| 11. |
- Huzzard, Tony, et al.
(author)
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System-Wide Change in Cancer Care: Exploring Sensemaking, Sensegiving and Consent
- 2014
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In: Research on Organizational Change and Development. - 0897-3016. ; 22
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Book chapter (peer-reviewed)abstract
- This article explores the symbolic aspects of change agency on a learning platform designed to facilitate system-wide transformation in cancer care. A sensemaking-sensegiving perspective is adopted to analyse the construction of meaning amongst of the leader of a regional cancer centre, senior physicians and an action research team in relation to patient-centred care. The analysis suggests that the physicians, as change agents, made sense of the vision from three quite distinct discourses in relation to the development effort. We argue that although meanings reconstructed in development initiatives may well be far from shared, this by no means implies that they are dysfunctional.
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| 12. |
- Kira, Mari, et al.
(author)
-
Sowing Seeds for Sustainability in Work Systems
- 2014
-
In: CSR, Sustainability, Ethics and Governance. - Berlin, Heidelberg : Springer Berlin Heidelberg. - 2196-7083 .- 2196-7075. ; , s. 57-81
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Book chapter (other academic/artistic)abstract
- The aim of this chapter is to suggest some ways in which the promotion of social and human sustainability at work may contribute positively to a work system’s ecological and economic sustainability. We also explore conceptual and practical ways to encourage the sustainability of social and human resources in contemporary working life. Throughout the chapter, we exemplify our arguments with case illustrations from the Skaraborg Hospital Group in Sweden. We discuss how the unwavering goals of protecting and regenerating various resources in work-system operations are critical hallmarks of a sustainable work system. We also outline some worldviews and ways of thinking that seem to underlie the operations of sustainable work systems. We then delineate the implications of the resource regeneration goals and sustainability-minded ways of thinking for work-system actors. Most importantly, we propose that sowing seeds for sustainability involves engaging co-workers with different knowledge and professional backgrounds in on-going learning dialogues concerning the actual development of the whole system.
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| 13. |
- Lifvergren, Svante, 1961, et al.
(author)
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Lessons from Sweden’s first large-scale implementation of Six Sigma in healthcare
- 2010
-
In: Operations Management Research. - : Springer Science and Business Media LLC. - 1936-9735 .- 1936-9743. ; 3:3-4, s. 117-128
-
Journal article (peer-reviewed)abstract
- The Skaraborg Hospital Group (SkaS) has implemented a variety of quality management initiatives in the last 20 years in accordance with its strategy of excelling at quality development to fulfill the needs and expectations of its patients. One such initiative is Six Sigma, which has contributed to more than 40 completed improvement projects. Using an action research approach, this article describes the lessons that were learned from the first 22 Six Sigma projects, completed between 2006 and 2008 and having a success rate of 75%. We further describe how these insights have contributed to other ongoing quality improvement activities at SkaS. In particular, the paper presents some key points not earlier described in other Six Sigma healthcare applications.
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| 14. |
- Lifvergren, Svante, 1961
(author)
-
Quality Improvement in Healthcare
- 2013
-
Doctoral thesis (other academic/artistic)abstract
- ABSTRACTThe Swedish healthcare system, although being one of the more efficientcare systems in the world with good medical outcomes at a moderate cost,faces tremendous future challenges. An ageing population with morepatients suffering from multiple diseases together with accelerating medicotechnical developments is putting increasing pressure on the system. The quality and safety of the system has also been called into question.Improvement science, where quality improvement theories and practices arecontinuously being translated to a healthcare context, has emerged as onepossible solution to these challenges. However, there is need for a furthertheoretical and practical development of the field.The purpose of the thesis is to explore quality improvement initiatives inhealthcare systems, suggesting alternative ways of improving quality andefficiency in healthcare organizations. The empirical material draws onleveraging events during two long-term improvement initiatives in thehealthcare system of Skaraborg in the Western region of Sweden. Theauthor, working as a development director at the Skaraborg hospital group(SkaS), played a major role in both cases as an inside action researcher. Thefirst case addresses a decade of development efforts that sought to improvecare for elderly people in West Skaraborg. The second case explores howquality management ideas at SkaS were used to improve quality, efficiencyand safety in hospital care from 2006 to 2008.The results of the research draw special attention to the importance ofmoving beyond the established static, linear step-for-step models for qualityimprovement, instead embracing a more open and processual view onimprovement. The thesis proposes that practices and theories from theaction research (AR) field in this respect are useful complements to theemerging field of improvement science. AR practices entail an approach thatenhances joint learning and reflection in iterative action-reflection cycles.Further, drawing from the vast repertoire of AR practices, cognitive,structural, networking, and procedural learning mechanisms are vitalingredients for quality improvement in complex healthcare systems.Learning mechanisms connect all parts of the system but they also supportindividual and organizational learning and action through new vocabularies,frameworks and concepts, procedures and tools.
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| 15. |
- Lifvergren, Svante, 1961, et al.
(author)
-
The path to sustainability in health care: Exploring the role of learning microsystems
- 2012
-
In: Organizing for Sustainable Effectiveness. - 2045-0613 .- 2045-0605. ; 2, s. 169-197
-
Book chapter (other academic/artistic)abstract
- Purpose – This chapter examines the developmental journey toward a sustainable health care system in the West of Skaraborg County in Sweden from 2008 to the present by proposing and illustrating the concept of a clinical microsystem to capture the work of a mobile team to care for elderly people with multiple diseases in its embedded context. Design – An action research approach was adopted that entailed four researchers, one of whom was also a health care practitioner, engaging in iterative dialogues with the mobile team. This aimed at catalyzing joint learning in repeated action-reflection cycles at least three times a year over a period of 3 years. Data from patient databases were also drawn upon as additional resources for reflection. Findings – The outcome of the initial periods of the team’s work in the microsystem dramatically improved the care of these patients, significantly increasing quality of life and stabilizing their medical situation. It has also led to decreased resource utilization, not just by the team, but elsewhere in the wider health system. Originality/value – We draw on and develop the concept of clinical microsystems to argue that such systems have a team at their core, but their work practices and patient outcomes require us to look beyond the team itself and take into account its interactions with patients and actors in the wider health care system. We also draw on the framework of Christensen, Grossman, and Hwang (2009) to propose that each microsystem has three distinct value configurations, namely shops, a chain, and a network. In terms of design, we suggest that the clinical microsystem can be seen as a parallel learning structure to that of the established health care bureaucracy.
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| 16. |
- Olsson, Erik, 1977, et al.
(author)
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Community collaboration to increase foreign-born women’s participation in a cervical cancer screening program in Sweden: a quality improvement project
- 2014
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In: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 13:1, s. 62-72
-
Journal article (peer-reviewed)abstract
- Introduction: The prevailing inequities in healthcare have been well addressed in previous research, especiallyscreening program participation, but less attention has been paid to how to overcome these inequities. This paperexplores a key factor of a successful improvement project: collaboration with local doulas to raise cervical cancerscreening participation by more than 40 percent in an area with a large number of foreign-born residents.Methods: Data was collected through two focus group discussions with the doulas in order to designinterventions and debrief after interventions had been carried out in the community. Various tools were used toanalyze the verbal data and monitor the progress of the project.Results: Three major themes emerged from the focus group discussions: barriers that prevent women fromparticipating in the cervical cancer screening program, interventions to increase participation, and the role of thedoulas in the interventions.Conclusions: This paper suggests that several barriers make participation in cervical cancer screening programmore difficult for foreign-born women in Sweden. Specifically, these barriers include lack of knowledge concerningcancer and the importance of preventive healthcare services and practical obstacles such as unavailable child careand language skills. The overarching approach to surmount these barriers was to engage persons with a sharedcultural background and mother tongue as the target audience to verbally communicate information. The doulaswho helped to identify barriers and plan and execute interventions gained increased confidence and a sense ofpride in assisting to bridge the gap between healthcare providers and users.
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| 17. |
- Yet, Barbaros, et al.
(author)
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Decision support system for Warfarin therapy management using Bayesian networks
- 2013
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In: Decision Support Systems. - : Elsevier BV. - 0167-9236. ; 55:2, s. 488-498
-
Journal article (peer-reviewed)abstract
- Warfarin therapy is known as a complex process because of the variation in the patients' response. Failure to deal with such variation may lead to death as a result of thrombosis or bleeding. The possible sources of variation such as concomitant illnesses and drug interactions have to be investigated by the clinician in order to deal with the variation. This paper describes a decision support system (DSS) using Bayesian networks for assisting clinicians to make better decisions in Warfarin therapy management. The DSS is developed in collaboration with a Swedish hospital group that manages Warfarin therapy for more than 3000 patients. The proposed model can assist the clinician in making dose-adjustment and follow-up interval decisions, investigating variation causes, and evaluating bleeding and thrombosis risks related to therapy. The model is built upon previous findings from medical literature, the knowledge of domain experts, and large dataset of patients.
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