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Öhrn, Annica
Publications (10 of 15) Show all publications
Carlfjord, S., Öhrn, A. & Gunnarsson, A. (2018). Experiences from ten years of incident reporting in health care: a qualitative study among department managers and coordinators. BMC Health Services Research, 18, Article ID 113.
Open this publication in new window or tab >>Experiences from ten years of incident reporting in health care: a qualitative study among department managers and coordinators
2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 113Article in journal (Refereed) Published
Abstract [en]

Background: Incident reporting (IR) in health care has been advocated as a means to improve patient safety. The purpose of IR is to identify safety hazards and develop interventions to mitigate these hazards in order to reduce harm in health care. Using qualitative methods is a way to reveal how IR is used and perceived in health care practice. The aim of the present study was to explore the experiences of IR from two different perspectives, including heads of departments and IR coordinators, to better understand how they value the practice and their thoughts regarding future application. Methods: Data collection was performed in Ostergotland County, Sweden, where an electronic IR system was implemented in 2004, and the authorities explicitly have advocated IR from that date. A purposive sample of nine heads of departments from three hospitals were interviewed, and two focus group discussions with IR coordinators took place. Data were analysed using qualitative content analysis. Results: Two main themes emerged from the data: "Incident reporting has come to stay" building on the categories entitled perceived advantages, observed changes and value of the IR system, and "Remaining challenges in incident reporting" including the categories entitled need for action, encouraged learning, continuous culture improvement, IR system development and proper use of IR. Conclusions: After 10 years, the practice of IR is widely accepted in the selected setting. IR has helped to put patient safety on the agenda, and a cultural change towards no blame has been observed. The informants suggest an increased focus on action, and further development of the tools for reporting and handling incidents.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2018
Keywords
Patient safety; Incident reporting; Qualitative research
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-145769 (URN)10.1186/s12913-018-2876-5 (DOI)000425416300001 ()29444680 (PubMedID)
Note

Funding Agencies|County Council of Ostergotland

Available from: 2018-03-22 Created: 2018-03-22 Last updated: 2019-05-01
Öhrn, A., Ericsson, C., Andersson, C. & Elfström, J. (2018). High Rate of Implementation of Proposed Actions for Improvement With the Healthcare Failure Mode Effect Analysis Method: Evaluation of 117 Analyses. Journal of patient safety, 14(1), 17-20
Open this publication in new window or tab >>High Rate of Implementation of Proposed Actions for Improvement With the Healthcare Failure Mode Effect Analysis Method: Evaluation of 117 Analyses
2018 (English)In: Journal of patient safety, ISSN 1549-8417, E-ISSN 1549-8425, Vol. 14, no 1, p. 17-20Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aims of this study were to investigate what kind of impact the Healthcare Failure Mode Effect Analysis (HFMEA) had on the organization in 1 county council in Sweden and to evaluate the method of working for multidisciplinary teams performing HFMEA. Three main outcome measures were used: the quality of the documentation from the HFMEAs, fulfillment of the primary goal of the HFMEA, and, finally, whether proposed actions for improvement were implemented.

METHODS: The study involved retrospective analysis of the documentation from 117 performed HFMEAs from 3 hospitals in the county council of Östergötland, Sweden, and interviews or questionnaires with team leaders and managers between 2006 and 2010.

RESULTS: A proposed change in the organizational structure was the most common issue in the analyses. Eighty-nine percent of the written reports were of high quality. A median of 10 serious risks were detected, and 10 proposed actions (median) were made. In 78% of the HFMEAs, all or a large part of these had been implemented a few years afterward. We were unable to find factors that promoted the rate of implementation of proposed actions. Seventy-eight percent of the managers were completely satisfied with the results of the HFMEA. The mean cost per risk analysis was &OV0556;1909.

CONCLUSIONS: Most of the proposed actions were implemented. The use of HFMEA can be improved using fewer team leaders but with more experience. The work involved in writing a report can be reduced without loss of impact on the organization.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
Keywords
HFMEA, evaluation, implementation, patient safety
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-126074 (URN)10.1097/PTS.0000000000000159 (DOI)000426551800006 ()25719818 (PubMedID)
Available from: 2016-03-23 Created: 2016-03-14 Last updated: 2019-05-02
Ahlberg, E.-L., Elfström, J., Borgstedt Risberg, M., Öhrn, A., Andersson, C., Sjödahl, R. & Nilsen, P. (2017). Learning From Incident Reporting?: Analysis of Incidents Resulting in Patient Injuries in a Web-Based System in Swedish Health Care. Journal of patient safety
Open this publication in new window or tab >>Learning From Incident Reporting?: Analysis of Incidents Resulting in Patient Injuries in a Web-Based System in Swedish Health Care
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2017 (English)In: Journal of patient safety, ISSN 1549-8417, E-ISSN 1549-8425Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives Incident reporting (IR) systems have the potential to improve patient safety if they enable learningfrom the reported risks and incidents. The aim of this study was to investigate incidents registered in an IR system in a Swedish county council.

Methods The study was conducted in the County Council of Östergötland, Sweden. Data were retrieved from the IR system, which included 4755 incidents occurring in somatic care that resulted in patient injuries from 2004 to 2012. One hundred correctly classified patient injuries were randomly sampled from 3 injury severity levels: injuries leading to deaths, permanent harm, and temporary harm. Three aspects were analyzed: handling of the incident, causes of the incident, and actions taken to prevent its recurrence.

Results Of the 300 injuries, 79% were handled in the departments where they occurred. The department head decided what actions should be taken to prevent recurrence in response to 95% of the injuries. A total of 448 causes were identified for the injuries; problems associated with procedures, routines, and guidelines were most common. Decisions taken for 80% of the injuries could be classified using the IR system documentation and root cause analysis. The most commonly pursued type of action was change of work routine or guideline.

Conclusions The handling, causes, and actions taken to prevent recurrence were similar for injuries of different severity levels. Various forms of feedback (information, education, and dialogue) were an integral aspect of the IR system. However, this feedback was primarily intradepartmental and did not yield much organizational learning.

Place, publisher, year, edition, pages
Wolters Kluwer, 2017
Keywords
patient safety;incident reporting;feedback;learning
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-154047 (URN)10.1097/PTS.0000000000000343 (DOI)29112034 (PubMedID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-02-06Bibliographically approved
Danielsson, M., Nilsen, P., Öhrn, 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.
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2014 (English)In: BMC nursing, ISSN 1472-6955, Vol. 13, no 1, p. 39-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: 2018-12-19
Nygren, M., Roback, K., Öhrn, A., Rutberg, H., Rahmqvist, M. & Nilsen, P. (2013). Factors influencing patient safety in Sweden: perceptions of patient safety officers in the county councils. BMC Health Services Research, 13(52)
Open this publication in new window or tab >>Factors influencing patient safety in Sweden: perceptions of patient safety officers in the county councils
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2013 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 52Article in journal (Refereed) Published
Abstract [en]

Background

National, regional and local activities to improve patient safety in Sweden have increased over the last decade. There are high ambitions for improved patient safety in Sweden. This study surveyed health care professionals who held key positions in their county council’s patient safety work to investigate their perceptions of the conditions for this work, factors they believe have been most important in reaching the current level of patient safety and factors they believe would be most important for achieving improved patient safety in the future.

Methods

The study population consisted of 218 health care professionals holding strategic positions in patient safety work in Swedish county councils. Using a questionnaire, the following topics were analysed in this study: profession/occupation; number of years involved in a designated task on patient safety issues; knowledge/overview of the county council’s patient safety work; ability to influence this work; conditions for this work; and the importance of various factors for current and future levels of patient safety.

Results

The response rate to the questionnaire was 79%. The conditions that had the highest number of responses in complete agreement were “patients’ involvement is important for patient safety” and “patient safety work has good support from the county council’s management”. Factors that were considered most important for achieving the current level of patient safety were root cause and risk analyses, incident reporting and the Swedish Patient Safety Law. An organizational culture that encourages reporting and avoids blame was considered most important for improved patient safety in the future, closely followed by improved communication between health care practitioners and patients.

Conclusion

Health care professionals with important positions in the Swedish county councils’ patient safety work believe that conditions for this work are somewhat constrained. They attribute the current levels of patient safety to a broad range of factors and believe that many different solutions can contribute to enhanced patient safety in the future, suggesting that this work must be multifactorial.

Place, publisher, year, edition, pages
BioMed Central, 2013
Keywords
Patient safety, Patient involvement, Communication, Safety culture, Root cause analysis, Risk analysis, Incident reporting
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-90200 (URN)10.1186/1472-6963-13-52 (DOI)000315330200001 ()
Note

Funding Agencies|Swedish Association of Local Authorities and Regions (SALAR)||

Available from: 2013-03-28 Created: 2013-03-21 Last updated: 2017-12-06Bibliographically approved
Nilsen, P., Nygren, M., Öhrn, A. & Roback, K. (2012). A new zero vision for Swedish patient safety - but how do we know that health care is becoming safer?. In: : . Paper presented at 2nd Nordic Conference on Research in Patient Safety and Quality in Healthcare, 6-7 March 2012, Copenhagen, Denmark.
Open this publication in new window or tab >>A new zero vision for Swedish patient safety - but how do we know that health care is becoming safer?
2012 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-90490 (URN)
Conference
2nd Nordic Conference on Research in Patient Safety and Quality in Healthcare, 6-7 March 2012, Copenhagen, Denmark
Available from: 2013-03-28 Created: 2013-03-28 Last updated: 2013-08-19
Öhrn, A. (2012). Measures of Patient Safety: Studies of Swedish Reporting Systems and Evaluation of an Intervention Aimed at Improved Patient Safety Culture. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Measures of Patient Safety: Studies of Swedish Reporting Systems and Evaluation of an Intervention Aimed at Improved Patient Safety Culture
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Unsafe health care delivery results in millions of patients suffering from injuries or death worldwide. A Swedish study estimated the prevalence of preventable adverse events as high as 8.6% in hospital care, which demonstrates that patient safety is no less a problem in Sweden than elsewhere. Reporting of adverse events has become an integral part of patient safety work. The aim of reporting is to identify patient safety problems and provide background data and information for efforts to improve patient safety. However, adverse events in health care can be captured and measured using different methods and stored in disparate systems that are not fully integrated. This makes it difficult to obtain a complete coherent picture of the frequency and nature of various types of adverse events. Another difficulty is to distinguish between adverse events and accepted complications of medical care.

The overall aim of this thesis is to generate knowledge for improved understanding of how patient safety can be measured in terms of reporting adverse events and improved by targeting patient safety culture with an intervention implemented in a Swedish county council. Three research questions have been derived from the aim: (1) To what extent can analysis of patient claims contribute to an understanding of the magnitude of the patient safety problem? (2) To what extent do data captured from different reporting systems in Sweden differ? (3) To what extent can a structured intervention that fosters learning on patient safety issues and encourages leadership commitment improve the patient safety culture in a Swedish county council from a five-year perspective?

The research is based on studies of three national reporting systems: Lex Maria to the National Board of Health and Welfare; patient claims to the County Councils´ Mutual Insurance Company; and medical data reported to the National Swedish Spine Register (Swespine). Data have also been assembled as part of an evaluation within the Patient Safety Dialogue intervention.

This thesis indicates that different Swedish reporting systems provide disparate views and have many discrepancies regarding data quality and coverage of adverse events. Patient claims seem to be an important source of information that can complement information from incident reporting systems and quality registries in health care to provide an understanding of the magnitude of the patient safety problem.

The research also shows that a structured intervention that fosters learning on patient safety issues and encourages leadership commitment can improve the culture of patient safety. However, a longer period of time and focused efforts might be required to achieve improvements across all departments within a Swedish county council.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. p. 85
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1267
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72594 (URN)978-91-7393-043-7 (ISBN)
Public defence
2012-01-13, Berzeliussalen, Universitetssjukhuset, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-11-29 Created: 2011-11-29 Last updated: 2019-12-10Bibliographically approved
Nilsen, P., Nygren, M., Öhrn, A. & Roback, K. (2012). Patientsäkerhet svårt att uppnå, svårt att värdera: Landstingens patientsäkerhetsberättelser granskas och diskuteras. Läkartidningen, 109(20-21), 1028-1031
Open this publication in new window or tab >>Patientsäkerhet svårt att uppnå, svårt att värdera: Landstingens patientsäkerhetsberättelser granskas och diskuteras
2012 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 20-21, p. 1028-1031Article in journal (Refereed) Published
Abstract [sv]

Ansträngningarna för ökad patientsäkerhet i Sverige intensifierades 2011 i och med den nya patientsäkerhetslagen och den satsning som regeringen och SKL gjorde på prestationsbaserad ersättning till landstingen.

Förväntningarna på ökad patientsäkerhet i Sverige är stora, men frågan är hur vi kan veta att vården blir säkrare.

Med avstamp i ett ramverk – en vidareutveckling av Donabedians triad – och genom tillägg av en kontextuell komponent och komplettering med en lärandedimension belyses svårigheterna och möjligheterna vid utvärdering av patientsäkerhet.

Ramverkets olika komponenter diskuteras med hänvisning till vad som redovisas i de patientsäkerhetsberättelser som landstingen har sammanställt för att beskriva sitt arbete med patientsäkerhet.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-77894 (URN)
Available from: 2012-05-31 Created: 2012-05-31 Last updated: 2017-12-07
Roback, K., Nygren, M., Öhrn, A., Rutberg, H. & Nilsen, P. (2012). Strategier för säker och ännu säkrare vård: Enkätstudie om landstingens patientsäkerhetsarbete. Läkartidningen, 109(45), 2024-2027
Open this publication in new window or tab >>Strategier för säker och ännu säkrare vård: Enkätstudie om landstingens patientsäkerhetsarbete
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2012 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 45, p. 2024-2027Article in journal (Refereed) Published
Abstract [sv]

I en enkät till 216 personer med särskilt ansvar för patientsäkerhet har frågor ställts om vad som har haft betydelse och vad som kommer att ha betydelse för att uppnå en god patientsäkerhet i framtiden.

Händelse- och riskanalyser ansågs ha varit mycket viktigt för att uppnå dagens patientsäkerhetsnivå, liksom rapportering av avvikelser och risker.

Faktorer som ansågs mycket viktiga för att öka patientsäkerheten var främst organisationskultur, kommunikation och utbildning.

Även förbättrad infektionskontroll och standardisering av rutiner samt bättre instruktioner och utbildning avseende medicinsk teknik var viktiga områden.

 

Place, publisher, year, edition, pages
Läkartidningen Förlag, 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-87753 (URN)
Available from: 2013-01-25 Created: 2013-01-22 Last updated: 2017-12-06
Öhrn, A., Elfström, J., Tropp, H. & Rutberg, H. (2012). What can we learn from patient claims?: Analysing of patient injuries following orthopaedic surgery. Patient Safety in Surgery, 6(2), 1-6
Open this publication in new window or tab >>What can we learn from patient claims?: Analysing of patient injuries following orthopaedic surgery
2012 (English)In: Patient Safety in Surgery, ISSN 1754-9493, Vol. 6, no 2, p. 1-6Article in journal (Refereed) Published
Abstract [en]

Background: Objective data on the incidence and pattern of adverse events after orthopaedic surgical procedures remain scarce, secondary to the reluctance for encompassing reporting of surgical complications. The aim of this study was to analyze the nature of adverse events after orthopaedic surgery reported to a national database for patient claims in Sweden.

Methods: In this retrospective review data from two Swedish national databases during a 4-year period were analyzed. We used the "County Councils' Mutual Insurance Company", a national no-fault insurance system for patient claims, and the "National Patient Register at the National Board of Health and Welfare".

Results: A total of 6,029 patient claims filed after orthopaedic surgery were assessed during the study period. Of those, 3,336 (55%) were determined to be adverse events, which received financial compensation. Hospital-acquired infections and sepsis were the most common causes of adverse events (n = 741; 22%). The surgical procedure that caused the highest rate of adverse events was "decompression of spinal cord and nerve roots" (code ABC**), with 168 adverse events of 17,507 hospitals discharges (1%). One in five (36 of 168; 21.4%) injured patient was seriously disabled or died.

Conclusions: We conclude that patients undergoing spinal surgery run the highest risk of being severely injured and that these patients also experienced a high degree of serious disability. The most common adverse event was related to hospital acquired infections. Claims data obtained in a no-fault system have a high potential for identifying adverse events and learning from them.

Keywords
Insurance Claim Review, Medical Errors, Orthopaedics, Patient Safety, Patient Admission, Safety Management
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72590 (URN)10.1186/1754-9493-6-2 (DOI)
Note

On the day of the defence date the status of this article was "Manuscript".

Available from: 2011-11-29 Created: 2011-11-29 Last updated: 2014-09-11Bibliographically approved
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