liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
BETA
Publications (10 of 28) Show all publications
Ridelberg, M., Roback, K., Nilsen, P. & Carlfjord, S. (2016). Patient safety work in Sweden: quantitative and qualitative analysis of annual patient safety reports.. BMC Health Services Research, 16(98), 1-9.
Open this publication in new window or tab >>Patient safety work in Sweden: quantitative and qualitative analysis of annual patient safety reports.
2016 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, no 98, 1-9 p.Article in journal (Refereed) Published
Abstract [en]

Background

There is widespread recognition of the problem of unsafe care and extensive efforts have been made over the last 15 years to improve patient safety. In Sweden, a new patient safety law obliges the 21 county councils to assemble a yearly patient safety report (PSR). The aim of this study was to describe the patient safety work carried out in Sweden by analysing the PSRs with regard to the structure, process and result elements reported, and to investigate the perceived usefulness of the PSRs as a tool to achieve improved patient safety.

Methods

The study was based on two sources of data: patient safety reports obtained from county councils in Sweden published in 2014 and a survey of health care practitioners with strategic positions in patient safety work, acting as key informants for their county councils. Answers to open-ended questions were analysed using conventional content analysis.

Results

A total of 14 structure elements, 31 process elements and 23 outcome elements were identified. The most frequently reported structure elements were groups devoted to working with antibiotics issues and electronic incident reporting systems. The PSRs were perceived to provide a structure for patient safety work, enhance the focus on patient safety and contribute to learning about patient safety.

Conclusion

Patient safety work carried out in Sweden, as described in annual PSRs, features a wide range of structure, process and result elements. According to health care practitioners with strategic positions in the county councils’ patient safety work, the PSRs are perceived as useful at various system levels.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keyword
Healthcare, Patient safety, Patient safety reports
National Category
Social and Clinical Pharmacy Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-127298 (URN)10.1186/s12913-016-1350-5 (DOI)000372864800001 ()27001079 (PubMedID)
Note

Funding agencies:  Swedish National Board of Health and Welfare

Available from: 2016-04-19 Created: 2016-04-19 Last updated: 2018-01-10Bibliographically approved
Carlfjord, S. & Festin, K. (2015). Association between organizational climate and perceptions and use of an innovation in Swedish primary health care: a prospective study of an implementation. BMC Health Services Research, 15(364).
Open this publication in new window or tab >>Association between organizational climate and perceptions and use of an innovation in Swedish primary health care: a prospective study of an implementation
2015 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, no 364Article in journal (Refereed) Published
Abstract [en]

Background: There is a need for new knowledge regarding determinants of a successful implementation of new methods in health care. The role of a receptive context for change to support effective diffusion has been underlined, and could be studied by assessing the organizational climate. The aim of this study was to assess the association between organizational climate when a computer-based lifestyle intervention tool (CLT) was introduced in primary health care (PHC) and the implementation outcome in terms of how the tool was perceived and used after 2 years. Methods: The CLT was offered to 32 PHC units in Sweden, of which 22 units agreed to participate in the study. Before the introduction of the CLT, the creative climate at each participating unit was assessed. After 24 months, a follow-up questionnaire was distributed to the staff to assess how the CLT was perceived and how it was used. A question on the perceived need for the CLT was also included. Results: The units were divided into three groups according to the creative climate: high, medium and low. The main finding was that the units identified as having a positive creative climate demonstrated more frequent use and more positive perceptions regarding the new tool than those with the least positive creative climate. More positive perceptions were seen at both individual and unit levels. Conclusions: According to the results from this study there is an association between organizational climate at baseline and implementation outcome after 2 years when a tool for lifestyle intervention is introduced in PHC in Sweden. Further studies are needed before measurement of organizational climate at baseline can be recommended in order to predict implementation outcome.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2015
National Category
Other Social Sciences
Identifiers
urn:nbn:se:liu:diva-121896 (URN)10.1186/s12913-015-1038-2 (DOI)000361290500001 ()26358045 (PubMedID)
Note

Funding Agencies|Swedish Council for Working Life and Social Research (FAS)

Available from: 2015-10-13 Created: 2015-10-12 Last updated: 2017-12-01
Roback, K., Ridelberg, M., Carlfjord, S. & Nilsen, P. (2015). Fyra år med patientsäkerhetsberättelsen: sammanställning och jämförande analys av uppgifter inrapporterade från vårdgivare i Sverige 2010-2013. Socialstyrelsen.
Open this publication in new window or tab >>Fyra år med patientsäkerhetsberättelsen: sammanställning och jämförande analys av uppgifter inrapporterade från vårdgivare i Sverige 2010-2013
2015 (Swedish)Report (Other academic)
Abstract [sv]

Sverige fick en ny patientsäkerhetslag 2011 i syfte att göra vården säkrare. I denna ingår att alla vårdgivare årligen ska ställ a samman en patientsäkerhetsberättelse (PSB) med början för verksamhetsåret 2010. PSB har nu skrivits för fjärde året i rad.

Syftet med denna rapport är att utifrån innehållet i landstingens/regionernas PSB ge en bild av patientsäkerhetsarbetet inom svensk hälso- och sjukvård, under de fyra år som PSB har sammanställts. Granskning en är dels en granskning av innehållet i 2013 års PS B men också en sammanfattning av utvecklingen av patientsäkerhetsarbetet under verksamhetsåren 2010 till 2013, så som det beskrivs i PSB:erna. Innehållet har analyserats utifrån perspektiven struktur, process och resultat och jämförelser har gjorts över tid och mellan olika landsting/regioner. Liknande granskningar har tidigare gjorts vid två tillfällen och analyserna bygger på en tidigare utarbetad och testad modell i de tidigare granskningarna av landstingens/ regionernas PSB.

En tydlig utveckling har skett över åren, både vad gäller beskrivningarna av patientsäkerhetsarbetet och vilka områden och resultat man vill lyfta fram. Granskningen visar att landstingen/regionerna har haft vägledning av de grundläggande och prestations - baserade krav som funnits för patientsäkerhetsarbetet i den överenskommelse som träffats mellan staten och SKL. Man har också följt SKL:s mall för att skriva PSB. Detta har dock inte lett till någon större samstämmighet i vad som verkligen rapporteras utan har mer varit en likriktning av rapporternas struktur. M ånga variabler som tagits med i redovisningen beskrivs dessutom i ganska vaga ordalag. Överlag har standarden dock ökat och många PSB är innehållsrika och ger en bra översikt över hur patientsäkerhetsarbetet bedrivs och vad som återstår att göra.

Jämfört med tidigare år har PSB 2013 fokuserat mer på resultat och egenkontroll. Tidigare berätta de man att man mäter och registrerar olika saker. Nu ange r man också resultat från de olika mätningarna i en högre grad. Vidare har ledningens roll för att höja säkerheten börjat uppmärksamma, även om många också påpekar att ansvaret för att bedriva en säker vård i slutändan ligger hos enskilda medarbetare.

Av sammanlagt 6 2 undersökta patientsäkerhetsvariabler som ingått i den landstingsvis a jämförelsen 2013 har täckningsgraden i snitt varit 6 7 %. Motsvarande, sett över hela tidsspannet 2010 - 2013 , är 63 %. Landsting en/regionerna har redovisat olika stor andel av de undersökta variablerna, med en högsta andel p å 75 % för Östergötland, räknat som ett genomsnitt över de fyra åren. Skillnaderna mellan landstingen/regionerna är dock inte stora och drygt hälften (11 st.) har ett resultat över 65 %.

Ett fåtal mer blygsamma resultat har uppmätts där en slentrianmässig rapportering förekommer och där den relevant a information en är sparsam. Detta kan tyda på att man inte ha r integrerat PSB:n som ett instrument i patientsäkerhetsarbetet, utan har andra medel för att skapa struktur och översikt över arbetet. D e allra flesta har dock sammanställt informativa och välstrukturerade rapporter. Mot bakgrund av den utveckling som skett av PSB:n , under en relativt kort tid, kan man förmoda att den kommer att fortsätta utvecklas i en pågående dynamisk process i många landsting/regioner och med tiden få en allt viktigare roll i arbetet för att åstadkomma en säkrare vård.

Place, publisher, year, edition, pages
Socialstyrelsen, 2015. 38 p.
Series
Socialstyrelsen
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-126581 (URN)
Note

Bilaga till rapporten Lägesrapport inom patientsäkerhetsområdet 2014.

Available from: 2016-03-30 Created: 2016-03-30 Last updated: 2016-04-27Bibliographically approved
Reichenpfader, U., Carlfjord, S. & Nilsen, P. (2015). Leadership in evidence-based practice: a systematic review. Leadership in Health Services, 28(4), 298-316.
Open this publication in new window or tab >>Leadership in evidence-based practice: a systematic review
2015 (English)In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 28, no 4, 298-316 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: We aimed to systematically review published empirical research on leadership as a determinant for the implementation of evidence-based practice (EBP) and to investigate leadership conceptualization and operationalization in this field.

Design/methodology/approach: A systematic review with narrative synthesis was conducted. Relevant bibliographic databases and reference lists of pertinent review articles were searched. To be included, a study had to involve empirical research and refer to both leadership and EBP in health care. Study quality was assessed with a structured instrument based on study design.

Findings: A total of 17 studies were included. Leadership was mostly viewed as a modifier for implementation success, acting through leadership support. Yet, there was definitional imprecision as well as conceptual inconsistency and studies seemed to inadequately address situational and contextual factors. Although referring to an organizational factor, the concept was mostly analysed at the individual or group level.

Research limitations/implications: The concept of leadership in implementation science seems to be not fully developed. It is unclear whether attempts to tap the concept of leadership in available instruments truly capture and measure the full range of the diverse leadership elements at various levels. Research in implementation science would benefit from a better integration of research findings from other disciplinary fields. Once a more mature concept has been established, researchers in implementation science could proceed to further elaborate operationalization and measurement.

Originality/value. Although the relevance of leadership in implementation science has been acknowledged, the conceptual base of leadership in this field has received only limited attention.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2015
Keyword
Leadership, Conceptualization, Measurement, Evidence-based practice, Systematic review
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-120935 (URN)10.1108/LHS-08-2014-0061 (DOI)
Available from: 2015-08-31 Created: 2015-08-31 Last updated: 2017-12-04
Danielsson, M., Carlfjord, S. & Nilsen, P. (2015). Patient safety walk rounds: views of frontline staff members and managers in Sweden. International Journal of Nursing, 2(2), 81-93.
Open this publication in new window or tab >>Patient safety walk rounds: views of frontline staff members and managers in Sweden
2015 (English)In: International Journal of Nursing, ISSN 2373-7662, Vol. 2, no 2, 81-93 p.Article in journal (Refereed) Published
Abstract [en]

Background: Leadership Walk Rounds (WRs) have been described as a promising intervention to achieve a culture of safety by means of engaging leaders at different levels in patient safety issues. The aim was to investigate WRs carried out in a Swedish county council in terms of advantages, disadvantages and opportunities for improvement, as perceived by the participating frontline staff members, local unit managers and top-level managers.Methods: A cross-sectional study of 19 WRs. Responses from questionnaireswere analysed using qualitative and quantitative methods. Content analysis was used to categorize the findings from open-ended questions regarding advantages, disadvantages and suggestions for improvement.Results: The response rate was 95%. The participants in the WRs were generally very positive about the intervention. They believed that the intervention had several advantages and that WRs could have an impact on patient safety. Few differences between the three personnel categories were found.Conclusions: A WR developed on the basis of descriptions in the literature was perceived to have many advantages according to frontline staff members, local managers and top-level managers who participated in the intervention. WRs are perceived to contribute to increased learning concerning patient safety and to influence the patient safety culture. The overall positive findings are broadly consistent with the predominantly optimistic reports of WRs in the patient safety literature. However, further research is needed to investigate how the potential of the WR can be realized, including evaluationsof the effectiveness of the intervention in terms of various patient safety outcomes.

Place, publisher, year, edition, pages
American research institute for policy development, 2015
Keyword
Patient safety, walk rounds, patient safety culture, management
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-135794 (URN)10.15640/ijn.v2n2a10 (DOI)
Available from: 2017-03-22 Created: 2017-03-22 Last updated: 2017-03-27
Lindblom, H., Waldén, M., Carlfjord, S. & Hägglund, M. (2014). Implementation of a neuromuscular training programme in female adolescent football: 3-year follow-up study after a randomised controlled trial. British Journal of Sports Medicine, 48(19), 1425-1430.
Open this publication in new window or tab >>Implementation of a neuromuscular training programme in female adolescent football: 3-year follow-up study after a randomised controlled trial
2014 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 19, 1425-1430 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Neuromuscular training (NMT) has been shown to reduce anterior cruciate ligament injury rates in highly structured clinical trials. However, there is a paucity of studies that evaluate implementation of NMT programmes in sports.

AIM: To evaluate the implementation of an NMT programme in female adolescent football 3 years after a randomised controlled trial (RCT).

METHODS: Cross-sectional follow-up after an RCT using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Sports Setting Matrix (RE-AIM SSM) framework. Questionnaires were sent to the Swedish Football Association (FA), to eight district FAs and coaches (n=303) that participated in the RCT in 2009, and coaches who did not participate in the RCT but were coaching female adolescent football teams during the 2012 season (n=496).

RESULTS: Response rates were 100% among the FAs, 57% among trial coaches and 36% among currently active coaches. The reach of the intervention was high, 99% of trial coaches (control group) and 91% of current coaches were familiar with the programme. The adoption rate was 74% among current coaches, but programme modifications were common among coaches. No district FA had formal policies regarding implementation, and 87% of current coaches reported no club routines for programme use. Maintenance was fairly high; 82% of trial coaches from the intervention group and 68% from the control group still used the programme.

CONCLUSIONS: Reach and adoption of the programme was high among coaches. However, this study identified low programme fidelity and lack of formal policies for its implementation and use in clubs and district FAs.

Place, publisher, year, edition, pages
B M J Group, 2014
Keyword
ACL; Adolescents; Implementation; Injury Prevention; Soccer
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-110380 (URN)10.1136/bjsports-2013-093298 (DOI)000341947200008 ()24850618 (PubMedID)
Available from: 2014-09-09 Created: 2014-09-09 Last updated: 2017-12-05
Ridelberg, M., Carlfjord, S., Nilsen, P. & Roback, K. (2014). Landstingens och regionernas patientsäkerhetsberättelser: Systematisk sammanställning och jämförande analys av uppgifter inrapporterade från vårdgivare i Sverige för åren 2010, 2011 och 2012. Socialstyrelsen.
Open this publication in new window or tab >>Landstingens och regionernas patientsäkerhetsberättelser: Systematisk sammanställning och jämförande analys av uppgifter inrapporterade från vårdgivare i Sverige för åren 2010, 2011 och 2012
2014 (Swedish)Report (Other academic)
Abstract [sv]

Sverige fick en ny patientsäkerhetslag 2011 (PSL 2010:659) i syfte att göra vården säkrare. Bland annat ställer lagen krav på att vårdgivare sammanställer en Patientsäkerhetsberättelse (PSB) årligen. Förra året gjordes en första granskning av de PSB som skrevs för år 2010 samt 2011. Uppdraget var att beskriva och jämföra innehållet från landstingens och regionernas PSB för verksamhetsåren 2010 och 2011 utifrån perspektiven struktur, process och resultat. För detta ändamål utarbetades en utvärderingsmodell som använ des i arbetet.

Denna rapport bygger på den tidigare utarbetad e och testad e modell en och avser att ge en bild av patientsäkerhetsarbetet inom svensk hälso- och sjukvård med utgångspunkt i de PSB som vårdgivarna har sammanställt för år 2012 samt att göra en jämförelse med innehållet i tidigare PSB. Analysen har gjorts med kvantitativ innehållsanalys.

Granskningen visar att 2012 års PSB har högre täckningsgrad av variabler i jämförelse med 2010 och 2011. Resultatet visar att många variabler har tagits med i redovisningen men att det ibland inte är tydligt beskrivet vad som har gjorts eller vilka strukturer redovisningen faktiskt syftar på. Det är även tydligt att landstingen har haft vägledning av de grundläggande och prestationsbaserade krav som SKL haft uppställda för 2012 år s patientsäkerhetsarbete utifrån överenskommelsen med regeringen, vilket även framkom i 2011 års PSB.

Av sammanlagt 5 2 undersökta patientsäkerhetsvariabler inom struktur (n=18 ), process (n=25) och resultat (n=9) som beskrivs fullständigt eller delvis i PSB år 2012, har olika landsting/regioner redovisat olika många möjliga variabler, med ett högsta värde av 44 av 52 och lägsta 28 av 5 2.

Konceptet PSB är unikt internationellt sett och ger en god bild av hur man arbetar med patientsäkerhetsfrågor i landstingen/regionerna, men det finns också en utvecklingspotential. Vi bedömer att PSB i dagsläget inte riktigt håller måttet för att utöva myndighetstillsyn då det fortfarande kan vara svårt att få en tydlig bild av vad som faktiskt görs inom olika landsting/regioner. PSB har blivit mer informativa 2012 än tidigare år men saknar enhetlighet vad gäller rapporterade variabler och rapporterade resultatmått. Ytterligare utveckling av SKL:s mall skulle kunna underlätta landstingens arbete med att sammanställa PSB och förbättra förutsättningarna för jämförelser mellan landsting/regioner och över tid

Place, publisher, year, edition, pages
Socialstyrelsen, 2014. 28 p.
Series
Socialstyrelsen
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-126583 (URN)
Note

Ingår i rapporten Lägesrapport inom patientsäkerhetsområdet 2014.

Available from: 2016-03-30 Created: 2016-03-30 Last updated: 2016-11-22Bibliographically approved
Carlfjord, S. (2014). Modeller och ramverk. In: Per Nilsen (Ed.), Implementering av evidensbaserad praktik: (pp. 115-133). Malmö: Gleerups Utbildning AB.
Open this publication in new window or tab >>Modeller och ramverk
2014 (Swedish)In: Implementering av evidensbaserad praktik / [ed] Per Nilsen, Malmö: Gleerups Utbildning AB, 2014, 115-133 p.Chapter in book (Other academic)
Place, publisher, year, edition, pages
Malmö: Gleerups Utbildning AB, 2014
Keyword
Evidensbaserad sjukvård
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-127011 (URN)978-91-4068-447-9 (ISBN)
Available from: 2016-04-12 Created: 2016-04-12 Last updated: 2018-01-10Bibliographically approved
Danielsson, M., Nilsen, P., Ohrn, A., Rutberg, H., Fock, J. & Carlfjord, S. (2014). Patient safety subcultures among registered nurses and nurse assistants in Swedish hospital care: a qualitative study.. BMC nursing, 13(1), 39.
Open this publication in new window or tab >>Patient safety subcultures among registered nurses and nurse assistants in Swedish hospital care: a qualitative study.
Show others...
2014 (English)In: BMC nursing, ISSN 1472-6955, Vol. 13, no 1, 39- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patient safety culture emerges from the shared assumptions, values and norms of members of a health care organization, unit, team or other group with regard to practices that directly or indirectly influence patient safety. It has been argued that organizational culture is an amalgamation of many cultures, and that subcultures should be studied to develop a deeper understanding of an organization's culture. The aim of this study was to explore subcultures among registered nurses and nurse assistants in Sweden in terms of their assumptions, values and norms with regard to practices associated with patient safety.

METHODS: The study employed an exploratory design using a qualitative method, and was conducted at two hospitals in southeast Sweden. Seven focus group interviews and two individual interviews were conducted with registered nurses and seven focus group interviews and one individual interview were conducted with nurse assistants. Manifest content analysis was used for the analysis.

RESULTS: Seven patient safety culture domains (i.e. categories of assumptions, values and norms) that included practices associated with patient safety were found: responsibility, competence, cooperation, communication, work environment, management and routines. The domains corresponded with three system levels: individual, interpersonal and organizational levels. The seven domains consisted of 16 subcategories that expressed different aspects of the registered nurses and assistants nurses' patient safety culture. Half of these subcategories were shared.

CONCLUSIONS: Registered nurses and nurse assistants in Sweden differ considerably with regard to patient safety subcultures. The results imply that, in order to improve patient safety culture, efforts must be tailored to both registered nurses' and nurse assistants' patient safety-related assumptions, values and norms. Such efforts must also take into account different system levels. The results of the present study could be useful to facilitate discussions about patient safety within and between different professional groups.

National Category
Clinical Medicine Nursing
Identifiers
urn:nbn:se:liu:diva-115378 (URN)10.1186/s12912-014-0039-5 (DOI)25435809 (PubMedID)
Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2015-03-31
Carlfjord, S. & Festin, K. (2014). Primary health care staffs opinions about changing routines in practice: a cross-sectional study. BMC Family Practice, 15(2).
Open this publication in new window or tab >>Primary health care staffs opinions about changing routines in practice: a cross-sectional study
2014 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 15, no 2Article in journal (Refereed) Published
Abstract [en]

Background: In health care organizations, there is a mutual interest from politicians, managers, practitioners and patients that the best available care is provided. Efforts are made to translate new knowledge and evidence-based practices into routine care, but there are a number of obstacles to this translation process. Factors related to the new practice as well as factors related to the implementation process are important, but there is still a knowledge gap regarding how to achieve effective implementation. The aim of the present study was to assess opinions about practice change among staff in primary health care (PHC), focusing on factors related to a new practice and factors related to the implementation process. Methods: A questionnaire was sent to 470 staff members at 22 PHC centres where a new tool for lifestyle intervention had recently been implemented. Thirteen items regarding the characteristics of the new practice and nine items regarding the implementation process were to be judged from not at all important to very important. A factor analysis was performed, and statistical analysis was done using the Kruskal-Wallis nonparametric test. Results: Four factors regarding the characteristics of the new practice were identified. Most important was Objective characteristics, followed by Evidence base, Subjectively judged characteristics and Organizational level characteristics. Two factors were identified regarding the implementation process: Bottom-up strategies were judged most important and Top-down strategies less important. The most important single items regarding characteristics were "easy to use" and "respects patient privacy", and the most important implementation process item was "information about the new practice". Nurses differed most from the other professionals, and judged the factors Evidence base and Organizational level characteristics more important than the others. Staff with more than 10 years experience in their profession judged the Evidence base factor more important than those who were less experienced. Conclusions: To incorporate new practices in PHC, objective characteristics of the new practice and the evidence base should be considered. Use of bottom-up strategies for the implementation process is important. Different opinions according to profession, gender and years in practice should be taken into account when planning the implementation.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keyword
Primary health care; Implementation; Staff opinions; Change
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103865 (URN)10.1186/1471-2296-15-2 (DOI)000329528100001 ()
Available from: 2014-01-31 Created: 2014-01-30 Last updated: 2017-12-06
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-9116-8156

Search in DiVA

Show all publications