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  • 1.
    Arvidsson, Eva
    et al.
    Linköping University, Faculty of Medicine and Health Sciences.
    Broqvist, Mari
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Bäckman, Karin
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Carlsson, Per
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Garpenby, Peter
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Gustavsson, Erik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Culture and Society, Division of Philosophy, History, Arts and Religion.
    Lindholm, Lars
    Umeå universitet.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Sandman, Lars
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Waldau, Susanne
    Umeå universitet.
    Wiss, Johanna
    Linköping University, Faculty of Medicine and Health Sciences.
    Vägen framåt2013In: Att välja rättvist: om prioriteringar i hälso- och sjukvården / [ed] Per Carlsson, Susanne Waldau, Lund: Studentlitteratur AB, 2013, Vol. Sidorna 207-214, p. 207-214Chapter in book (Other academic)
    Abstract [sv]

    Som vi visat har utvecklingen av metoder och strukturer för öppna prioriteringar i Sverige kommit långt. Många frågor återstår likväl. Under vårt arbete med denna bok har vi identifierat ett antal förbättringsområden och utmaningar som vi avslutningsvis vill lyfta fram. Det rör sig om vilka som ska delta i prioriteringarna, tydliggörande av värdegrunden, behov av bättre kunskap, baserad på både vetenskaplig metod och erfarenhet, och fortsatt utveckling av prioriteringsprocesser på olika nivåer och i olika sammanhang. Även om vi i Sverige skulle nå en god enighet kring principer och kriterier för prioriteringar så kommer vi alltid finna många olika sätt att praktiskt lösa specifika prioriteringsproblem.

  • 2.
    Brüggemann, Jelmer
    et al.
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Guntram, Lisa
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    On difficult patients and informal complaints2023Other (Other (popular science, discussion, etc.))
    Abstract [en]

    Thinking critically about the role of complaint in patient care, Jelmer Brüggemann, Lisa Guntram and Ann-Charlotte Nedlund explore the ’difficult patient’ as a medical humanities concept.

  • 3.
    Brüggemann, Jelmer
    et al.
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Guntram, Lisa
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    The “Difficult Patient”: Dominant Logics and Misfits in Medicine2023In: Handbook of Social Sciences and Global Public Health / [ed] Pranee Liamputtong, Cham: Springer, 2023, p. 1-14Chapter in book (Other academic)
    Abstract [en]

    Medicine is organized around specific kinds of patients. In the cross-section of overarching biomedical narratives, international and national regulations and guidelines, and local practices, a particular kind of “ideal” patient is produced. The ideal patient embraces the larger biomedical paradigm, fits standardized diagnostic or treatment protocols, and behaves in expected and respectful ways. At the same time, its downside is created. Modern medicine’s narrow pathways create all sorts of “difficult patients.” Rather than focusing on the “difficult patient” as a psychological or relational struggle for individual care professionals or patients – a common focus in medical literature and debate – this chapter approaches the “difficult patient” as a phenomenon inherent in the ways in which medicine is organized. It shows how the difficult patient can provide an analytic lens through which individuals can see health care norms and logics in play. In particular, the chapter discusses how the difficult patient comes into being in “misfits” between dominant logics in medicine and individual patient lives and needs.

    The full text will be freely available from 2024-12-29 17:49
  • 4.
    Bäckman, Karin
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Broqvist, Mari
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Garpenby, Peter
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Jacobsson, Catrine
    PrioriteringsCentrum.
    Johansson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Karlsson, Erling
    PrioriteringsCentrum.
    Larsson, Sven
    PrioriteringsCentrum.
    Lund, Karin
    PrioriteringsCentrum.
    Liss, Per-Erik
    Linköping University, Department of Medical and Health Sciences, Division of Health and Society. Linköping University, Faculty of Arts and Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Arts and Sciences.
    Vårdens alltför svåra val?: kartläggning av prioriteringsarbete och analys av riksdagens principer och riktlinjer för prioriteringar i hälso- och sjukvården2007Report (Other academic)
    Abstract [sv]

    PrioriteringsCentrum har på uppdrag av Socialstyrelsen genomfört en kartläggning av på vilket sätt hälso- och sjukvårdens huvudmän och andra centrala aktörer arbetar med prioriteringar och har utvärderat hur detta arbete överensstämmer med intentionerna i riksdagens beslut om prioriteringar. Vi har även analyserat innehållet i och tillämpningen av riksdagens riktlinjer för prioriteringar i hälso- och sjukvården. Det har skett genom en etisk analys och mot bakgrund av ett stort antal intervjuer i landsting och kommuner samt med representanter för statliga myndigheter och yrkesorganisationer och med ledning av vad som framkommit i tidigare uppföljningar. Vi föreslår i rapporten ett anta förändringar och förtydliganden av riktlinjerna.

    Vi kan konstatera att sättet att arbeta med prioriteringar i landsting och kommuner inte är helt olikt det som gällde när Prioriteringsdelegationen redovisade en motsvarande uppföljning år 2001. Fortfarande finns knappast några öppna beslut om fördelning och prioritering av resurser om man med öppenhet avser att beslutsfattaren medvetet överväger flera alternativ och att grunderna för besluten är kända för dem som önskar ta del av dem.

    I situationer då tillgängliga resurser inte befinner sig i paritet med  önskvärda ambitioner får sjukvårdspersonalen ta det största ansvaret för att besluta om och genomföra ransonering av vården. Förutom på chefsnivå tycks dock sjukvårdpersonal fortfarande i liten utsträckning vara medveten om de etiska principer som enligt riksdagsbeslutet ska styra prioriteringar i vården. Få känner till den etiska plattformen med de tre etiska principerna. Lokala mallar eller styrdokument för prioriteringar är ovanliga. Det saknas nödvändiga förutsättningar för att tillämpa riksdagens prioriteringsbeslut och det finns inte heller några tydliga strategier för hur man vill skapa sådana förutsättningar inom landstingen.

    Den kommunala vård- och omsorgsverksamheten upplever sig fortfarande i ringa utsträckning berörd av den etiska plattformen och prioriteringsprinciperna. Någon gemensam prioritering mellan huvudmännen sker knappast alls.

    Medborgarna är i mycket liten utsträckning involverade i prioriteringsarbetet. Den ökade öppenheten gentemot brukare innebär oftast att viss information om prioriteringar sker genom traditionella kanaler som patientorganisationer, pensionärsråd och handikappråd och synpunkter inhämtas via allmänna patientenkäter medan klagomål hanteras genom patientnämnder.

    Vi har också funnit tydliga skillnader när det gäller hur arbetet med prioriteringar bedrivs idag jämfört med för sex år sedan. Genom Socialstyrelsen och Läkemedelsförmånsnämnden har staten tagit  ledningen när det gäller att visa hur prioriteringar kan göras på ett systematiskt och öppet sätt. Detta arbete har resulterat i en tydlig metodutveckling. Idag finns det dessutom flera exempel på konkret utvecklingsarbete och samverkan mellan huvudmän kring det vidare begreppet kunskapsstyrd vård till vilket systematiska prioriteringar är starkt relaterat. Vi kan också notera olika initiativ till vertikala prioriteringar i verksamheten där det framförallt är läkarkåren som engagerat sig; men också enstaka försök med systematiska politiska prioriteringar. Det finns dessutom flera lovande utvecklingsprojekt rörande prioriteringar som initierats av och drivs av sjukvårdspersonal både lokalt och nationellt. Yrkesförbunden är också mer aktiva idag när det gäller att sprida kunskap om prioriteringar....

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  • 5.
    Bäckman, Karin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Nedlund, Ann-Charlotte
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Carlsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Garpenby, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Erfarenheter av öppna politiska prioriteringar: uppföljning av prioriteringar i Östergötland efter fyra år2008Report (Other academic)
    Abstract [en]

    In 2003, the politicians in one county council in Sweden, The County Council of Östergötland, decided that certain health-care services would no longer be covered within the publicly financed health care. This decision was unique since both the content of it and the decision-making process was transparent. The media attention was extensive and the decision, which media called the "black list", was debated at both local and national levels. The experience of the transparent decision and its aftermath frightened many politicians – even though the authorities, medical professionals and other organizations welcomed the initiative.

    Since the decision was made in 2003, The County Council of Östergötland has continued its attempt to work with transparent and systematic priority setting, and has also further developed its procedure for priority setting on the political level. The National Centre for Priority Setting in Health Care has followed Östergötlands work with priority setting in health care since 2003; this is the fourth report on the subject. Based on archive data and interviews with politicians, public officials and health-care executives, we present the results of a study that on one hand aimed to describe the 2006 priority-setting procedure in the county council, and on the other hand aimed to highlight possible differences in the priority-setting procedure during the years 2003-2006. Special focus was made to study expectations, goals, changes in procedure and in the practical approach. This includes the informants’ view of roles, how arguments and line of reasoning was presented, how well the notion of priority setting was established among various actors and the informants’ perception of transparency.

    The opportunity to study Östergötlands work with priority setting during four years has also given us the possibility to reflect on a characterization of a political priority-setting procedure. The procedure of setting priorities is a continuous activity within the county council and during the past four years the political priority-setting procedure has improved gradually in many ways. Vertical ranking-lists are now established for more disease groups than before. In recent years, more medical professional groups are involved in the construction of ranking lists and to report the descriptions of consequences if rationalizing. Reasons and justifications for the decisions have not always existed during the studied years, but have been gradually developed.

    In addition, examples of areas where informants consider there have been improvements are:

    • A clearer procedure and a clearer division of responsibility.

    • A more realistic timetable including better scheduled time for discussion and processing information needed for the decision making (facts and knowledge).

    • Better communication between the politicians and the medical professionals, mostly through public officials, who are perceived to have a central role as translators, mediators and being the driving force in the priority-setting process.

    Despite all the positive trends towards a transparent procedure for political priorities, there are certain areas in need of further improvement, such as:

    • How to spread knowledge throughout the organization about reasons and rationales behind the priority-setting procedure and also how decisions about resource allocation are carried out.

    • How to clarify the roles and division of responsibility including which decision might be appropriate to bring up to the political level.

    • How to balance information from the vertical ranking-lists and the descriptions of consequences with political values and with information from other sources.

    • How to accomplish and strengthen internal support.

    • How to encourage the external understanding for priority setting and how to publicly present the reasons and justifications behind decisions.

    • How to monitor the collaboration methods, decisions and implementation of decisions.

    Furthermore, from the experience of the work in Östergötland we found that a procedure for priority setting on the political level is characterized by the following six different phases:

    1.  The grounding phase (directives, conditions, roles)

    2.  The fact finding phase (gathering relevant information, i.e. facts and knowledge)

    3.  The dialogue phase (the internal dialogue)

    4.  The decision-making phase (making decisions including presenting justifications)

    5.  The publicity phase (activities, internal and external support and understanding)

    6.  The evaluation phase (assessment of procedure and results).

    In the report we give a few brief thoughts on each of these phases, and discuss lessons learned and essential components to consider when planning for a procedure for priority setting on the political level.

     

    Finally, we note that there is a consensus among leading politicians, public officials and healthcare executives to continue the work with transparent priority setting on the political level. However, it is still uncertain how this practically should be carried out. We do not believe that we have managed to detect and explain every aspect of how an approach to set priorities on the political level might be carried out, but hopefully our reflections can serve as a starting point for further work and further development.

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    Erfarenheter av öppna politiska prioriteringar: Uppföljning av prioriteringar i Östergötland efter fyra år
  • 6.
    Carlsson, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Garpenby, Peter
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Sandman, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Högskolan i Borås, Institutionen för vårdvetenskap.
    Öppna prioriteringar inom vård och omsorg - var står vi idag och hur ska vi komma vidare?2014In: Vägval för välfärden: En antologi om finansieringsgap, prioriteringar och försäkring som kompletterande lösning / [ed] Kristina Ström Olsson, Stockholm: Svensk Försäkring , 2014, p. 31-61Chapter in book (Other academic)
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    Öppna prioriteringar inom vård och omsorg - var står vi idag och hur ska vi komma vidare?
  • 7.
    Eckard, Nathalie
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Using cost-effectiveness evidence in making priority gradings: the case of the Swedish national guidelines for heart diseases2017In: Qualitative methods in health economics / [ed] Joanna Coast, London: Rowman & Littlefield Publishers, 2017Chapter in book (Other academic)
  • 8.
    Eckard, Nathalie
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Reaching agreement in uncertain circumstances: the practice of evidence-based policy in the case of the Swedish National Guidelines for heart diseases2017In: Evidence and Policy: A Journal of Research, Debate and Practice, ISSN 1744-2648, no 4, p. 687-707Article in journal (Refereed)
    Abstract [en]

    This paper explores the practice of evidence-based policy in a Swedish healthcare context. The study focused on how policymakers in the specific working group, the Priority-Setting Group (PSG), handled the various forms of evidence and values and their competing rationalities, when producing the Swedish National Guidelines for heart diseases that are based on both clinical and economic evidence and are established to support explicit priority-setting in healthcare. The study contributes to the theoretical and practical debate on evidence-based policy (EBP) by illustrating how the practical tensions of coming to agreement were managed, to a large extent, through deliberation and by creativity.

  • 9.
    Eklund Saksberg, My
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bielsten, Therese
    Jonkoping Univ, Sweden.
    Cahill, Suzanne
    Trinity Coll Dublin, Ireland.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Sandman, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Pier
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Nurses' priority-setting for older nursing home residents during COVID-192024In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989Article in journal (Refereed)
    Abstract [en]

    Background Ethical principles behind prioritization in healthcare are continuously relevant. However, applying ethical principles during times of increased need, such as during the COVID-19 pandemic, is challenging. Also, little is known about nursing home nurses' prioritizations in their work to achieve well-being and health for nursing home residents.Aim The aim of this study was to explore nursing home nurses' priority-setting for older nursing home residents in Sweden during the COVID-19 pandemic.Research design, participants, and research context We conducted a qualitative interview study. Data were collected through in-depth interviews (retrospective self-reports) between February and May 2021 with 21 nursing home nurses. To help respondents to recall their memories, we used the critical incident technique (CIT). We analyzed data within the theoretical framework and the methodological orientation of content analysis.Ethical considerations Written and verbal consent was obtained before the interviews, and information was given to participants informing them that participation was entirely voluntary. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to the research project (Dnr. 2020-05649).Findings We identified an overarching theme-nursing home nurses struggling on multiple fronts, "just do it"-and seven categories: striving for survival and caring about a dignified death; responding sensitively to relatives' expectations; ranking the urgency of needed care; responding to input from different actors; combating the spread of infection in unconventional ways; taking the lead and doing what is required; and following the ideals of person-centered nursing.Conclusions Nurses' priority-setting for older nursing homes residents during the COVID-19 pandemic meant strain and struggle. In some cases, nurses had taken responsibility for priorities falling outside their statutory powers. Different demands and interests affected nurses' priorities. Nursing home nurses need organizational and managerial support to prioritize.

  • 10.
    Eriksson, Thérèse
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Centrality and compatibility of institutional logics when introducing value-based reimbursement2021In: Journal of Health Organization & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 35, no 9, p. 298-314Article in journal (Refereed)
    Abstract [en]

    Purpose: Using financial incentives has been criticised for putting too much focus on things that can be measured. Value-based reimbursement may better align professional values with financial incentives. However, professional values may differ between actor groups. In this article, the authors identify institutional logics within healthcare-providing organisations. Further, the authors analyse how the centrality and compatibility of the identified logics affect the institutionalisation of external demands.

    Design/methodology/approach: 41 semi-structured interviews were conducted with representatives from healthcare providers within spine surgery in Sweden, where a value-based reimbursement programme was introduced. Data were analysed using thematic content analysis with an abductive approach, and a conceptual framework based on neo-institutional theory.

    Findings: After the introduction of the value-based reimbursement programme, the centrality and compatibility of the institutional logics within healthcare-providing organisations changed. The logic of spine surgeons was dominating whereas physiotherapists struggled to motivate a higher cost for high quality physiotherapy. The institutional logic of nurses was aligned with spine surgeons, however as a peripheral logic facilitating spine surgery. To attain holistic and interdisciplinary healthcare, dominating institutional logics within healthcare-providing organisations need to allow peripheral institutional logics to attain a higher centrality for higher compatibility. Thus, allowing other occupations to take responsibility for quality and attain the feeling of professional pride.

    Originality/value: Interviewing spine surgeons, physiotherapists, nurses, managers and administrators allows us to deepen the understanding of micro-level behaviour as a reaction (or lack thereof) to macro-level decisions.

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  • 11.
    Eriksson, Thérèse
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    The introduction of a value-based reimbursement programme - Alignment and resistance among healthcare providers2023In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 38, no 1, p. 129-148Article in journal (Refereed)
    Abstract [en]

    Reimbursement programmes are used to manage care through financial incentives. However, their effects are mixed and the programmes can motivate behaviour that goes against professional values. Value-based reimbursement programmes may better align professional values with financial incentives. The aim of this study is to analyse if and how healthcare providers adapt their practices to a value-based reimbursement programme that combines bundled payment with performance-based payment. Forty-one semi-structured interviews were conducted with representatives from healthcare providers within spine surgery in Sweden. Data were analysed using thematic analysis with an abductive approach and a conceptual framework based on neo-institutional theory. Healthcare providers were positive to the idea of a value-based reimbursement programme. However, during its introduction it became evident that some aspects were easier to adapt to than others. The bundled payment provided a more comprehensive picture of the patients needs but to an increased administrative burden. Due to the financial impact of the bundled payment, healthcare providers tried to decrease the amount of post-discharge care. The performance-based payment was appreciated. However, the lack of financial impact and transparency in how the payment was calculated caused providers to neglect it. Healthcare providers adapted their practices to, but also resisted aspects of the value-based reimbursement programme. Resistance was mainly caused by lack of understanding of how to interpret and act on new information. Providers had to face unfamiliar situations, which they did not know how to handle. Better IT-facilitation and clearer definition of related care is needed to strengthen the value-based reimbursement programme among healthcare providers. A value-based reimbursement programme seems to better align professional values with financial incentives.

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  • 12.
    Garpenby, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Bäckman, Karin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Broqvist, Mari
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Landstinget Kronoberg - i linje med prioriteringar2010Report (Other academic)
    Abstract [sv]

    I november 2008 beslutade Landstinget Kronoberg att genomföra en process med öppna prioriteringar, som ett inslag av flera i en plan för strategisk utveckling av hälso- och sjukvården mellan 2009 och 2015.

    PrioriteringsCentrum fick i maj 2009 i uppdrag av landstingsdirektören att genomföra en uppföljning av Landstinget Kronobergs arbete med prioriteringar under år 2008-2009. Syftet var dels att bidra till landstingets interna lärande och dels att sprida erfarenheter nationellt. Tillsammans med landstingsledningen kom vi fram till att uppföljningen skulle genomföras i form av två delstudier – en enkätstudie riktad till ett antal nyckelgrupper i processen och en begränsad intervjustudie.

    Intervjustudiens syfte var att kartlägga några väsentliga inslag i prioriteringsprocessen och jämföra olika aspekter i processen med motsvarande delar i prioriteringsprocessen 2008 inom Västerbottens läns landsting. Från intervjustudien kan vi dra några övergripande slutsatser:

    • Prioriteringsarbetet i Kronoberg byggde på mikrostrategier – att påverka individer – framför makrostrategier – att förändra organisationen. Det var ett medvetet val i linje med landstingets bild av hur förändringar bör genomföras.
    • Eftersom verksamhetsledningarna inte deltog i granskning av förslag, vilade en stor börda på projektledaren och ledningsgruppen, som fick både sortera och granska förslag av olika dignitet och kvalitet.
    • Ledningsgruppen ställde inte förslag mot varandra och med våra ögon har ingen horisontell prioritering egentligen genomförts. Inprioriteringarna har, liksom i Västerbotten, följt ett eget spår vilket gör ihopkopplingen svår att se för andra än de verkligt initierade i processen.
    • Dialog kring prioriteringsarbetet har skett i driftsledningarna men också direkt mellan verksamheter och projektledaren respektivelandstingsdirektören. Det har inte skapats utrymme för någon dialog mellan verksamheterna och politikerna.
    • I jämförelse med Västerbottens läns landsting gick förslagen på lågt prioriterade åtgärder tidigt i processen över till Ledningsgruppen där ansvaret för innehållet stannade under i stort sett hela processen.
    • Fördelen var att Ledningsgruppen tidigt fick en uppfattning om materialets styrkor och svagheter, kunde gallra detta och även lägga in ett helhetsperspektiv tidigt i processen.
    • I jämförelse med prioriteringsarbetet i Västerbottens läns landsting hade politikerna i Kronoberg en betydligt mindre framträdande roll att spela. De gjorde valet att inte kommunicera direkt med verksamhetsföreträdare – helt i linje med den inställning om uppgiftsfördelning som tillämpas i landstinget. I Kronoberg förekom ingen politisk beredning av förslagen till vare sig ransonering, effektivisering eller inprioritering.

    Enkätstudiens syfte var i första hand att bidra till landstingets interna lärande och utvecklingsarbete. Detta genom att samla erfarenheter och synpunkter från de medverkande vid de olika arbetsstegen i processen. De grupper som främst medverkat i prioriteringsarbetet är: den politiska styrgruppen, ledningsgruppen, den medicinska kommittén inkl arbetsutskottet, sjukdomsgrupper under den medicinska kommittén samt verksamhetschefer.

    Ett axplock av de slutsatser vi drog från enkätstudien är att:

    • En majoritet av de svarande ansåg att prioriteringsarbetet som det bedrevs i landstinget på det hela taget var motiverat. Däremot var det skilda uppfattningar om arbetet på det hela taget bedrevs på ett ändamålsenligt sätt.
    • Kommentarer om vad deltagarna upplevt som mest värdefullt med prioriteringsarbetet handlade i huvudsak om: - att öppet få möjlighet att diskutera prioriteringar, - att få göra en genomlysning av all verksamhet, - att onödiga moment som görs idag nu identifieras och tas bort, och - att nyttiga diskussioner och delaktighet skapats.
    • Medan upplevelser av vad som varit mest negativt mest handlade om:- att den avsatta tiden varit för knapp,- att beslutsunderlagen hållit ojämn kvalité, och- att en återkoppling och diskussion kring resultaten saknats.
    • Uppfattningarna går isär när det gället om landstinget levt upp till syftet att skapa en ökad öppenhet internt, inom landstinget, om prioriteringar.
    • Endast en mindre andel, i alla grupper, ansåg att landstinget levt upp till syftet att skapa en ökad öppenhet externt, mot medborgarna, omprioriteringar.
    • Kännedomen om den nationella modellen för vertikala prioriteringar som användes i arbetet varierade bland verksamhetscheferna. Färre än hälften ansåg att modellen var lämplig för att identifiera och rangordna de lägst prioriterad åtgärderna inom området.
    • Många av verksamhetscheferna ansåg att de endast i liten utsträckning eller inte alls skulle komma att ha någon nytta av det prioriteringsarbete de genomfört.
    • En mindre andel av verksamhetscheferna upplevde att prioriteringsarbetet bidragit med nya insikter om den egna verksamheten.
    • Det var vanligt att en stor del av medarbetarna på den egna enheten engagerades i arbetet med att identifiera och rangordna de lägst prioriterade åtgärderna inom ett verksamhetsområde, men inom vissa områden var endast ledningsgruppen på den egna enheten engagerad.
    • Underlagsmaterialen som varje grupp i sitt respektive arbetssteg i processen fick att ta ställning till upplevdes ha varit av varierande kvalitet.
    • Att sammansättningen på den grupp man ingick var lämplig för sitt syfte och att den egna gruppen löst sin uppgift på ett tillfredsställande sätt ansåg en majoritet av personerna i ledningsgruppen, den medicinska kommittén och dess sjukdomsgrupper.
    • Endast en minoritet av personerna i den politiska styrgruppen, ledningsgruppen respektive den medicinska kommittén ansåg att de gjort någon horisontell prioritering, d v s en vägning mellan åtgärder från olika verksamhetsområden.
    • Uppfattningarna om landstingets arbete med s k inprioriteringar hade skett på ett lämpligt sätt varierade.
    • En majoritet ansåg att landstinget framöver ska upprepa prioriteringsarbetet, med samma upplägg som nu eller att man ska upprepa arbetet fast med modifieringar. Däremot varierade svaren när det gällde om man personligen skulle vilja delta i liknande prioriteringsarbete i framtiden.

    Landstinget Kronoberg har fattat ett beslut om att fortsätta med prioriteringsarbetet och planeringen av nästa omgång har startat. Vår förhoppning är att de båda delstudier, som är sammanförda till en gemensam rapport, kan förmedla erfarenheter för dem som medverkade i det första prioriteringsarbetet i Kronoberg och för andra intresserade.

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    Landstinget Kronoberg - i linje med prioriteringar
  • 13.
    Garpenby, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Implementation as learning and balancing: the launching of a new program for dialogic intervention in Östergötland County Council2013Conference paper (Other academic)
  • 14.
    Garpenby, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Division of Health and Society. Linköping University, Faculty of Health Sciences.
    Ordnat införande av metoder i klinisk verksamhet: En studie av försök med dialogmöten inom Landstinget i Östergötland2013Report (Other academic)
    Abstract [en]

    During 2010 to 2012 Östergötland County Council together with the Department of Medical and Health Sciences at Linköping University developed and tested a programme, The Östergötland Model, where research-based knowledge were compiled and presented in dialogic meetings among clinical units within the county council. The intention was to adapt and adjust a Canadian model of dialogic intervention, “The Alberta Ambassador Program”, to a Swedish healthcare context. This was done in order to better understand how research-based knowledge and practise-based knowledge can be systematically integrated in a real-world health care context.

    The working group, which was commissioned by the Advisory Board on Medical Technology at Östergötland County Council to manage this programme, organised 14 dialogic meetings at clinical units and health centres during 2012.

    The aim of this report is to analyse and discuss the development and the implemention of the local programme, The Östergötland Model, based on an analytical framework for “knowledge brokering” – a form for knowledge transition in health care. The findings will also be compared with the Canadian model in order to identify differences and similarities between these two models.

    The main data source is observations of the meetings of the Advisory Board and its working group, supplemented with a web questionnaire and semi-structured interviews with key participants.

    The report shows that the programme in Östergötland had elements from the different forms of “knowledge brokering”. One was “linkage and exchange” that emphasises the meeting between research and practise. However, as the programme was carried out the element “knowledge management” became more pronounced since a lot of work was put into establishing and disseminating a certain kind of knowledge. A third element, “capacity building” which is supporting practising clinicians to formulate issues that can be answered by research-based knowledge, can be identified but was never particularly prominent in the programme.

    A marked difference between the two programmes was that in Alberta the aimed effects was in a sense indirect by giving participants the role as opinion leaders with the task to communicate information and knowledge in the health care system. As a contrast, in Östergötland the ambition was to directly influence the behaviours at specific clinical units.

    Even though a great part of the work in the initial phase of the programme concerned the development of a document presenting evidence on the medical effects, this was not the central aim of the programme in Östergötland. Moreover, to compile evidence is not anything unique but rather an ordinary process in the health-care context. Instead, the most important part of this programme is the dialogic meeting where the participants were given the opportunity to reflect over their own way of acting and possibly to change in direction of a more systematic integration of research-based knowledge and practice-based knowledge in their clinics and health centres. Among the participants this form of implementing knowledge proved to be of great interest. Therefore, as this report shows, there are good reasons to reflect over how new forms of dialogue can be incorporated into the health-care organisation and thus form a process where both research-based and practice-based knowledge are integrated. This report argues that mediating bodies have an important role in facilitating such a dialogic process.

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    Ordnat införande av metoder i klinisk verksamhet: En studie av försök med dialogmöten inom Landstinget i Östergötland
  • 15.
    Garpenby, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Division of Health and Society. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Organisering av prioriteringsprocessen2013In: Att välja rättvist: om prioriteringar i hälso- och sjukvården / [ed] Per Carlsson och Susanne Waldau, Lund, 2013, 1, p. 119-135Chapter in book (Other academic)
    Abstract [sv]

    Hur en prioriteringsprocess organiseras har betydelse både för hälso- och sjukvårdens medarbetare och för allmänheten. Organiseringen ger tydliga signaler till omvärlden vilket kan resultera i en reflektion kring prioriteringsarbetet som medför att detta uppfattas negativt eller positivt. Öppenhet i samband med prioriteringar leder ofta tankarna mot främst insyn i processen. Men insyn är i sig inte en egenskap som gör att prioriteringsprocessen vinner uppslutning. I detta kapitel argumenteras i stället för en öppenhet om omfattar dialog, interaktion mellan hälso- och sjukvårdens många intressenter och en organisering som leder till gemensamt meningsskapande kring problem och lösningar på resursfördelningens dilemma.

  • 16.
    Garpenby, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Political strategies in difficult times - The "backstage" experience of Swedish politicians on formal priority setting in healthcare2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 163, p. 63-70Article in journal (Refereed)
    Abstract [en]

    This paper contributes to the knowledge on the governing of healthcare in a democratic context in times of austerity. Resource allocation in healthcare is a highly political issue but the political nature of healthcare is not always made clear and the role of politicians is often obscure. The absence of politicians in rationing/disinvestment arrangements is usually explained with blame-shifting arguments; they prefer to delegate "the burden of responsibility" to administrative agencies or professionals. Drawing on a case where Swedish regional politicians involved themselves in setting priorities at a more detailed level than previously, the findings suggest that the subject of "blame avoidance" is more complicated than usually assumed. A qualitative case study was designed, involving semi-structured interviews with 14 regionally elected politicians in one Swedish health authority, conducted in June 2011. The interviews were analysed through a thematic analysis in accordance with the "framework approach" by Ritchie and Lewis. Findings show that an overarching strategy among the politicians was to appear united and to suppress conflict, which served to underpin the vital strategy of bringing the medical profession into the process. A key finding is the importance that politicians, when appearing "backstage", attach to the prevention of blame from the medical profession. This case illustrates that one has to take into account that priority settings requires various types of skills and knowledges - not only technical but also political and social. Another important lesson points toward the need to broaden the political leadership repertoire, as leadership in the case of priority setting is not about politicians being all in or all out. The results suggest that in a priority-setting process it is of importance to have politics on-board at an early stage to secure loyalty to the process, although not necessarily being involved in all details.

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  • 17.
    Garpenby, Peter
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    The patient as a policy problem: Ambiguous perceptions of a critical interface in healthcare2022In: Health, ISSN 1363-4593, E-ISSN 1461-7196, Vol. 26, no 6, p. 681-701Article in journal (Refereed)
    Abstract [en]

    The interface between the patient and the health service has changed, which constitutes a potential problem for various policy-makers. Using a critical policy perspective and drawing on the theory of problem framing, this paper explores how actor groups with different responsibilities perceive the patient as a constructed policy problem. This is a qualitative study where data consists of single episode interviews with healthcare politicians, senior administrators, service strategists, and unit mangers from one regional health authority in Sweden. A thematic content analysis of the interviews was carried out in accordance with "the framework approach". The study illustrates how the actors interpret their reality using diverse problem frames. This becomes more visible when the framing is disentangled with regard to what perspective they employ in relation to different accounts: society or the individual, or the (healthcare) system or the (healthcare) professional. The actor groups are part of the same institutional context, which explains certain tendencies of similarities in terms of the accounts being used, but still they approach the constructed problem differently which is visible as shifts-scaling up and down-between different accounts. By analyzing and structuring the various problem frames (including its policy styles) we can enhance our knowledge about how those responsible for the governance of healthcare approach the patient as a policy problem, as something that concerns only the patient and/or the provider, or as something that needs to be addressed in broader strategic terms.

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    fulltext
  • 18.
    H Österholm, Johannes
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Larsson Ranada, Åsa
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Mapping Collaboration and Coordination of Health and Care Services for Older People with Dementia: A Scoping Review2023In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 2023, article id 8858773Article, review/survey (Refereed)
    Abstract [en]

    Responsibility for health and care services for people with dementia is often divided between various professionals, agencies, and authorities, causing a fragmentation of care and an unclear division of responsibility between different stakeholders. In relation to this, collaboration and coordination of health and care services are often described as vital for catering to diverse needs and to provide adequate support. The aim of this scoping review was to map how different health and care agencies collaborate and coordinate services for older people with dementia. Joanna Briggs Institute's proposed methodology for scoping reviews was used, and systematic searches were carried out in six databases. A total of 59 articles published within the last 10 years were included based on certain eligibility criteria. The Research Pyramid was used to critically appraise these articles, suggesting that available research is of moderate quality. The descriptive content analysis of the articles revealed eight categories describing the characteristics of collaboration and coordination for people with dementia, as presented in previous articles. These characteristics are described in terms of different barriers, the function of the care coordinator, assessment and planning to provide services, interprofessional collaboration, information sharing, knowledge needed to navigate a complex health and care system and understanding of dementia, and personalisation of care. Engaging care coordinators with diverse competencies to address both medical and social care needs is essential, especially since people with dementia experience multiple and complex needs. It is also important to explain and visualise available services and when these services are suitable for implementation. Knowledge about dementia is necessary to empower people with dementia in everyday life situations.

  • 19.
    H Österholm, Johannes
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Larsson Ranada, Åsa
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Collaboration and coordination of health and care services for older people with dementia by multidisciplinary health and care providers: a scoping review protocol2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 12, article id e066578Article, review/survey (Refereed)
    Abstract [en]

    IntroductionCollaboration and coordination of health and care services are key to catering for the diverse needs of a growing population of older people with dementia. When multidisciplinary health and care providers work together, they have the possibility to use resources in a fair, accurate and effective way and thereby do the right thing, at the right time, for the right individual. The aim of this scoping review is to map how different care-providing agencies collaborate and coordinate health and care services for older people with dementia. Methods and analysisA scoping review will be carried out following the proposed methodology by Joanna Briggs Institute and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Systematic searches will be carried out in scientific databases. Studies published within the last 10 years will be included based on certain eligibility criteria. All included studies will be critically appraised using the Research Pyramid. Data from included studies will be charted and subjected to content analysis. Ethics and disseminationEthics approval is not required for scoping reviews. The dissemination of findings will be conducted through conference presentations and publication in international scientific journals.

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  • 20.
    Holmér, Suzana
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Rehabilitation in Motala.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Thomas, Kristin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Krevers, Barbro
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    How health care professionals handle limited resources in primary care - an interview study2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 6Article in journal (Refereed)
    Abstract [en]

    Introduction: Health care systems around the world are struggling with limited resources, in relation to the prevailing health care need. An accessible primary care is an important part of the solution for how to provide affordable care for the population and reduce pressure on the overall health care system such as unnecessary hospital stays and associated costs. As primary care constitutes an important first line of healthcare, the task of prioritising and deciding what to do and for whom lies in practice, primarily with the primary care professionals. Thus, the decisions and behaviour of primary care professionals have a central role in achieving good and equal health in the population. The aim of this study is to explore how primary health care professionals handle situations with limited resources and enhance our knowledge of priorities in practice. Methods: Semi-structured interviews with 14 health care professionals (7 nurses, 7 physicians) working in Swedish primary care were interviewed. Data were analysed inductively with content analysis. Findings: Three main categories were found: Influx of patients; Structural conditions; and Actions. Each category illustrates an important aspect for what primary care professionals do to achieve good and equal care. The influx of patients concerned what the professionals handled in terms of patients healthcare needs and patient behaviour. Structural conditions consisted of policies and goals set for primary care, competence availability, technical systems, and organisational culture. To handle situations due to limited resources, professionals performed different actions: matching health care needs with professionals competency, defining care needs to suit booking systems appointments, giving care at the inappropriate health care level, rearranging workhours, and passing on the decision making. Conclusion: Priorities in primary care are not, "one fits all " solution. Our study shows that priorities in primary care comprise of ongoing daily processes that are adapted to the situation, context of patient influx, and structural conditions. Healthcare professionals actions for how influx of patients is handled in relation to limited resources, are created, and shaped within this context which also sets the boundaries for their actions.

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    fulltext
  • 21.
    Issakainen, Mervi
    et al.
    University of Eastern Finland, Finland.
    Karjalainen, Katja
    University of Eastern Finland, Finland.
    Heimonen, Sirkkaliisa
    Age Institute, Helsinki, Finland.
    Ylhäinen, Marjo
    University of Eastern Finland, Finland.
    Astell, Arlene
    University of Toronto, Toronto, Ontario, Canada.
    Boger, Jennifer
    University of Waterloo, Waterloo, Ontario, Canada.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Nygård, Louise
    Karolinska institutet, Stockholm, Sweden.
    Mäki-Petäja-Leinonen, Anna
    University of Eastern Finland, Finland.
    Rissanen, Sari
    University of Eastern Finland, Finland.
    Muistisairaana työelä­mässä: tutkimushanke sairastuneiden kokemuksista ja oi­keuksien toteutumisesta2018In: Gerontologia, ISSN 0784-0039, Vol. 32, no 4, p. 288-291Article in journal (Refereed)
  • 22.
    Issakainen, Mervi
    et al.
    Department of Social Sciences, University of Eastern Finland, Kuopio, Finland.
    Mäki-Petäjä-Leinonen, Anna
    UEF Law School, University of Eastern Finland, Joensuu, Finland.
    Heimonen, Sirkkaliisa
    Age Institute, Helsinki, Finland.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Astell, Arlene
    KITE Research Institute, University Health Network, Toronto, Canada Departments of Occupational Science & Occupational Therapy and Psychiatry, University of Toronto, Toronto, Canada School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK.
    Boger, Jennifer
    Systems Design Engineering, University of Waterloo, Waterloo, Canada Research Institute for Aging, Waterloo, Canada.
    Rissanen, Sari
    Department of Social Sciences, University of Eastern Finland, Finland.
    Nygård, Louise
    Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden.
    Experiences of influencing one's own life when living with working-age dementia2023In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 43, no 8, p. 1934-1953, article id PII S0144686X21001525Article in journal (Refereed)
    Abstract [en]

    Having opportunities to make decisions and choices regarding one's life is crucial when living with dementia. This inter-disciplinary study draws on the concept of relational autonomy to explore how working-age people living dementia seek to influence their lives, and what makes it easier or more difficult for them in their everyday life. The data consist of three focus group discussions conducted with 12 retired adults who developed dementia while still employed. The results illuminate various resources that enable a person to (a) handle their difficulties at work and related consequences with dignity, (b) manage everyday tasks and live a fulfilling life, and (c) fight the stigma associated with (working-age) dementia. Challenges related to these aspects reported by the participants reveal gaps and obstacles that impede the full realisation of the rights of people living with early onset dementia. This research highlights the need for workplace education for different stakeholders, equal and ongoing access to guidance and counselling for younger people who live with dementia, and an effort by society as a whole to eradicate stigma.

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    fulltext
  • 23.
    Karjalainen, Katja
    et al.
    Univ Eastern Finland, Finland.
    Issakainen, Mervi
    Univ Eastern Finland, Finland.
    Ylhainen, Marjo
    Univ Eastern Finland, Finland.
    Marashi, Sheida
    Univ Waterloo, Canada.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Boger, Jennifer
    Univ Waterloo, Canada; Res Inst Aging, Canada.
    Astell, Arlene
    Univ Hlth Network, Canada; Univ Toronto, Canada; Univ Toronto, Canada; Univ Toronto, Canada; Univ Reading, England.
    Maki-Petaja-Leinonen, Anna
    Univ Eastern Finland, Finland.
    Nygard, Louise
    Karolinska Inst, Sweden.
    Supporting continued work under the UNCRPD - views of employees living with mild cognitive impairment or early onset dementia2022In: International Journal of Discrimination and the Law, ISSN 1358-2291, E-ISSN 2047-9468, Vol. 22, no 4, p. 371-385Article in journal (Refereed)
    Abstract [en]

    This article reports the results of a socio-legal investigation into how continued work among people living with progressive cognitive impairments such as mild cognitive impairment (MCI) or early onset dementia (EOD) can be supported. This study that makes use of empirical data collected in Finland, Sweden and Canada seeks to give voice to people living with MCI or EOD and set their experiential knowledge in dialogue with equality rights related tools provided by the UN Convention on the Rights of the Persons with Disabilities (UNCRPD). The results illustrate that there are effective tools available that remove barriers to participation and support continued work of employees living with cognitive impairments at least for some time while impairments are mild. Ideally, flexibility and solidarity in the workplace automatically eliminates the effects of individual impairment. However, cognitive impairments are often such that along with general accessibility measures individual accommodations are needed. Supporting continued work expands the freedom to continue meaningful work in the preferred manner and offers people the means to gain a livelihood and participate in society as a member of the work community on equal basis with others.

  • 24.
    Kokorelias, Kristina M.
    et al.
    Sinai Hlth Syst, Canada; Univ Hlth Network, Canada; Mt Sinai Hosp, Canada.
    Nadesar, Nirusa
    Univ Hlth Network, Canada; Univ Toronto, Canada.
    Bak, Katherine
    Univ Toronto, Canada; Univ Hlth Network, Canada.
    Boger, Jennifer
    Univ Waterloo, Canada; UBC Okanagan, Canada.
    Nygard, Louise
    Karolinska Inst, Sweden.
    Maeki-Petaejae-Leinonen, Anna
    Univ Eastern Finland, Finland.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Astell, Arlene
    Univ Toronto, Canada; Univ Hlth Network, Canada; Univ Reading, England.
    The impact on employment and education of caregiving for a family member with young onset dementia: A scoping review2024In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684Article in journal (Refereed)
    Abstract [en]

    Young-onset dementia (YOD) affects individuals under 65 years of age, often leading to loss of employment and independence. Families provide increasing levels of care to family members with YOD, resulting in changes to their daily lives, including their occupational pursuits. This review examines evidence of the occupational implications for family members who provide care to a family with YOD to identify: (i) the influence and impact caregiving tasks and responsibilities have on employment, volunteering, and education, and (ii) caregiver, and caregiving situation factors associated with changes in employment, volunteering, and education. A scoping review was performed using eight electronic databases. Included articles were narratively synthesized using a thematic analysis. Sixteen studies met the inclusion criteria and were included for review. The over-arching (main) theme of 'decision-making' was identified, with family members required to make choices about their own occupational goals and roles to be able to provide care to family living with YOD. The outcomes of these decisions are dynamic and changeable across the caregiving trajectory. Three caregiving factors influence decision-making: (1) Implications of Combining Caregiving and Occupations, (2) Altered Identity (3) Strategies to Support Caregivers of Individuals Living with YOD. A fourth theme was also identified 'Guidance for Researchers To Support Caregivers'. There is a scarce body of literature examining the influence caregiving has on occupational outcomes for the YOD caregiver population. Much of this work is descriptive and lacks focus on the implications, particularly long-term impacts. This review provides a foundational guide for future research and practices to support YOD family caregivers to obtain and sustain occupations.

  • 25.
    Landwehr, Claudia
    et al.
    Johann Wolfgang Goethe-Universität, Tyskland.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Legitimacy Problems in the Allocation of Health Care:: Decision-Making Procedures in International Comparison2009In: In Search for Legitimacy: Policy Making in Europe and the Challenge of Complexity, Opladen/Farmington Hills, MI: Budrich Publishers , 2009, 1, p. 247-267Chapter in book (Other academic)
    Abstract [en]

    In European societies, social differentiation, value pluralism, and international integration have brought about a condition of previously unknown complexity. Citizen expectations are rising with regard to political participation and the legitimization of government policy, yet the capacities for social integration and political consensus formation may be in decline. This volume investigates how political actors and institutions in established European democracies are seeking to manage this condition of complexity and how it reconfigures the foundations of democratic politics. Contents include: Legitimacy Crises, Efficiency Gaps, Democratic Deficits Efficiency Versus Democracy: Conceptual Reconciliation of a Troubled Relationship? Citizens' Expectations: Is What Matters Only What Works? Re-Engaging Citizens: Institutional Responses to Political Disengagement Informal Government: Complexity, Transparency and Accountability Delegated Authority: Legitimizing Independent Regulatory Agencies Delegation to the EU: Participation Versus Efficiency in German EU-Policy The Open Method of Co-ordination (OMC) and The European Employment Strategy Committee Governance in EU Agricultural Policy Efficiency Versus Legitimacy: The Governance of Technology The Post-Democratic Turn: Complexity and the Reconfiguration of Democratic Politics.

  • 26.
    Lundqvist, Martina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Alwin, Jenny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    To live with a wagging tailed assistant - Service and hearing dog ownership from the perspective of Swedish owners2021In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 29, no 4, p. 935-946Article in journal (Refereed)
    Abstract [en]

    Individuals who have a functional or health impairment, are often in great need of conventional healthcare, social care and support, as well as help from family and friends. The use of dogs may be an important assistive support for this population. Assistance dogs are trained to assist with their owners specific needs. The aim of this study is to explore service and hearing dog ownership from the owner s perspective, by examining the owners expectations before training a dog, and experiences after having a certified dog. This study was designed as a longitudinal intervention study with pre-post design. The participants included in the study trained their own dogs to become service or hearing dogs. A number of open-ended questions were answered by the participants before the training of the dog started, three months after the dog was certified, and 1-3 years after the first follow-up. Data were analysed using thematic content analysis. The participants expectations of what the dog would contribute after being certified was high. Their perceived experiences in many ways reflected their expectations. For example, they perceived that the dog contributed to improved health status, a more active lifestyle, improved ability to feel secure, and that they had become more independent. They also felt that the dog had strengthened their social relationships. Negative experiences were also identified. Not being allowed to bring their dog into public places and negative attitudes from other people were examples of this. This study shows that individuals being supported by an assistance dog experience the dog as an invaluable help in their everyday life. By improving the owners lives in many ways, a certified service or hearing dog is a novel and important assistive support for people with a functional or health impairment.

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  • 27.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Citizenship bricolage: How to make sense of citizenship for people with dementia2014Conference paper (Refereed)
  • 28. Order onlineBuy this publication >>
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Designing for Legitimacy: Policy Work and the Art of Juggling When Setting Limits in Health Care2012Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Limit-setting in publicly funded healthcare is unavoidable, and increasingly important in the governance and management of the demand for health services. The work of limit-setting takes place in the organising of the provision of health services, where various health workers (professionals, administrators, unit managers, politicians) collectively exercise their skills. Limit-setting often creates tensions which impose the quest for legitimacy; it involves norms and values which are related to the interests of the health workers, and moreover to society at large. In that sense, limit-setting is related to internal processes of legitimacy within the healthcare organisation, i.e. internal legitimacy, and external processes of legitimacy where citizens are legitimating the activities in the healthcare organisation, i.e. external legitimacy.

    The purpose of this thesis was to discover, and increase the understanding of the dilemma associated with sustaining, generating and designing internal legitimacy, when working with a policy of limit-setting in healthcare, in relation to the provision of Assistive Technologies (AT). It has explored what health workers do when they are working with a policy, and in particular how they work out what they should be doing. Finally the role of mediating institutions in supporting and designing internal legitimacy, was explored in the thesis.

    Following a case-study design and a qualitative approach, where fifty-seven semi-structured open-ended interviews were conducted, data allowed the exploration of internal legitimacy in a context of complex interaction and construction of policy work in two Swedish county councils.

    This research produced a number of key findings; in an environment of finite resources health workers encountered situations that were characterised by conflicting pressures, and handled these by way of interaction, sense making, presenting arguments, negotiating and seeking support for an appropriate course of action and practices. The policy work with limit-setting can therefore be regarded as a dynamic interactive process, which incorporates several actors in different situations and locations, together negotiating and institutionalising the policy. Various policy sites, which had the role of mediating institutions, were identified, and were important in the interactive processes of forming a shared collective meaning in order to reach an appropriate act. Hence, designing legitimacy has to acknowledge the interactive policy work, and its contextual character, taking place at the different levels of a healthcare system.

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    Designing for Legitimacy: Policy Work and the Art of Juggling When Setting Limits in Health Care
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  • 29.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Dilemmas in Care-Managing: Citizens with Dementia Encountering the Welfare-State2015Conference paper (Refereed)
    Abstract [en]

    The presentation will consist of empirical findings from our interview study with care managers. We present the dilemmas that they face in their line of work and in their meetings with persons applying for social services, in other words, present the experience of difficulties that care managers have in their profession and how they manage them. We also plan to present the implications that these dilemmas and solutions have on the possibilities for citizens, and more specifically people with dementia, to claim their rights as citizens and further how this affects the rights that citizens have i.e. what we call the content of citizenship.

  • 30.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Does policy design matter when handling distributive conflicts? (Abstract)2010Conference paper (Refereed)
  • 31.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Governance of rationing as an art of juggling: Example from the policy work with for provision of assistive technologies2012Conference paper (Refereed)
    Abstract [en]

    Background Rationing is an apparent activity at all levels in a publicly funded healthcare system. In Sweden, where the main providers of health services are the county councils (CCs), the responsibility for rationing is shared by locally elected politicians, administrators and professionals. Thus, the work of rationing is described differently depending on whom you ask. This paper focus at the policy work for provision on assistive technologies (AT) in two CCs. Issues of ATs affect the users’ quality of life which emphasises the controversial character of rationing. Hence, the work is related to issues of legitimacy.

    Objectives To study how provision of AT is organised in the context of rationing.

    Methods 57 semi-structured open-ended interviews with prescribers of AT and administrators involved in the provision on AT. Studies of archive data.

    Findings These two cases serve as an example of how health workers at different levels encountered various types of pressures that they had to handle, pressures that seldom were in harmony. In order to manage situations the actors interacted, interpreted and negotiated in different locations, and together institutionalised the policy. The approaches differed considerably between the two CCs. In both CCs “mediating institutions” played an important role in this work.

    Implications Governance of rationing is not a simple act of craftsmanship by an elusive category of "policy makers", rather it is an interactive work of juggling that involves several actors. Mediating institutions play a crucial role in the governance and could be a way of handling issues of legitimacy.

  • 32.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Grasping what to do: Implementation and learning in the case of implementing policy for provision of AT in two Swedish county councils2013Conference paper (Refereed)
  • 33.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Just procedures in health care - the importance of strengthening policy legitimacy when setting priorities.: A comparison of policy design for provision of assistive devices in two Swedish county councils2009In: ECPR (European Consortium for Political Research) 5th General Conference, 2009Conference paper (Other academic)
  • 34.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Learning priorities: a framework for enabling legitimacy and understanding welfare-state worker's creative ways of practicing ambiguous directives in times of austerity2018Conference paper (Refereed)
  • 35.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Medborgarskapandet som process2016In: Att leva med demens / [ed] Ingrid Hellström, Lars-Christer Hydén, Malmö: Gleerups Utbildning AB, 2016, p. 167-169Chapter in book (Other academic)
  • 36.
    Nedlund, Ann-Charlotte
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Om vikten av legitimitet och rättvisa processer – prioriteringens infrastruktur2022In: Prioriteringscentrum – 20 år i rättvisans tjänst / [ed] Lars Sandman, Linköping: Linköping University Electronic Press, 2022, , p. 192p. 103-118Chapter in book (Other academic)
    Abstract [sv]

    Det här kapitlet handlar om vikten av legitimitet och detdilemma som kan kopplas till legitimitet när prioriteringargörs och gränser sätts i offentligt solidariskt finansieradhälso- och sjukvård. Den som är uppmärksam ser att jaghär väljer att skriva görs och sätts då jag ser prioriteringarsom just aktiviteter, handlingar och göranden – vare sig deär medvetna och systematiska eller det motsatta – där fleraaktörer tillsammans utövar sina färdigheter. Dessa aktörerkan vara kliniska verksamma vårdprofessioner, verksamhetschefer, tjänstepersoner och de medborgarföreträdandepolitikerna. Att arbeta med prioritering involverar mångahänder och är en aktivitet som skapas, organiseras, görs ochpraktiseras. Vi kan här se det i termer av prioriteringarnasinfrastruktur och arkitektur. I kapitlet kommer jag att diskutera legitimitet från ett utåtblickande, inåtblickande ochgenomblickande perspektiv. Utkiksposten, där jag står somkapitelförfattare, är hälso- och sjukvård som organisation.Jag kommer också att ge några exempel som visar på skapandet av legitimitet och dess koppling till dissonans ochresonans i hälso- och sjukvårdssystemet.

  • 37.
    Nedlund, Ann-Charlotte
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Politikens räckvidd, innehåll och organisering vid prioriteringar2022In: Prioriteringscentrum – 20 år i rättvisans tjänst / [ed] Lars Sandman, Linköping: Linköping University Electronic Press, 2022, , p. 192p. 89-101Chapter in book (Other academic)
    Abstract [sv]

    Vi börjar med en politisk betraktelse av Hälso- och sjukvårdslagen (HSL):”Målet med hälso- och sjukvården är en god hälsa och engod vård på lika villkor för hela befolkningen. Vården skages med respekt för alla människors lika värde och för denenskilda människans värdighet. Den som har det störstabehovet av hälso- och sjukvård ska ges företräde till vården.”

  • 38.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    The guardians of democracy: the forgotten but important role of the healthcare professionals when setting limits in health care2018Conference paper (Refereed)
  • 39.
    Nedlund, Ann-Charlotte
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    The Importance of Policy Legitimacy - In Search for Legitimacy when Setting Priorities in Swedish Health Care2008In: ECPR - European Consortium for Political Research: ECPR Graduate Conference,2008, 2008Conference paper (Other academic)
    Abstract [en]

      

  • 40.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    The Policy Work and the Art of Juggling with Conflicting Views (paper): In Search for Setting Fair Limits when Rationing in Swedish Health Care2011Conference paper (Refereed)
  • 41.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    The value of internal legitimacy when setting limits in health care2012Conference paper (Other academic)
  • 42.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences. prioriteringscentrum på Linköpings universitet.
    Vårdprofessionens roll som demokratins väktare i sjukvården2015In: Dagens Medicin, ISSN 1402-1943, Vol. 49, no 15, p. 30-Article in journal (Other (popular science, discussion, etc.))
  • 43.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    What is the meaning of a solution when the meanings of the problem differ? A study of an intermediary solution for an evidence-based approach when adopting new medical innovations'2012Conference paper (Refereed)
    Abstract [en]

    In the field of health care there is an extremely strong tradition to both develop and practice new knowledge. This is by some emphasised as a requirement for an advanced health-care system. An often emphasised need is however to adopt new medical innovations, both technologies and methods, more systematically, since the use of technologies and methods are different depending on the care giver and geographical areas. Another argument is that in a tax-financed health-care system it is reasonable to monitor that methods are suitable and effective. It was in this setting the County Council of Östergötland in Sweden established a Health Technology Advisory Committee (HTAC). The top level managers’ intention was to support a controlled introduction and disinvestment of medical technologies. The aim was to develop an efficient way which would combine evidence-based knowledge with practice-based knowledge. Issues should be initiated by clinicians who, in their everyday practise, encountered knowledge gaps related to a medical technology. Few issues were however initiated to the HTAC which could be regarded as a setback. The aim of the paper is to study the different problem frames the various actors (clinicians and unit managers, experts, higher administrators and politicians) associate to “the problem” of introduction of new medical technologies. Is HTAC a solution of a non-problem? Are other solutions available? The paper explores issues related to problem-structuring, puzzling, powering, participation, evidence-based medicine and other factors as contextual-bound knowledge, social- and political aspects.

  • 44.
    Nedlund, Ann-Charlotte
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Who is 'fair-minded people' in a 'messy business'? In search for trustworthy institutions in Swedish health care2007In: European Consortium for Political Research ECPR,2007, 2007Conference paper (Other academic)
  • 45.
    Nedlund, Ann-Charlotte
    et al.
    Linköping University, Faculty of Arts and Sciences.
    Bartlett, Ruth
    University of Southampton.
    Citizenship-in-and-as-practice: a framework for improving life with dementia2017In: Living with dementia: relations, responses and agency in everyday life / [ed] Lars-Christer Hydén, Eleonor Antelius, Basingstoke: Palgrave Macmillan, 2017, Vol. Sidorna 49-67, p. 49-67Chapter in book (Refereed)
  • 46.
    Nedlund, Ann-Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Bartlett, Ruth
    VID University, Oslo.
    Clarke, Charlotte
    University of Edinburgh, Edinburgh, Scotland, UK.
    Everyday citizenship: a way to broaden our view of life with dementia2019In: Everyday citizenship and people with dementia / [ed] Ann-Charlotte Nedlund, Ruth Bartlett, Charlotte L. Clarke, Dunedin: Dunedin Academic Press, 2019, p. 1-12Chapter in book (Other academic)
  • 47.
    Nedlund, Ann-Charlotte
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bartlett, RuthVID Specialised University, Oslo.Clarke, CharlotteUniveristy of Edinburgh, Edinburgh, Scotland, UK.
    Everyday citizenship and people with dementia2019Collection (editor) (Other academic)
    Abstract [en]

    Everyday Citizenship and People with Dementia prioritises the ordinary lives of people with dementia, and thereby broadens the agenda towards everyday citizenship.  The contributors bring to the fore the idea that a person living with dementia has multiple opinions, identities and a stake in society. 

    The notion of everyday citizenship is used to shift the focus away from care settings and diagnostic and post-diagnostic support - all of which are important, of course - to the ‘normal’ everyday routines and settings of a person’s life.  The notion of citizenship is mobilised within a range of contexts from dealing with the welfare system to living and being a part of a neighbourhood.  Each chapter focuses on everyday citizenship from the perspective of people living with dementia and shows how citizenship is a necessity for a vibrant, inclusive society.  The discussion is informed by empirically based work and authored by experts from different parts of the world, including Canadian and Scots citizens who are living with dementia.  The stress, throughout the book, is that the everyday and mundane is not only important in a practical sense but also in a political one. The book is thus for all interested in current debates about equality and the rights of people with dementia.

  • 48.
    Nedlund, Ann-Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Bartlett, Ruth
    VID University, Oslo.
    Clarke, Charlotte
    University of Edinburgh, Edinburgh, Scotland, UK.
    Recognising everyday citizenship and dementia: what is known and what more needs to be done2019In: Everyday citizenship and people with dementia / [ed] Ann-Charlotte Nedlund, Ruth Bartlett, Charlotte L. Clarke, Dunedin: Dunedin Academic Press, 2019, p. 91-95Chapter in book (Other academic)
  • 49.
    Nedlund, Ann-Charlotte
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Bäckman, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Carlsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Garpenby, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Challanges of transparent priority-setting for health-care politicians (oral presentation)2008In: 7th International conference on Priorities in Health Care,2008, 2008Conference paper (Other academic)
    Abstract [en]

       

  • 50.
    Nedlund, Ann-Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Bærøe, Kristine
    Department of Global Public Health and Primary Care, University of Bergen, Norway.
    Legitimate Policymaking: The Importance of Including Health-care Workers in Limit-Setting Decisions in Health care2014In: Public Health Ethics, ISSN 1754-9973, E-ISSN 1754-9981, Vol. 7, no 2, p. 123-133Article in journal (Refereed)
    Abstract [en]

    The concept of legitimacy is often used and emphasized in the context of setting limits in health care, but rarely described is what is actually meant by its use. Moreover, it is seldom explicitly stated how health-care workers can contribute to the matter, nor what weight should be apportioned to their viewpoints. Instead the discussion has focused on whether they should take on the role of the patients’ advocate or that of gatekeeper to the society’s resources. In this article, we shed light on the role of health-care workers in limit setting and how their conferred legitimacy may support subordinators’ (i.e. citizens’) conferred legitimacy. We argue that health-care workers have an important role to play as both moral and political agents in limit setting, and delineate normative conditions that justify and facilitate health-care workers in conferring legitimacy on this kind of decision. Their role and potential impact on political limit setting does not—theoretically—affect the idea of democratic legitimacy negatively. Rather, as we suggest, by designing for limit-setting policymaking accordingly, health-care workers, as well as citizens, are more justified in conferring democratic legitimacy to health-care limit-setting decisions than if these concerns were not addressed.

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