a Swedish university hospital. Second component was conducting semi-structured interviews with 11 investigators from all regulatory authority regional offices in Sweden. Results: In a minority of incident investigations, where further demands for action were required by the regulatory authority, a major portion of these were aimed at the micro-level. A plan for follow-up was expressed in only one tenth of the investigations. All investigators had a background from the healthcare system and saw this as advantageous. Their personal memory was claimed to be the only tool when referring to previous cases. Less fieldwork, more office work and more uniformity of language were recognised changes in comparison over time. The role of doing “auditing” was the most common description by the investigators themselves. Conclusions: The micro-level focus of the investigations reflected an organisational structure within the regulatory authority. We saw signs of parallel system weaknesses within the Swedish healthcare system with a clear absence of formalised organisational memory and a malfunctioning follow-up system of incident investigations. This can be seen both regarding the healthcare providers and the regulatory authority. The reports from the qualitative interviews data indicated that “auditing at the office” was considered the main occupation in incident investigations conducted by the regulatory authority.
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| 21. |
- Fröst, Peter, 1954
(författare)
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Administrative workplaces in healthcare: Designing an efficient and patient-focused environment
- 2016
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Ingår i: Journal of Hospital Administration. - 1927-7008. ; 5:4/2016
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Tidskriftsartikel (refereegranskat)abstract
- The article presents an “Evidence-Based Concept Program” for the administrative workplaces in healthcare. Several studies show that Swedish doctors and nurses use about half their working time on administrative work. Despite this, very little attention has been given to the design of administrative workplaces in healthcare. Although healthcare focuses on detailed functional planning of their clinical areas, administrative workplaces are typically designed very traditionally, supporting hierarchical and downpipe organisations. Consequently, they are not always supportive of today’s healthcare needs, which focus on teamwork around the involved and informed patient. This makes provision of healthcare less efficient and patient friendly. However, new technologies and new ways of working means that the conditions for administrative/office work have changed drastically in recent decades. It is therefore time to seek inspiration from other sectors of society so as to rethink healthcare design. Conclusive report findings indicate that a changed approach needs to be introduced to the design of administrative workspaces. Mapping exercises of existing conditions show low utilisation of non-care-related administrative workplaces. These workplaces can be made more efficient by organising the plan according to activity-based usage and thereby reducing the area needed. Included survey also indicate that the degree of utilisation of administrative workplaces close to patients is relatively high. The report concludes that patient-related administrative workplaces need to be developed further through adding new room types and number of functions. Unused space can be redistributed to care located closer to patients, as the need is greater and this will help promote work efficiency. However, the design of new and more activity-based administrative workplaces in healthcare relies heavily on the introduction of new portable and seamless information and communication technology (ICT)-systems.
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