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  • 1.
    Andersson, Ann-Christine
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Managers’ Views and Experiences of a Large-Scale County Council Improvement Program: Limitations and Opportunities2013In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 22, no 2, p. 152-160Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore and evaluate managers’ views of a large-scale improvement program, including their experiences and opinions about improvement initiatives and drivers for change. The study is based on a survey used in 2 nationwide mappings of improvement initiatives and developmental trends in Swedish health care. The participants were all managers in a county council in Sweden. Data were analyzed descriptively, and statements were ranked in order of preferences. A majority of the respondents stated that they had worked with improvements since the county council improvement program started. The managers sometimes found it difficult to find data and measurements that supported the improvements, yet a majority considered that it was worth the effort and that the improvement work yielded results. The top-ranked driving forces were ideas from personnel and problems in the daily work. Staff satisfaction was ranked highest of the improvement potentials, but issues about patients’ experiences of their care and patient safety came second and third. The managers stated that no or only a few patients had been involved in their improvement initiatives. Large-scale county council improvement initiatives can illuminate quality problems and lead to increased interest in improvement initiatives in the health care sector.

  • 2.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Idvall, Ewa
    Malmö högskola, Fakulteten för Hälsa och samhälle.
    Perseius, Kent-Inge
    Landstinget i Kalmar län.
    Five Types of Practice-Based ImprovementIdeas in Health Care Services: An EmpiricallyDefined Typology2011In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 20, no 2, p. 122-130Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to empirically identify and present different kinds of practice-based improvement ideas developed in health care services. The focus is on individual placement needs, problems/issues, and the ability to organize work on the development, implementation, and institutionalization of ideas for the health care sector. This study is based on a Swedish county council improvement program. Health care departments and primary health care centers in the Kalmar County Council were invited to apply for money to accomplish improvement projects. A qualitative content analysis was done of 183 proposed applications from various health care departments and primary health care centers. The following 5 types of improvement projects were identified: organizational process, evidence and quality, competence development, process technology, and proactive patient work. This illustrates the range of strategies that encourage letting individual units define their own improvement needs. These projects point to the various problems and experiences health care professionals encounter in their day-to-day work. To generalize beyond this improvement program and to validate the typology, we applied it to all articles found when searching for quality improvement projects in the journal Quality Management in Health Care during the last 2 years and found that all of them could be fitted into at least 1 of those 5 categories. This article provides valuable insights into the current state of improvemen  work in Swedish health care, and will serve as a foundation for further investigations in this quality improvement program.

  • 3.
    Aronsson, Håkan
    et al.
    Linköping University, Department of Management and Engineering, Logistics Management. Linköping University, The Institute of Technology.
    Hvitfeldt Forsberg, Helena
    Karolinskan Institutet, Stockholm.
    Lindblad, Staffan
    Karolinska institutet, Stockholm.
    Keller, Christina
    Högskolan i Jönköping.
    Managing health care decisions and improvement through simulation modeling2011In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 20, no 1, p. 15-29Article in journal (Refereed)
    Abstract [en]

    Simulation modeling is a way to test changes in a computerized environment to give ideas for improvements before implementation. This article reviews research literature on simulation modeling as support for health care decision making. The aim is to investigate the experience and potential value of such decision support and quality of articles retrieved. A literature search was conducted, and the selection criteria yielded 59 articles derived from diverse applications and methods. Most met the stated research-quality criteria. This review identified how simulation can facilitate decision making and that it may induce learning. Furthermore, simulation offers immediate feedback about proposed changes, allows analysis of scenarios, and promotes communication on building a shared system view and understanding of how a complex system works. However, only 14 of the 59 articles reported on implementation experiences, including how decision making was supported. On the basis of these articles, we proposed steps essential for the success of simulation projects, not just in the computer, but also in clinical reality. We also presented a novel concept combining simulation modeling with the established plan-do-study-act cycle for improvement. Future scientific inquiries concerning implementation, impact, and the value for health care management are needed to realize the full potential of simulation modeling.

  • 4.
    Jesper, Olsson
    et al.
    Swedish Federation of County Councils, Stockholm.
    Kammerlind, Peter
    Linköping University, Department of Mechanical Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Thor, J
    Elg, Mattias
    Linköping University, Department of Mechanical Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Surveying improvement activities in health care on a national level--the swedish internal collaborative strategy and its challenges2003In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 12, no 4, p. 202-216Article in journal (Refereed)
    Abstract [en]

    In order to map improvement activities in Swedish health care, we surveyed the managers of all primary health care centers (n = 958) and clinical hospital departments (n = 1355), with a response rate of 46%. The majority reports that their staff view improvement work positively. The most common driver of improvement is work environment problems, whereas external drivers have less influence. Among 35 methods, the most commonly used are educational initiatives, stress management, guidelines, and leadership development, whereas accreditation is used the least. Respondents who report extensive improvement efforts indicate the greatest benefit from educational interventions, analysis of patient incidents, guidelines, and rapid cycle tests. Respondents claim that improvement initiatives yield positive results, in particular regarding the working environment, administrative routines, workflow, and communication, although only 15%-30% of respondents report having data to support their claims. Our findings indicate an introverted focus of most improvement efforts, starting with staff and administration needs. Further research is needed to understand how and why some centers and departments have managed to achieve strategic, measurable, patient-focused, systems improvements, whereas most have not.

  • 5.
    Lionis, Christos
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Vlachonikolis, John
    Chatziarseni, Marios
    Faresjö, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Kristjansson, Ingolfur
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Tzagournissakis, Minas
    Plaitakis, Andreas
    Trell, Erik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Managing Alzheimer´s disease in primary care in Crete, Greece: room for improvement.2001In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 9, p. 16-21Article in journal (Refereed)
  • 6.
    Malmvall, Bo-Erik
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Darelid, Johan
    Department of Infectious Diseases, Ryhov Hospital, Jönköping, Sweden.
    Hiselius, A.
    National Corporation of Swedish Pharmacies, Ryhov Hospital, Jönköping, Sweden.
    Larsson, L
    Pediatric Outpatient Clinic, Eksjö Primary Care Center, Eksjö, Sweden.
    Swanberg, J.
    Department of Clinical Microbiology, Ryhov Hospital, Jönköping, Sweden.
    Åbom, P-E
    Department of Communicable Disease Control, Jönköping, Sweden.
    Reduction of antibiotics sales and sustained low incidence of bacterial resistance: report on a broad approach during 10 years to implement evidence-based indications for antibiotic prescribing in Jönköping County, Sweden2007In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 16, no 1, p. 60-67Article in journal (Refereed)
    Abstract [en]

    Background: Increased prevalence of resistance in major pathogens decreases the possibility to treat common infectious conditions. In the beginning of the 1990s, resistant pneumococci spread among children in southern Sweden, which alarmed both the profession and the medical authorities. We describe the measures taken to curb the spread of resistance and to reduce the use of antibiotics in outpatient care.

    Method: A national organization, Strama (Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance), was initiated in 1994 and a regional committee was formed in Jönköping County in 1995. A multifaceted program was started aiming at reducing antibiotic use in the county by 25% and that the prevalence of resistant pneumococci should not increase.

    Results: The efforts by the Jönköping County committee has resulted in a 31% total reduction of the consumption of antibiotic drugs in primary care between 1993 and 2005 and a 50% reduction among children aged 0 to 4 years. There has been no increase in the prevalence of resistant pneumococci or Haemophilus influenzae in the county. The decrease in antibiotic use was greater than the average in Sweden.

    Conclusion: Our regional efforts have been successful. This has probably been achieved by a sustained strategy including repeated campaigns in the media, information to the profession, implementation of guidelines, and feedback to the profession on data on antibiotic prescribing and resistance. We believe it is of outmost importance not only to inform the profession but also the public on the limited effects of antibiotics in most respiratory tract infections.

  • 7.
    Olsson, Jesper
    et al.
    Swedish Federation of County Councils, Stockholm.
    Elg, Mattias
    Linköping University, Department of Mechanical Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Molfenter, Todd
    Reflections on transnational transferability of improvement technologies-A comparison of factors for successful change in the United States and northern Europe2003In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 12, no 4, p. 259-269Article in journal (Refereed)
    Abstract [en]

    Two reliable models for predicting the success of change initiatives have been developed through the same research process. One model represents what is important in order to conduct successful improvements in the United States. The other model has been developed to predict successful improvement initiatives in Sweden. Through qualitative comparison between two reliable models we found some similarities and differences framing the underlying management heuristics for driving improvement initiatives. These findings are important pieces in transnational knowledge acquirement on quality improvements. They contribute a basis for discussions on transferability of management change concepts, and prompts for areas in need of considerations of adaptation before using different improvement ideas in other contexts than those for which they were developed.

  • 8.
    Olsson, Jesper
    et al.
    Swedish Association of Local Authorities and Regions, Stockholm.
    Terris, Darcy
    Elg, Mattias
    Linköping University, Department of Mechanical Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Lundberg, Johan
    Lindblad, Staffan
    The one-person randomized controlled trial2005In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 14, no 4, p. 206-216Article in journal (Refereed)
    Abstract [en]

    Currently, the gold standard for collection of clinical evidence is the randomized controlled trial (RCT), preferably with large, multicenter samples of subjects. Although this approach provides valuable information, many clinicians find it difficult to translate RCT results to the individual patient level. In this report, a statistical approach called Design of Experiments (DOE) is described as a method of applying the principles of RCTs one person at a time. An overview of the method, with a simple clinical example, is presented. As shown, DOE is a more efficient method than the sequential approach often taken by clinicians and their patients when evaluating various treatment choices. Further, the effect of multiple interventions can be assessed, alone or in combination with each other. In this way, DOE can be an important addition to the field of evidence-based medicine, although further studies are needed.

  • 9.
    Poksinska, Bozena
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    The current state of Lean implementation in health care: literature review2010In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 19, no 4, p. 319-329Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    The purpose of this article is to discuss the current state of implementation of Lean production in health care. The study focuses on the definition of Lean in health care and implementation process, barriers, challenges, enablers, and outcomes of implementing Lean production methods in health care.

    DESIGN/METHODOLOGY/APPROACH:

    A comprehensive search of the literature concerning the implementation of Lean production in health care was used to generate a synthesis of the literature around the chosen research questions.

    FINDINGS:

    Lean production in health care is mostly used as a process improvement approach and focuses on 3 main areas: (1) defining value from the patient point of view, (2) mapping value streams, and (3) eliminating waste in an attempt to create continuous flow. Value stream mapping is the most frequently applied Lean tool in health care. The usual implementation steps include conducting Lean training, initiating pilot projects, and implementing improvements using interdisciplinary teams. One of the barriers is lack of educators and consultants who have their roots in the health care sector and can provide support by sharing experience and giving examples from real-life applications of Lean in health care. The enablers of Lean in health care seem not to be different from the enablers of any other change initiative. The outcomes can be divided into 2 broad areas: the performance of the health care system and the development of employees and work environment.

  • 10.
    Rejler, Martin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Spångeus, Anna
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology and Gastroenterology UHL. Linköping University, Department of Medical and Health Sciences, Internal Medicine.
    Tholstrup, Jörgen
    Department of Medicine, Hoglands Hospital in Eksjö, Sweden.
    Andersson-Gäre, Boel
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Improved population-based care: Implementing patient-and demand-directed care for inflammatory bowel disease and evaluating the redesign with a population-based registry2007In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 16, no 1, p. 38-50Article in journal (Refereed)
    Abstract [en]

    The gastroenterology unit at the Höglands Hospital in Eksjö is responsible for the care of all 466 patients with inflammatory bowel disease (IBD) in a geographic area including approximately 115,000 inhabitants. In 2000, the frustration over an inadequate traditional outpatient clinic inspired us to redesign our outpatient unit to become more patient and demand directed. The redesign included the following: A direct telephone line for patients to a specialized nurse, available during working hours, appointments were scheduled in accordance with expected needs, and emergency appointments were available daily, traditional follow-ups of IBD patients were replaced by an annual telephone contact with a specialized nurse, the team agreed on a patient-centered value base for its work, and the redesign was monitored using clinical outcome measures reflecting 4 dimensions (see parentheses below) of the care in a "Value compass", quality of life (functional) and routine blood samples (clinical) were followed yearly and collected in a computerized IBD registry together with basic information about the patients, access and waiting lists together with patient satisfaction (satisfaction) are followed regularly, and ward utilization (financial) was registered. Our study shows that the new design offers a more efficient outpatient clinic in which waiting lists are markedly reduced although production rates remains the same. Utilization data show a significant decrease in comparison with national data, showing that the new care is economically favorable. The clinical results regarding anemia frequency in the IBD population are highly comparable with or even better than those found in the literature. We also show good results regarding quality of life where more than 88% of patients achieve set goals. In conclusion, our new patient- and demand-directed care seems to be more efficient and with clinical and quality-of-life results remaining on a high standard. ©2007Lippincott Williams & Wilkins, Inc.

  • 11.
    Thörne, Karin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Jönköping University, Sweden.
    Andersson-Gare, Boel
    Jonköping University, Sweden.
    Hult, Håkan
    Karolinska Institute, Sweden.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Co-Producing Interprofessional Round Work: Designing Spaces for Patient Partnership2017In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 26, no 2, p. 70-82Article in journal (Refereed)
    Abstract [en]

    Within wide-ranging quality improvement agendas, patient involvement in health care is widely accepted as crucial. Ward rounds that include patients active participation are growing as an approach to involve patients, ensure safety, and improve quality. An emerging approach to studying quality improvement is to focus on "clinical microsystems," where patients, professionals, and information systems interact. This provides an opportunity to study ward rounds more deeply. A new model of conducting ward rounds implemented through quality improvement work was studied, using the theory of practice architectures as an analytical tool. Practice architecture focuses on the cultural-discursive, social-political, and material-economic conditions that shape what people do in their work. Practice architecture is a sociomaterial theoretical perspective that has the potential to change how we understand relationships between practice, learning, and change. In this study, we examine howchanges in practices are accomplished. The results show that practice architecture formed co-productive learning rounds, a possible model integrating quality improvement in daily work. This emerged in the interplay between patients through their " double participation" (as people and as information on screens), and groups of professionals in a ward round room. However, social interplay had to be renegotiated in order to accomplish the goals of all ward rounds.

  • 12.
    Vackerberg, Nicoline
    et al.
    Jonköping University, Sweden.
    Sund-Levander, Märtha
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Thor, Johan
    Jonköping University, Sweden.
    What Is Best for Esther? Building Improvement Coaching Capacity With and for Users in Health and Social Care-A Case Study2016In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 25, no 1, p. 53-60Article in journal (Refereed)
    Abstract [en]

    While coaching and customer involvement can enhance the improvement of health and social care, many organizations struggle to develop their improvement capability; it is unclear how best to accomplish this. We examined one attempt at training improvement coaches. The program, set in the Esther Network for integrated care in rural Jonkoping County, Sweden, included eight 1-day sessions spanning 7 months in 2011. A senior citizen joined the faculty in all training sessions. Aiming to discern which elements in the program were essential for assuming the role of improvement coach, we used a case-study design with a qualitative approach. Our focus group interviews included 17 informants: 11 coaches, 3 faculty members, and 3 senior citizens. We performed manifest content analysis of the interview data. Creating will, ideas, execution, and sustainability emerged as crucial elements. These elements were promoted by customer focusembodied by the senior citizen trainershared values and a solution-focused approach, by the supportive coach network and by participants expanded systems understanding. These elements emerged as more important than specific improvement tools and are worth considering also elsewhere when seeking to develop improvement capability in health and social care organizations.

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