| 1. |
- Abrahamsen Grøndahl, Vigdis, 1964-, et al.
(author)
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Exploring patient satisfaction predictors in relation to a theoretical model
- 2013
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In: International Journal of Health Care Quality Assurance. - : Emerald Group Publishing Limited. - 0952-6862 .- 1758-6542. ; 26:1, s. 37-54
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Journal article (peer-reviewed)abstract
- The aim is to describe patients' care quality perceptions and satisfaction and to explore potential patient satisfaction predictors as person‐related conditions, external objective care conditions and patients' perception of actual care received (“PR”) in relation to a theoretical model.Design/methodology/approachA cross‐sectional design was used. Data were collected using one questionnaire combining questions from four instruments: Quality from patients' perspective; Sense of coherence; Big five personality trait; and Emotional stress reaction questionnaire (ESRQ), together with questions from previous research. In total, 528 patients (83.7 per cent response rate) from eight medical, three surgical and one medical/surgical ward in five Norwegian hospitals participated. Answers from 373 respondents with complete ESRQ questionnaires were analysed. Sequential multiple regression analysis with ESRQ as dependent variable was run in three steps: person‐related conditions, external objective care conditions, and PR (p < 0.05).FindingsStep 1 (person‐related conditions) explained 51.7 per cent of the ESRQ variance. Step 2 (external objective care conditions) explained an additional 2.4 per cent. Step 3 (PR) gave no significant additional explanation (0.05 per cent). Steps 1 and 2 contributed statistical significance to the model. Patients rated both quality‐of‐care and satisfaction highly.Originality/valueThe paper shows that the theoretical model using an emotion‐oriented approach to assess patient satisfaction can explain 54 per cent of patient satisfaction in a statistically significant manner.
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| 2. |
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| 3. |
- Andersson, Maria, 1969-, et al.
(author)
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Oral care : identifying quality improvement areas
- 2019
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In: International Journal of Health Care Quality Assurance. - : Emerald Group Publishing Limited. - 0952-6862 .- 1758-6542. ; 32:1, s. 45-58
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Journal article (peer-reviewed)abstract
- Purpose: To describe and compare nurses' and healthcare assistants' oral care qualityperceptions, including perceived reality and subjective importance, to identify improvementareas in intensive care and short-term care, and to explore potential nursing satisfactionpredictors regarding oral care.Design/methodology/approach: Swedish staff, 154 within intensive care and 278 withinshort-term care responded to a modified Quality of Care from a Patient Perspectivequestionnaire. Descriptive and analytical statistics were used.Findings: Staff scored oral care quality both high and low in relation to perceived reality andsubjective importance. Improvement areas were identified, despite high satisfaction valuesregarding oral care. Setting, subjective importance, and perceived reality explained 51.5% ofthe variance in staff satisfaction regarding oral care quality.Practical implications: Quality improvements could guide oral care development.Originality/value: This study describes oral care by comparing nurse perceptions of howimportant they perceive different oral care aspects and to what extent these oral care aspectsare performed.
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| 4. |
- Bastholm Rahmner, Pia, et al.
(author)
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Physicians perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system
- 2004
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In: International journal of health care quality assurance incorporating leadership in helath services. - : Emerald. - 1366-0756 .- 2051-3135. ; 17:4, s. 173-179
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Journal article (peer-reviewed)abstract
- Seeks to identify physicians' perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system. Details a descriptive, qualitative study, with semi-structured individual interviews of 21 physicians in the Accident and Emergency Department of South Stockholm General Hospital. Identifies four descriptive categories for possibilities and obstacles. Concludes that gaining access to patient drug history enables physicians to carry out work in a professional way – a need the computerised prescription support system was not developed for and thus cannot fulfil. Alerts and producer-independent drug information are valuable in reducing workload. However, technical prerequisites form the base for a successful implementation. Time must be given to adapt to new ways of working.
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| 5. |
- Björkman, Ingeborg, et al.
(author)
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Developing the role of the drug and therapeutics committees : Perceptions of chairs
- 2007
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In: International Journal of Health Care Quality Assurance. - : Emerald. - 0952-6862. ; 20:2, s. 161-178
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Journal article (peer-reviewed)abstract
- Purpose – According to Swedish law, every county is required to have a local drug and therapeutics committee (DTC) to contribute to safe and cost-effective drug use. The law presents merely a framework and gives no detailed instructions addressing, for example, organisation and methods. The aim of this study is to explore the variation of conceptions of the role of the DTCs among committee Chairs and to compare the results with an earlier study. Design/methodology/approach – Data were collected by questionnaires and telephone interviews with committee chairs, which were analysed using a phenomenographic approach. Findings – Four conceptions were identified, namely: traditional, patient-aware, influential, holistic and cooperative, which all involved prescribers. In one conception the DTC acted as an expert to decision-makers. One conception included the notion that cooperation across the bureaucratic borders was important. Patients were involved in two conceptions. Comparison with the earlier study showed a trend toward higher patient awareness and a higher agreement on DTC goals with an increased focus on quality issues. Originality/value – This study demonstrates an alternative research method bringing in new perspectives when exploring activities within healthcare. Patient involvement in the work of the DTCs is increasing, but should be further explored and developed.
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| 6. |
- Björkman, Ingeborg, et al.
(author)
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The role of drug and therapeutics committees : Perceptions of chairs and information officers
- 2005
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In: International Journal of Health Care Quality Assurance. - : Emerald. - 0952-6862. ; 18:4, s. 235-48
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Journal article (peer-reviewed)abstract
- Purpose – Improved quality and safety in drug use is a public health goal of major importance. In Sweden, local drug and therapeutics committees (DTCs) have adopted the task of working for safe and rational drug use. This study aimed to explore how chairs conceived the role of the DTCs, to explore how information officers conceived their own role, and to determine whether the respondents included patients in their answers. Design/methodology/approach – Data were collected using questionnaires and the answers were analysed according to phenomenographic method to identify conceptions. “Patient awareness” was studied by content analysis. Findings – In both groups the prescribers were the focus of attention, and only a few respondents mentioned patients. A variation of four conceptions was found among chairs and three among information officers. It would be beneficial if DTCs used this knowledge in their development. Originality/value – The importance of “patient awareness” within DTCs must be further explored.
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| 7. |
- Bunkenborg, Gitte, et al.
(author)
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Bedside vital parameters that indicate early deterioration
- 2019
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In: International Journal of Health Care Quality Assurance. - 0952-6862. ; 32:1, s. 262-272
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Journal article (peer-reviewed)abstract
- Purpose: The purpose of this paper is to determine associations between initially recorded deviations in individual bedside vital parameters that contribute to total Modified Early Warning Score (MEWS) levels 2 or 3 and further clinical deterioration (MEWS level=4). Design/methodology/approach: This was a prospective study in which 27,504 vital parameter values, corresponding to a total MEWS level⩾2, belonging to 1,315 adult medical and surgical inpatient patients admitted to a 90-bed study setting at a university hospital, were subjected to binary logistic and COX regression analyses to determine associations between vital parameter values initially corresponding to total MEWS levels 2 or 3 and later deterioration to total MEWS level ⩾4, and to evaluate corresponding time intervals. Findings: Respiratory rate, heart rate and patient age were significantly (p=0.012, p<0.001 and p=0.028, respectively) associated with further deterioration from a total MEWS level 2, and the heart rate also (p=0.009) from a total MEWS level 3. Within 24 h from the initially recorded total MEWS levels 2 or 3, 8 and 17 percent of patients, respectively, deteriorated to a total MEWS level=4. Patients initially scoring MEWS 2 had a 27 percent 30-day mortality rate if they later scored MEWS level=4, and 8.7 percent if they did not. Practical implications: It is important to observe all patients closely, but especially elderly patients, if total MEWS levels 2 or 3 are tachypnoea and/or tachycardia related. Originality/value: Findings might contribute to patient safety by facilitating appropriate clinical and organizational decisions on adequate time spans for early warning scoring in general ward patients.
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| 8. |
- Carlström, Eric
(author)
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Middle managers on the slide
- 2012
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In: Leadership in Health Services. - : Emerald. - 1751-1879 .- 1751-1887 .- 0952-6862. ; 25:2, s. 90-105
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Journal article (peer-reviewed)abstract
- Purpose– This article aims to examine middle managers in health care and how their role has changed in times of fiscal constraints. It seeks to focus particularly on how cost savings influence the position of middle managers in the organisation between governance and advocacy pressure.Design/methodology/approach– A total of 25 Swedish middle managers from public health care organisations during fiscal constraints were interviewed about what contributes to their positioning in the organisation.Findings– The loyalty of middle managers is tested in the "in between" role. Excessive loyalty, in any direction, can distance a middle manager from their expected position. In times of a weakening economy, middle managers are expected to be a tool that is used by the management to communicate savings, personnel reductions, redundancies and closures. This contributes to middle managers sliding out of their role in between.Practical implications– Middle managers' skills are within care itself. In times of cost savings, demands are placed on their ability to handle advanced management tasks. They need to gain a clearer insight into management control, understanding conflict management and leadership.Originality/value– The article explains not only why middle managers slide up (take on governance roles) and down (take on advocacy roles) in the organisation, which has been described previously. It also explains why middle managers slide out (abdicate responsibility) of the role between governance and advocacy during times of fiscal limitations.
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| 9. |
- Cregård, Anna, 1971, et al.
(author)
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Perceptions of trust in physician-managers
- 2015
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In: Leadership in Health Services. - : Emerald Group Publishing Limited. - 1751-1879 .- 1751-1887 .- 0952-6862. ; 28:4, s. 281-297
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Journal article (peer-reviewed)abstract
- Purpose – The purpose of this paper is to explore the dual role of physician-managers through an examination of perceptions of trust and distrust in physician-managers. The healthcare sector needs physicians to lead. Physicians in part-time managerial positions who continue their medical practice are called part-time physician-managers. This paper explores this dual role through an examination of perceptions of trust and distrust in physician-managers. Design/methodology/approach – The study takes a qualitative research approach in which interviews and focus group discussions with physician-managers and nurse-managers provide the empirical data. An analytical model, with the three elements of ability, benevolence and integrity, was used in the analysis of trust and distrust in physician-managers. Findings – The respondents (physician-managers and nurse-managers) perceived both an increase and a decrease in physicians’ trust in the physician-managers. Because elements of distrust were more numerous and more severe than elements of trust, the physician-managers received negative perceptions of their role. Research limitations/implications – This paper’s findings are based on perceptions of perceptions. The physicians were not interviewed on their trust and distrust of physician-managers. Practical implications – The healthcare sector must pay attention to the diverse expectations of the physician-manager role that is based on both managerial and medical logics. Hospital management should provide proper support to physician-managers in their dual role to ensure their willingness to continue to assume managerial responsibilities. Originality/value – The paper takes an original approach in its research into the dual role of physician-managers who work under two conflicting logics: the medical logic and the managerial logic. The focus on perceived trust and distrust in physician-managers is a new perspective on this complicated role.
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| 10. |
- Dahlin, Sara, 1980, et al.
(author)
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Relationship between patient costs and patient pathways
- 2019
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In: International Journal of Health Care Quality Assurance. - 0952-6862. ; 32:1, s. 246-261
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Journal article (peer-reviewed)abstract
- Purpose – The purpose of this paper is to identify actual (as-is) patient pathway variation among breast cancer patients and to investigate the relationship between pathways and the cost incurred by patients. Design/methodology/approach – Both quantitative and qualitative methods were employed to analyze data from four Swedish hospital groups. Quantitative methods include event-log data mining and statistical analyses on the related patient cost from the Swedish breast cancer quality registry and case-costing system. Qualitative methods included collaboration with and interviewing domain experts. Findings – Unique pathways, followed by only one patient, were generally costlier than the most and less frequent pathways. Earlier study findings are confirmed for mastectomy patients, withmore frequent pathways having a lower cost, whereas contradicting and inconclusive results emerged for the partial mastectomy patient groups. Highest variation in pathways was identified for patients receiving chemotherapy. Practical implications – The common belief – if one follows a standardized patient pathway, then the cost will be lower – should be re-examined based on the actual pathways that occur in reality. Originality/value – The relationships between patient pathways and patient cost allow more complex insights, beyond the general causal relationship between successfully implementing a “to-be” care pathway and lower cost. This highlights data-driven research’s importance, where actual pathways (as-is) provide more useful information than to-be care pathways.
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