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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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- Ghazawneh, Ahmad
(author)
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Towards a Boundary Resources Theory of Software Platforms
- 2012
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Doctoral thesis (other academic/artistic)abstract
- The last few years have witnessed a significant increase in the frequency and magnitude of involving third-party application developers in software platforms. While this involvement offers great opportunities in building and sustaining platform innovation, it also exposes platform owners to significant challenges. Typically, platform owners facilitate the involvement of third-party developers by providing resources, referred to in this thesis as boundary resources, that give access to the platform, shift design capability, and facilitate the use of the platform’s core technologies. At the same time, these resources have the potential to be used to maintain platform control. This involves seemingly conflicting goals that creates a challenge for platform owners in finding the right balance.The main objective of this thesis is to investigate and understand the role of boundary resources in platform owners’ efforts to stimulate third-party development. To this end, this thesis proposes a theoretical model of boundary resources. This model centres on various drivers behind boundary resources design and use, and how these drivers interact in third-party development. The thesis also presents a comprehensive view of governance and strategizing practices used by platform owners through boundary resources. This thesis comprises a cover and a collection of five published research papers. The thesis applies a qualitative research method and employs multiple case studies. Boundary resources, innovation networks and platform governance perspectives have been synthesized to build a theoretical basis to analyze the empirical findings.This thesis complements and extends the literature on software platforms, and the insights derived from the thesis enhance previous research on third-party development. In addition, it provides a focused theoretical account of the interfaces between platform owners and third-party developers that contributes to the body of knowledge developed around using tools for innovation.
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| 12. |
- Gäre, Klas, 1948-, et al.
(author)
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An analysing model
- 2004
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In: The Roles of IT. - Linköping : Linköping University.
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Book chapter (other academic/artistic)
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- Gäre, Klas, 1948-, et al.
(author)
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Empowering health care professionals by IS education : Enhancing reflective empowerment
- 2010
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In: Proceedings of the 18th European Conference on Information Systems (ECIS) 2010. - 9780620471725
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Conference paper (peer-reviewed)abstract
- The paper presents findings from a research study of an information systems master program in Sweden, targeting healthcare professionals. The aim of the study was to explore if and how mechanisms of empowerment and reflective practice can be evoked in healthcare professionals by participating in a master program in information systems. A mixed research methodology was applied, including participant observation, document analysis and a learning style inventory. The findings of the study showed signs of the students achieving a higher degree of empowerment in their professional roles, as well as beginning to actively use reflective practice as a means of professional development. The findings are summarised in a tentative framework of reflective empowerment. The findings call for further research on how IT-centred master programs targeting healthcare professional could enhance professional development.
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| 18. |
- Gäre, Klas, et al.
(author)
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Formative Infrastructure for ICT-adoption in SME’s : A Study of Conditions for Progress
- 2008
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In: Proceedings of the 16<sup>th</sup> European Conference on Information Systems. - Galway, Ireland : National University of Ireland. - 9780955315923 ; , s. 1082-1093
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Conference paper (other academic/artistic)abstract
- The focus in this paper is on conditions for ICT use in SMEs expressed as formative infrastructure. Questions concern needs for infrastructure among SMEs, actors roles, and concepts constituting a formative infrastructure for ICT-adoption and use. Few – if any – studies, take the perspective of SMEs’ needs for infrastructure concerning use of ICT. A formative ICT infrastructure is constituted by the identified needs among SMEs, and it contains three parts; (1) sensemaking, (2) sensegiving, and (3) service infrastructures. In SMEs there is less of infrastructure and less of overhead services and these are to be found outside the SME. The adoption processes in SMEs differ from the ones in larger enterprises. ICT adoption is the process where the formative infrastructure is maintained as well as changed by actors enacting this context. SMEs rely more on external relations in a public infrastructure. In dividing ICT infrastructure into two major areas – hard and formative infrastructure, the results indicate that, both are important, but formative ICT infrastructure in SMEs is a less known and a less elaborated concept. When analyzing the need for formative ICT infrastructure, three types, emerge – sensemaking infrastructure, sensegiving infrastructure, and service infrastructure, as three cornerstones of a formative ICT-infrastructure.
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| 20. |
- Gäre, Klas, et al.
(author)
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Formative Infrastructure for IT-Adoption : Understanding the Dynamics of IT-Use in SME’s
- 2010
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In: Sprouts Working Papers on Information Systems. - Amsterdam : Sprouts. - 1535-6078. ; 10:67, s. 1-34
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Journal article (peer-reviewed)abstract
- IT has considerable importance for productivity increase and growth. IT use requires a lot of resources to create value. Few, if any, studies, take the perspective of SMEs' needs for infrastructure concerning use of IT. As resources are more limited in smaller enterprises, and the contexts and conditions for IT use in SMEs are not well known. Formative infrastructure is a way of understanding cognitive and technical arrangements needed for IT adoption and use, depending on IT resources crossing organizational boundaries. The purpose is to study conditions for IT-use in SMEs for a better understanding of how a formative infrastructure contributes to enterprises. The methodological point of departure and approach in this study is qualitative and explorative. More than 60 interviews are performed within a geographical region. Questions concern needs for infrastructure among SMEs, actors roles, and concepts constituting a formative infrastructure for IT adoption and use. Data was analyzed for similarities and patterns into themes and topics. A theoretical framework for formative infrastructure is presented as a multi theory lens for developing the concept of formative infrastructure. A formative IT infrastructure is constituted by the identified needs among SMEs, and it contains three parts; (1) sensemaking, (2) senegiving, and (3) service infrastructures. Formative IT infrastructure in SMEs is not a well known concept, concerning IT use in SME's. The need of for formative infrastructure in sensemaking IT adoption and use in SME's rely on external partners and other actors for sensemaking and sensegiving processes. Further research is needed for better understanding of actors and roles as well as arenas for sensemaking IT in SMEs. The emphasis on infrastructure for IT adoption processes will help SME's to more relevant investments.
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| 28. |
- Gäre, Klas, 1948-, et al.
(author)
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SME’s Need Formative Infrastructure for Business Transformation
- 2011
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In: Journal of Enterprise Information Management. - : Emerald Group Publishing Limited. - 1741-0398 .- 1758-7409. ; 24:6, s. 520-533
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Journal article (peer-reviewed)abstract
- Purpose – ICT has considerable importance for increasing productivity and growth. Using ICT requires resources to create value. As resources are more limited in smaller enterprises, and the contexts and conditions for using ICT in SMEs are not well known, the purpose is to investigate conditions in the context of sensemaking for ICT adoption and use among SMEs.Design/methodology/approach – This study uses a qualitative and explorative methodological point of departure and approach. More than 60 interviews are performed within a geographical region. Empirical data were analyzed for similarities and patterns into themes and topics.Findings – The article was able to highlight the conditions for using ICT in SMEs by applying a qualitative research approach. The important findings from this research as a formative ICT infrastructure can be viewed as constituted by needs identified among SMEs, in sensemaking, sensegiving, and service infrastructures. In SMEs there are less infrastructure and fewer overhead and support services than in larger enterprises. The adoption processes in SMEs differ from the ones in larger enterprises in that they rely more on external relations in a public infrastructure for sensemaking in ICT adoption and use.Research limitations/implications – Formative ICT infrastructure in SMEs is not a well-known concept. The need for formative infrastructure in ICT adoption and use in SMEs relies on external partners and other actors in the sensemaking and sensegiving processes. Further research is needed for understanding actors and roles better, as well as arenas for sensemaking ICT in SMEs.Practical implications – Designing the infrastructure for ICT use and development, particularly in SMEs, but also in other enterprises and organizations, requires better understanding of the conditions. The emphasis on infrastructure for ICT adoption processes will help SMEs to receive more relevant investments.Originality/value – The study integrates micro- and macro-perspectives and combines theories from different fields to extend the knowledge of formative infrastructure for SME's adoption and use of ICT in terms of firm size and dependency on public infrastructure.
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| 29. |
- Gäre, Klas, et al.
(author)
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Sociomaterial actors in the assimilation gap : a case study of web service, management and IT-assimilation
- 2013
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In: Information Systems and E-Business Management. - Berlin : Springer Berlin/Heidelberg. - 1617-9846 .- 1617-9854. ; 11:4, s. 481-506
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Journal article (peer-reviewed)abstract
- This paper investigates the conditions for the assimilation of information systems (IS) and information technology (IT) in organizations and the influence of various actors in the organization and eBusiness context. To do so it draws on the literature on assimilation gap, sociomateriality and infrastructure together with a study of implementation and use of information and communication technology in and among organizations in a Swedish region. There were substantial investments in web infrastructure made on a regional level and the focus of this study is how the investments were transformed and assimilated in practices, relations and communication. Based on the empirical data from the case study, the paper extends the assimilation process into interplay among actors in organizations contexts. It describes organizations' strategies for coping with their needs for information and the actors in these processes. Two categories of actors are identified, sensemaking and sensegiving actors, as most important in assimilation of IS/IT in organizations. A sociomaterial perspective gives guidance and a better understanding of the assimilation process in terms of knowledge and interpretative frames, and how assimilation involves identity construction and negotiations among sensemaking and sensegiving actors. The contribution of this paper is a better understanding of the context of assimilation and adaptation of IT in organizations' business processes, and steps to be taken to improve readiness.
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| 31. |
- Gäre, Klas, 1948-
(author)
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Tre perspektiv på förväntningar och förändringar i samband med införande av informationssystem
- 2003
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Doctoral thesis (other academic/artistic)abstract
- Vad är det vi inte upptäcker i implementeringsprojekt? Varför? Vilka är skälen till oväntade och oplanerade konsekvenser? Det finns inga enkla samband mellan satsningar på IT och t ex produktivitet. För att bättre förstå dessa samband behövs begrepp och teorier för att beskriva dem. Införande och användning av IS genererar förändringar i handlingar, rutiner och sociala processer. Både när vi genomför och ser tillbaka på systemimplementeringar brukar utgångspunkten vara planeringsperspektivet: planering, riskanalys och uppföljning mot plan. Detta perspektiv förbiser t ex ofta skilda förväntningar på förändring som kan omkullkasta projektplanerna, lärande i organisationer och aktörsgruppers betydelse i projektet. I studien prövas därför tre olika perspektiv för beskrivning och analys. De tre perspektiven handlar om att betrakta processen från tre utgångspunkter för att nå en bättre förståelse för oväntade förändringar och avvikelser som inträffar i samband med införande och användning av stora system som berör många människor. Tre perspektiv ger en god bild av processen, dess innehåll och dynamik och i studien fångas vad som rör sig i människors tankar och hur detta inverkar vid interaktion med kollegor, medarbetare, partners m fl. Tre perspektiv ger också tydlighet åt samverkan mellan teknik i form av stora datasystem och användande människor.Planeringstraditionsperspektivet fokuserar på aktiviteter i förhållande till planen: uppföljning av planen, avvikelser från planen, hur den kan förbättras och framgångsfaktorer i lyckade projekt. Detta var det dominerande perspektivet hos aktörerna i fallstudien.Struktureringsperspektivet ser individen som en del i ett socialt sammanhang av meningsskapande, dominering och legitimerande. Perspektivet lyfter fram hur aktörers olika föreställningar om verksamheten, förändring och den egna rollen i helheten ger upphov till handlingar och konsekvenser som ofta är annorlunda än de som finns i krav- och projektdokument.I aktörsnätverksperspektivet, står handlingar i centrum, handlingar som utförs av aktörer, som relaterar till andra aktörer i nätverk. Aktörer är inte bara människor, utan även mänskliga skapelser som affärssystem. Centralt är aktörers drivande av intressen och hur de försöker värva och låter sig värvas till nätverk.Avhandlingen ger rika bilder av perspektiven på implementering och användning, med skilda förklaringar och förståelser av processen att implementera och använda ett affärssystem, och av skillnader mellan förväntningar och inträffade förändringar. Användning av affärssystem påverkar verksamheten i hög grad. Det förändrar individerna in i nya arbetssätt eller håller kvar gamla trots behov av ständiga förbättringar. Avhandlingen ger grund för nya sätt att kommunicera i införandeprojekt, visar skillnader i intressen och föreställningar tillsammans med olika förutsättningar för styrning och styrbarhet, tecknar systemet som medaktör mer än tekniskt verktyg.
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| 33. |
- Keller, Christina, 1961-, et al.
(author)
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Designing for Complex Innovations in Health Care : Design Theory and Realist Evaluation Combined
- 2009
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In: Proceedings of DESRIST '09 the 4th International Conference on Design Science Research in Information Systems and Technology 2009 in Malvern, PA, USA. - : ACM.
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Conference paper (peer-reviewed)abstract
- Innovations in health care are often characterized by complexity and fuzzy boundaries, involving both the elements of the innovation and the organizational structure required for a full implementation. Evaluation in health care is traditionally based on the collection and dissemination of evidence-based knowledge stating the randomized controlled trial, and the quasi-experimental study design as the most rigorous and ideal approaches. These evaluation approaches capture neither the complexity of innovations in health care, nor the characteristics of the organizational structure of the innovation. As a result, the reasons for innovations in health care not being disseminated are not fully explained. The aim of the paper is to present a design – evaluation framework for complex innovations in health care in order to understand what works for whom under what circumstances by combining design theory and realist evaluation. The framework is based on research findings of a case study of a complex innovation, a health care quality register, in order to understand underlying assumptions behind the design of the innovation, as well as the characteristics of the implementation process. The design - evaluation cycle is hypothesized to improve the design and implementation of complex innovation by using program/kernel theories to develop design propositions, which are evaluated by realistic evaluation, resulting in further refinement of program/kernel theories. The goal of the design – evaluation cycle is to provide support to implementers and practitioners in designing and implementing complex innovations in health care. As a result, the design – evaluation cycle could provide opportunities of improving dissemination of complex innovations in health care.
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| 35. |
- Keller, Christina, 1961-, et al.
(author)
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Innovations in health care : Design theory and realist evaluation combined
- 2010
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Other publication (other academic/artistic)abstract
- Innovations in health care are often characterized by complexity and fuzzy boundaries, involving both the elements of the innovation and the organizational structure required for a full implementation. Evaluation in health care is traditionally based on the collection and dissemination of evidence-based knowledge stating the randomized controlled trial, and the quasi-experimental study design as the most rigorous and ideal approaches. These evaluation approaches capture neither the complexity of innovations in health care, nor the characteristics of the organizational structure of the innovation. As a result, the reasons for innovations in health care not being disseminated are not fully explained. The aim of the paper is to present a design-evaluation framework for complex innovations in health care in order to understand what works for whom under what circumstances combining design theory and realist evaluation. The framework is based on research findings of a case study of a complex innovation, a health care quality register, in order to understand underlying assumptions behind the design of the innovation, as well as the characteristics of the implementation process. The design-evaluation cycle is hypothesized to improve the design and implementation of complex innovation by using program/kernel theories to develop design principles, which are evaluated by realistic evaluation, resulting in further refinement of program/kernel theories. The goal of the design-evaluation cycle is to provide support to implementers and practitioners designing and implementing complex innovations in health care, for improving dissemination of complex innovations.
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| 37. |
- Svensson, Anders, et al.
(author)
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Online Participation with Obstacles : Non-Willingness to Become Facebook fans of a Health-Promoting Web Site
- 2011
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In: Merz. - 0176-4918. ; :6, s. 70-80
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Journal article (other academic/artistic)abstract
- Within dominant branches of contemporary research and public debate, applications like Facebook and Twitter are perceived as social media for user participation. Technical possibilities and socio cultural restrictions for user involvement are identified and discussed. Common to both perspectives is that users’ willingness to participate tends to be taken for granted. By studying a case where the users’ response indicates weak willingness to participate, despite the website producers’ efforts to offer social media for participation, this article wish to contribute to a better understanding of the conditions for online participation on the so-called social Web.UMO is a very popular Swedish health promoting website intended for offering adolescents knowledge and advisory service on sexual, reproductive and psychical health. In 2010 UMO extended the use of social media by opening a Facebook fan page. One of the reasons was to attract new segments of the target audience, another was to make adolescents become fans. More than a year after the start, none of this have developed in accordance with the intentions and expectations. Analyses of data, gained from a content analysis of UMO’s Facebook fan page besides completing interviews with the administrator of the fan page and adolescent users of UMO, indicates a whole set of possible explanations for UMO’s shortcomings.The study shows on yet another problem with uncritically asserting that the new Web 2.0 and social media benefit participation. What has been overlooked is that obstacles to participation might as well be sought from the participants themselves, and be an active choice by the audience. The bottom line is that mediatization does not describe a fait accompli, and that socio-cultural change in its wake in no way is universal, but rather is characterized by a set of particularities.
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