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- Bergerum, Carolina, 1967-, et al.
(författare)
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Patient involvement in quality improvement - a 'tug of war' or a dialogue in a learning process to improve healthcare?
- 2020
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Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Co-production and co-design approaches to quality improvement (QI) efforts are gaining momentum in healthcare. Yet, these approaches can be challenging, not least when it comes to patient involvement. The aim of this study was to examine what might influence QI efforts in which patients are involved, as experienced by the patients and the healthcare professionals involved.METHODS: This study involved a qualitative design inspired by the constructivist grounded theory. In one mid-sized Swedish hospital's patient process organisation, data was collected from six QI teams that involved patients in their QI efforts, addressing care paths for patients with transient, chronic and/or multiple parallel diagnoses. Field notes were collected from participant observations during 53 QI team meetings in three of the six patient processes. Individual, semi-structured interviews were conducted with 12 patients and 12 healthcare professionals in all the six QI teams.RESULTS: Patients were involved in QI efforts in different ways. In three of the QI teams, patient representatives attended team meetings regularly. One team consulted patient representatives on a single occasion, one team collected patient preferences structurally from individual interviews with patients, and one team combined interviews and a workshop with patients. The patients' and healthcare professionals' expressions of what might influence the QI efforts involving patients were similar in several ways. QI team members emphasized the importance of organisational structure and culture. Furthermore, they expressed a desire for ongoing interaction between patients and healthcare professionals in healthcare QI.CONCLUSIONS: QI team members recognised continuous dialogue and collective thinking by the sharing of experiences and preferences between patients and healthcare professionals as essential for achieving better matches between healthcare resources and patient needs in their QI efforts. Significant structural and cultural aspects of performing QI in complex hospital organisations were considered to be obstructions to progress. Therefore, to sustain learning and behaviour change through QI efforts at the team level, a deeper understanding of how structural and cultural aspects of QI promote or prevent success appears essential.
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| 3. |
- Fallman, Sara L., et al.
(författare)
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Managerial approaches for maintaining low levels of sick leave: A qualitative study
- 2022
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 30:7, s. 3546-3552
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of this study was to identify first-line managers' approaches for maintaining low levels of sick leave among health care employees. Introduction One challenge in health care is the high level of sick leave among employees. High work demands and conflicting pressures characterize the work situation of both employees and first-line managers, with potential negative effects on work-related health. Method First-line managers at units with low and/or decreasing sick leave were interviewed. Thematic analysis was used to analyse the data. Results The managers took a holistic approach in meeting their employees' broader needs, and they were balancing high organisational demands through insubordination. To keep sick leave rate low, they created possibilities for the employees to influence their own working life through a present, visible and trustful leadership. Conclusion Managers responsible for units with low sick leave seemed to utilize a holistic approach with focus on their employees and prioritized needs of their employees before organisational demands from top management. Implications for nursing management First-line managers in health care can have impact on sick leave among their employees and create good working conditions, despite pressure from their superiors.
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