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  • 1
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    Online Resource
    Implementing organisation and management innovations in Swedish healthcare : Lessons from a comparison of 12 cases
    Emerald ; 2012
    In:  Journal of Health Organization and Management Vol. 26, No. 2 ( 2012-05-18), p. 237-257
    Details
    In: Journal of Health Organization and Management, Emerald, Vol. 26, No. 2 ( 2012-05-18), p. 237-257
    Abstract: The purpose of this paper is to compare the implementation of 12 different organisation and management innovations (OMIs) in Swedish healthcare, to discover the generic and specific factors important for successful healthcare improvement change in a public health system. Design/methodology/approach Longitudinal cross‐case comparison of 12 case studies was employed, where each case study used a common framework for collecting data about the process of change, the content of the change, the context, and the intermediate and final outcomes. Findings Clinical leaders played a more important part in the development of these successful service innovations than managers. Strategies for and patterns of change implementation were found to differ according to the type of innovation. Internal organisational context factors played a significant role in the development of nearly all, but external factors did not. “Developmental evolution” better described the change process than “implementation”. Research limitations/implications The 12 cases were all of relatively successful change processes: some unsuccessful examples would have provided additional testing of the hypotheses about what would predict successful innovation which were used in the case comparison. The cross‐case comparative hypothesis testing method allows systematic comparison if the case data are collected using similar frameworks, but this approach to management research requires considerable resources and coordination. Practical implications Management innovations that improve patient care can be carried out successfully by senior clinicians, under certain circumstances. A systematic approach is important both for developing and adapting an innovation to a changing situation. A significant amount of time was required for all involved, which could be reduced by “fast‐tracking” approval for some types of change. Originality/value This is the first empirical report comparing longitudinal and contextualised findings from a number of case studies of different organisational and management healthcare innovations. The findings made possible explanations for success factors and useful practical recommendations for conditions needed to nurture such innovation in public healthcare.
    Type of Medium: Online Resource
    ISSN: 1477-7266
    URL: Article
    DOI: 10.1108/14777261211230790
    Language: English
    Publisher: Emerald
    Publication Date: 2012
    detail.hit.zdb_id: 2109532-2
    SSG: 3,2
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  • 2
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    Online Resource
    Perceived Organizational Problems in Health Care : A Pilot Test of the Structured Problem and Success Inventory
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Quality Management in Health Care Vol. 21, No. 2 ( 2012-04), p. 93-103
    Details
    In: Quality Management in Health Care, Ovid Technologies (Wolters Kluwer Health), Vol. 21, No. 2 ( 2012-04), p. 93-103
    Type of Medium: Online Resource
    ISSN: 1063-8628
    URL: Article
    DOI: 10.1097/QMH.0b013e31824d18ff
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 2093170-0
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  • 3
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    Managers do it their way: How managers act in a decentralised healthcare services provider organisation – a mixed methods study
    SAGE Publications ; 2022
    In:  Health Services Management Research Vol. 35, No. 4 ( 2022-11), p. 215-228
    Details
    In: Health Services Management Research, SAGE Publications, Vol. 35, No. 4 ( 2022-11), p. 215-228
    Abstract: Purpose: Decentralisation is considered a way to get managers more committed and more prone to respond to local needs. This study analyses how managers perceive a decentralised management model within a large public healthcare delivery organisation in Sweden. Design/methodology/approach: A programme theory evaluation was performed applying direct content analysis to in-depth interviews with healthcare managers. Balance score card data were used in a blinded comparative content analysis to explore relations between performance and how the delegated authority was perceived and used by the managers. Findings: Managers’ perceptions of the decentralised management model supported its intentions to enable the front-line to make decisions to better meet customer needs and flexibly adapt to local conditions. The managers appreciated and used their delegated authority. Central policies and control on human resources and investments were accepted as those are to the benefit of the whole organisation. Leadership development and organisation-wide improvement programmes were of support. Units showing high organisational performance had proactive managers, although differences in manager perceptions across units were small. Originality: This, one of the first of its kind, study of a decentralisation in service delivery organisation shows a congruence between the rationale of a management model, the managers’ perceptions of the authority and accountability as well as management practises. These observations stemming from a large public primary and community healthcare organisation has not, to our knowledge, been reported and provide research-informed guidance on decentralisation as one strategy for resolving challenges in healthcare service delivery organisations.
    Type of Medium: Online Resource
    ISSN: 0951-4848 , 1758-1044
    URL: Article
    DOI: 10.1177/09514848211065467
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2035604-3
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  • 4
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    Sense-Making, Mutual Learning and Cognitive Shifts When Applying Systems Thinking in Public Health – Examples From Sweden Comment on "What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health"
    Maad Rayan Publishing Company ; 2020
    In:  International Journal of Health Policy and Management ( 2020-07-05)
    Details
    In: International Journal of Health Policy and Management, Maad Rayan Publishing Company, ( 2020-07-05)
    Abstract: It is widely acknowledged that systems thinking (ST) should be implemented in the area of public health, but how this should be done is less clear. In this commentary we focus on sense-making and double-loop learning processes when using ST and soft systems methodology in research collaborations with policy-makers. In their study of policymakers’ experiences of ST, Haynes et al emphasize the importance of knowledge processes and mutual learning between researchers and policy-makers, processes which can change how policy-makers think and thus have impact on real-world policy concerns. We provide some additional examples from Sweden on how ST has been applied to create learning and shared mental models among stakeholders and researchers in national and regional healthcare development initiatives. We conclude that investigating and describing such processes on micro-level can aid the knowledge on how to implement ST in public health.
    Type of Medium: Online Resource
    ISSN: 2322-5939
    URL: Article
    DOI: 10.34172/ijhpm.2020.106
    Language: English
    Publisher: Maad Rayan Publishing Company
    Publication Date: 2020
    detail.hit.zdb_id: 2724317-5
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  • 5
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    Digital Health Technologies Enabling Partnerships in Chronic Care Management: Scoping Review
    JMIR Publications Inc. ; 2022
    In:  Journal of Medical Internet Research Vol. 24, No. 8 ( 2022-8-1), p. e38980-
    Details
    In: Journal of Medical Internet Research, JMIR Publications Inc., Vol. 24, No. 8 ( 2022-8-1), p. e38980-
    Abstract: An increasing number of patients expect and want to play a greater role in their treatment and care decisions. This emphasizes the need to adopt collaborative health care practices, which implies collaboration among interprofessional health care teams and patients, their families, caregivers, and communities. In recent years, digital health technologies that support self-care and collaboration between the community and health care providers (ie, participatory health technologies) have received increasing attention. However, knowledge regarding the features of such technologies that support effective patient-professional partnerships is still limited. Objective This study aimed to map and assess published studies on participatory health technologies intended to support partnerships among patients, caregivers, and health care professionals in chronic care, focusing specifically on identifying the main features of these technologies. Methods A scoping review covering scientific publications in English between January 2008 and December 2020 was performed. We searched PubMed and Web of Science databases. Peer-reviewed qualitative, quantitative, and mixed methods studies that evaluated digital health technologies for patient-professional partnerships in chronic care settings were included. The data were charted and analyzed thematically. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist was used. Results This review included 32 studies, reported in 34 papers. The topic of participatory health technologies experienced a slightly increasing trend across publication years, with most papers originating from the United States and Norway. Diabetes and cardiovascular diseases were the most common conditions addressed. Of the 32 studies, 12 (38%) evaluated the influence of participatory health technologies on partnerships, mostly with positive outcomes, although we also identified how partnership relationships and the nature of collaborative work could be challenged when the roles and expectations between users were unclear. Six common features of participatory health technologies were identified: patient-professional communication, self-monitoring, tailored self-care support, self-care education, care planning, and community forums for peer-to-peer interactions. Conclusions Our findings emphasize the importance of clarifying mutual expectations and carefully considering the implications that the introduction of participatory health technologies may have on the work of patients and health care professionals, both individually and in collaboration. A knowledge gap remains regarding the use of participatory health technologies to effectively support patient-professional partnerships in chronic care management.
    Type of Medium: Online Resource
    ISSN: 1438-8871
    URL: Article
    DOI: 10.2196/38980
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2022
    detail.hit.zdb_id: 2028830-X
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  • 6
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    Agile, a guiding principle for health care improvement?
    Emerald ; 2015
    In:  International Journal of Health Care Quality Assurance Vol. 28, No. 5 ( 2015-6-8), p. 468-493
    Details
    In: International Journal of Health Care Quality Assurance, Emerald, Vol. 28, No. 5 ( 2015-6-8), p. 468-493
    Abstract: – The purpose of this paper is to contribute to increased understanding of the concept agile and its potential for hospital managers to optimize design of organizational structures and processes to combine internal efficiency and external effectiveness. Design/methodology/approach – An integrative review was conducted using the reSEARCH database. Articles met the following criteria: first, a definition of agility; second, descriptions of enablers of becoming an agile organization; and finally, discussions of agile on multiple organizational levels. In total, 60 articles qualified for the final analysis. Findings – Organizational agility rests on the assumption that the environment is uncertain, ranging from frequently changing to highly unpredictable. Proactive, reactive or embracive coping strategies were described as possible ways to handle such uncertain environments. Five organizational capacities were derived as necessary for hospitals to use the strategies optimally: transparent and transient inter-organizational links; market sensitivity and customer focus; management by support for self-organizing employees; organic structures that are elastic and responsive; flexible human and resource capacity for timely delivery. Agile is portrayed as either the “new paradigm” following lean, the needed development on top of a lean base, or as complementary to lean in distinct hybrid strategies. Practical implications – Environmental uncertainty needs to be matched with coping strategies and organizational capacities to design processes responsive to real needs of health care. This implies that lean and agile can be combined to optimize the design of hospitals, to meet different variations in demand and create good patient management. Originality/value – While considerable value has been paid to strategies to improve the internal efficiency within hospitals, this review raise the attention to the value of strategies of external effectiveness.
    Type of Medium: Online Resource
    ISSN: 0952-6862
    URL: Article
    DOI: 10.1108/IJHCQA-04-2014-0044
    Language: English
    Publisher: Emerald
    Publication Date: 2015
    detail.hit.zdb_id: 2010023-1
    SSG: 3,2
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  • 7
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    Online Resource
    What Happened to the No-Wait Hospital? A Case Study of Implementation of Operational Plans for Reduced Waits
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Quality Management in Health Care Vol. 21, No. 1 ( 2012-01), p. 34-43
    Details
    In: Quality Management in Health Care, Ovid Technologies (Wolters Kluwer Health), Vol. 21, No. 1 ( 2012-01), p. 34-43
    Type of Medium: Online Resource
    ISSN: 1063-8628
    URL: Article
    DOI: 10.1097/QMH.0b013e3182418113
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 2093170-0
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  • 8
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    Online Resource
    How can technology support quality improvement? Lessons learned from the adoption of an analytics tool for advanced performance measurement in a hospital unit
    Springer Science and Business Media LLC ; 2020
    In:  BMC Health Services Research Vol. 20, No. 1 ( 2020-12)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2020-12)
    Abstract: Technology for timely feedback of data has the potential to support quality improvement (QI) in health care. However, such technology may pose difficulties stemming from the complex interaction with the setting in which it is implemented. To enable professionals to use data in QI there is a need to better understand of how to handle this complexity. This study aims to explore factors that influence the adoption of a technology-supported QI programme in an obstetric unit through a complexity informed framework. Methods This qualitative study, based on focus group interviews, was conducted at a Swedish university hospital’s obstetric unit, which used an analytics tool for advanced performance measurement that gave timely and case mix adjusted feedback of performance data to support QI. Data was collected through three focus group interviews conducted with 16 managers and staff. The Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework guided the data collection and analysis. Results Staff and managers deemed the technology to effectively support ongoing QI efforts by providing timely access to reliable data. The value of the technology was associated with a clear need to make better use of existing data in QI. The data and the methodology in the analytics tool reflected the complexity of the clinical conditions treated but was presented through an interface that was easy to access and user friendly. However, prior understanding of statistics was helpful to be able to fully grasp the presented data. The tool was adapted to the needs and the organizational conditions of the local setting through a collaborative approach between the technology supplier and the adopters. Conclusions Technology has the potential to enable systematic QI through motivating professionals by providing timely and adequate feedback of performance. The adoption of such technology is complex and requires openness for gradual learning and improvement.
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/s12913-020-05622-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2050434-2
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  • 9
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    Table_2.DOCX
    Frontiers Media SA ; 2023
    In:  Frontiers in Public Health Vol. 11 ( 2023-9-29)
    Details
    In: Frontiers in Public Health, Frontiers Media SA, Vol. 11 ( 2023-9-29)
    Abstract: Interest in applying systems thinking (ST) in public health and healthcare improvement has increased in the past decade, but its practical use is still unclear. ST has been found useful in addressing the complexity and dynamics of organizations and welfare systems during periods of change. Exploring how ST is used in practice in national policy programs addressing complex and ill-structured problems can increase the knowledge of the use and eventually the usefulness of ST during complex changes. In ST, a multi-level approach is suggested to coordinate interventions over individual, organizational, and community levels, but most attempts to operationalize ST focus on the individual level. This study aimed to investigate how ST is expressed in policy programs addressing wicked problems and describe the specific action strategies used in practice in a national program in Sweden, using a new conceptual framework comprising ST principles on the organizational level as an analytical tool. The program addresses several challenges and aims to achieve systems change within women's healthcare. Methods The case study used a rich set of qualitative, longitudinal data on individual, group, and organizational levels, collected during the implementation of the program. Deductive content analysis provided narrative descriptions of how the ST principles were expressed in actions, based on interviews, observations, and archival data. Results The results showed that the program management team used various strategies and activities corresponding to organizational level ST. The team convened numerous types of actors and used collaborative approaches and many different information sources in striving to create a joint and holistic understanding of the program and its context. Visualization tools and adaptive approaches were used to support regional contact persons and staff in their development work. Efforts were made to identify high-leverage solutions to problems influencing the quality and coordination of care before, during, and after childbirth, solutions adaptable to regional conditions. Discussion/conclusions The organizational level ST framework was useful for identifying ST in practice in the policy program, but to increase further understanding of how ST is applied within policy programs, we suggest a multi-dimensional model to identify ST on several levels.
    Type of Medium: Online Resource
    ISSN: 2296-2565
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.3389/fpubh.2023.957653
    DOI: 10.3389/fpubh.2023.957653.s001
    DOI: 10.3389/fpubh.2023.957653.s002
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2023
    detail.hit.zdb_id: 2711781-9
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  • 10
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    Online Resource
    Temporal dynamics, diversity, and interplay in three components of the virodiversity of a Mallard population: Influenza A virus, avian paramyxovirus and avian coronavirus
    Elsevier BV ; 2015
    In:  Infection, Genetics and Evolution Vol. 29 ( 2015-01), p. 129-137
    Details
    In: Infection, Genetics and Evolution, Elsevier BV, Vol. 29 ( 2015-01), p. 129-137
    Type of Medium: Online Resource
    ISSN: 1567-1348
    URL: Article
    DOI: 10.1016/j.meegid.2014.11.014
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2015
    detail.hit.zdb_id: 2057622-5
    SSG: 12
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