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  • 1.
    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....

  • 2.
    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.

  • 3.
    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)
  • 4.
    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.

  • 5.
    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.

  • 6.
    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)
  • 7.
    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.

  • 8.
    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: Studentlitteratur, 2013, 1, p. 119-135Chapter in book (Other academic)
    Abstract [sv]

    Hälso- och sjukvårdens resurser räcker inte till alla behov och önskemål från patienter och medborgare, vilket gör att personal och beslutsfattare hamnar i svåra situationer. Hur ska vi veta att det är rätt patienter som tvingas stå tillbaka? Att välja rättvist tar upp centrala begrepp och etiska principer kring prioriteringar. Boken beskriver även metoder för att göra prioriteringar på ett systematiskt sätt och erfarenheter av såväl nationella som internationella prioriteringar.

    Prioriteringsbeslut fattas på alla nivåer och kan gälla fördelning av resurser till olika verksamheter, behandlingsbeslut av enskilda patienter eller investeringar i nya medicinska metoder. Boken ger förslag på hur beslutsunderlagen kan förbättras. Här ges anvisningar om hur man mäter behov och nytta hos patientgrupper och i befolkningen, hur kostnadseffektivitet beräknas och hur man skapar ett kunskapsunderlag. På så sätt får läsaren inte bara ta del av prioriteringarnas teori utan även av deras praktik, inte minst genom konkreta exempel på hur öppna prioriteringar i dag tillämpas i svensk hälso- och sjukvård.

    Boken är avsedd för dig som arbetar kliniskt eller planerar att arbeta med prioriteringar – nationellt, i landsting eller i kommuner. Boken ger även en värdefull inblick för dig som vill lära mer om hur vårdens svåra val ska kunna hanteras i framtiden.

  • 9.
    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.

  • 10.
    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.

  • 11.
    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)
  • 12.
    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.

  • 13.
    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.

  • 14.
    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)
  • 15.
    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.

  • 16.
    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)
  • 17.
    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)
  • 18.
    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)
  • 19.
    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]

      

  • 20.
    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)
  • 21.
    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)
  • 22.
    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.))
  • 23.
    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.

  • 24.
    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)
  • 25.
    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]

       

  • 26.
    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.

  • 27.
    Nedlund, Ann-Charlotte
    et al.
    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.
    Kan rättvisa procedurer stärka förtroendet för prioriteringar?2008Report (Other academic)
    Abstract [sv]

    Rättvisa förknippas ofta med något positivt och grundläggande vid sociala möten och vid transaktioner mellan människor. Vid fördelningen av nyttigheter i ett samhälle finns det olika sätt att lösa problem med rättvisa. Man kan använda sig av i förväg etablerade principer (exempelvis "mest till störst behov") eller försöka utveckla procedurer som uppfattas som rättvisa (exempelvis "förhandlingar och avtal").

    Vid prioriteringar inom hälso- och sjukvård, som direkt eller indirekt kan påverka våra liv, intar rättvisa en central plats. Om prioriteringarna inte uppfattas som rättvisa kan legitimitetsproblem uppstå som kan leda till minskat förtroende från medborgarna och patienterna till hälso- och sjukvårdssystemet.

    Uppfattningar om rättvisa vid prioriteringar kan även vara angeläget inom hälso- och sjukvårdens organisation, eftersom prioriteringar kan resultera i kontroverser mellan politiker (med olika partitillhörighet), tjänstemän och vårdprofessioner (med olika expertområden). Det är därför angeläget att stärka uppfattningen om rättvisa vid prioriteringar, både för den externa (mot medborgarna) och för den interna (inom organisationen) legitimiteten.

    Under senare år har "rättvisa" procedurer alltmer kommit att uppmärksammas som ett sätt att stärka legitimiteten vid prioriteringar. Vad som avses är utformningen av beslutsprocessen och betydelsen av denna för uppfattningen av ett fördelningsbeslut. Daniels och Sabins förslag till strategi för att stärka uppfattningen om rättvisa vid prioritering ("Accountability for reasonableness" eller på svenska "Ansvarstagande för rimlighet") har fått stor uppmärksamhet internationellt. Daniels och Sabins strategi bygger på kunskap från forskning om procedurrättvisa som sträcker sig mer än 30 år tillbaka i tiden.

    I denna rapport görs en inventering av kunskapsläget angående procedurrättvisa, från rent experimentell forskning till olika tillämpningar på samhällsnivån. Avsikten är att undersöka vilken kunskap som finns bakom Daniels och Sabins resonemang och förslag om rättvisa beslutsprocesser vid prioriteringar i hälso- och sjukvård. Syftet är att se om och hur kunskapen om procedurrättvisa kan tillämpas vid fördelning av hälso- och sjukvård och om det kan förbättra beslut om resursfördelning och prioritering så att dessa uppfattas som rättvisa.

  • 28.
    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.
    Garpenby, Peter
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Priority Setting as a Game of Blame? Political Leadership in Health Care Priority Setting2014Conference paper (Refereed)
  • 29.
    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.
    Garpenby, Peter
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Puzzling about problems: the ambiguous search for an evidence-based strategy for handling influx of health technology2014In: Policy sciences, ISSN 0032-2687, E-ISSN 1573-0891, Vol. 47, no 4, p. 367-386Article in journal (Refereed)
    Abstract [en]

    This paper focuses on problem frame differences among actors (members of an advisory body, senior administrators and clinical unit managers) who are concerned with the introduction of new health technology at the regional level in Sweden. It explores issues related to problem framing, puzzling, powering, participation and the various rationales articulated in the ambiguous search for an evidence-based strategy to handle the influx of new technologies. The Health Technology Advisory Committee (HTAC) was established in one Swedish county council in 2004 with the intention of controlling both the introduction of health technology and supporting policy decision and clinical practice by promoting the use of best evidence. The HTAC followed a scientific rationality dominated by one problem frame, although the problematic situation, as it was framed by all the actor groups, was highly complex and not solely a matter of evidence. This paper illustrates how problem frame differences shape the puzzling of a policy problem and how the different distinguishable policy styles are dependent on who is participating and who is not participating in the puzzling.

  • 30.
    Nedlund, Ann-Charlotte
    et al.
    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.
    Jansson, Marie
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Nordh, Jonas
    Linköping University, Department of Social and Welfare Studies. Linköping University, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Medborgare med demenssjukdom2016In: Att leva med demens / [ed] Ingrid Hellström, Lars-Christer Hydén, Malmö: Gleerups Utbildning AB, 2016, p. 171-181Chapter in book (Other academic)
  • 31.
    Nedlund, Ann-Charlotte
    et al.
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Nordh, Jonas
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Arts and Sciences.
    Constructing citizens: a matter of labeling, imaging and underlying rationales in the case of people with dementia2017In: Critical Policy Studies, ISSN 1946-0171, E-ISSN 1946-018XArticle in journal (Refereed)
    Abstract [en]

    A highly significant element in politics and policies is the process of constructing, categorizing and imaging – such as categorizing citizens as target groups. In governing documents, distinctions are drawn to distinguish deserving and undeserving categories of citizens. This paper explores the construction of citizenship for people with dementia and the connection to underlying categories of rationales, by analyzing how this group has been categorized and imaged in policy documents. The study is based on a qualitative textual analysis of national policy documents in Sweden, covering nearly 40 years. It shows that the way people with dementia have been imaged has differed over time, where people living with dementia have been situated in various target groups and discourses. However, to a large extent, the underlying understanding has nevertheless remained persistent where the position of people with dementia has remained weak. It offers a taxonomy of categories of rationales and shows the interplay of rationales and target groups for certain social constructions. The study offers insights into the policy process related to policy change, and on citizenship as something transformative and interrelated that risks upholding democratic values that delimit disempowered groups, in this case people with dementia, to influence their citizenship.

  • 32.
    Nedlund, Ann-Charlotte
    et al.
    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.
    Nordh, Jonas
    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.
    Constructing citizen(ship):: A matter of the power of experts and the politics of time in the case of people with dementia2013Conference paper (Refereed)
  • 33.
    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.
    Nordh, Jonas
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Health Sciences.
    Constructing citizenship targets:: A matter of labelling and belonging in the case of people with dementia2014Conference paper (Refereed)
  • 34.
    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.
    Nordh, Jonas
    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.
    Crafting citizen(ship) for people with dementia: How policy narratives at national level in Sweden informed politics of time from 1975 to 20132015In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 34, p. 123-133Article in journal (Refereed)
    Abstract [en]

    This article explores how policy narratives in national policy documents in Sweden inform associated politics on people with dementia. This is disentangled in terms of how people with dementia have been defined, what the problems and their imminent solutions have been, and if and how these have differed overtime. Based on a textual analysis of policy documents at national level in Sweden, covering nearly 40 years the study shows how divergent policy narratives shape the construction of citizens with dementia as policy target groups. This study shows the temporal character of people with dementia as a political problem, the implications of policy narratives on people with dementia as a citizen group, and policy narratives as something being crafted rather than shaped by fixed pre-existing "facts". Dementia, and further citizens living with dementia, does not have a once and for all stabilised meaning. Instead, the meanings behind the categories continue to evolve and to be crafted, which affects the construction of citizens living with dementia, the space in which to exercise their citizenship and further belonging to the society.

  • 35.
    Nedlund, Ann-Charlotte
    et al.
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Nordh, Jonas
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Arts and Sciences.
    Critical discourse and policy analysis as a method to understand dementia policies2018In: Social research methods in dementia studies: inclusion and innovation / [ed] John Keady, Lars-Christer Hydén, Ann Johnson, Caroline Swarbrick, Abingdon, Oxon: Routledge, 2018, p. 192-204Chapter in book (Other academic)
  • 36.
    Nedlund, Ann-Charlotte
    et al.
    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.
    O'Connor, Deborah
    Centre for Research on Personhood and Dementia, University of British Columbia, Canada.
    Editorial introduction: Special issue on Citizenship and Dementia.2016In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 15, no 3, p. 285-288Article in journal (Other academic)
  • 37.
    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.
    Taghizadeh Larsson, Annika
    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.
    Being a Full Citizen with Cognitive Impairment  : How Supported Decision-Making Is Managed For People with Dementia in Sweden.2015Conference paper (Refereed)
  • 38.
    Nedlund, Ann-Charlotte
    et al.
    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.
    Taghizadeh Larsson, Annika
    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.
    Ställföreträdarskap och självbestämmande2016In: Att leva med demens / [ed] Ingrid Hellström, Lars-Christer Hydén, Malmö: Gleerups Utbildning AB, 2016, p. 183-192Chapter in book (Other academic)
    Abstract [sv]

    I detta kapitel kopplas den internationella diskussionen kring medborgarskap och demenssjukdom och hur denna kan hjälpa till att förstå den svenska situationen för personer demenssjukdom till frågan kring ställföreträdarskap vad gäller beslutsfattande och personer med demenssjukdom.

  • 39.
    Nedlund, Ann-Charlotte
    et al.
    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.
    Taghizadeh Larsson, Annika
    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.
    Support, protection and citizenship: The case of people living with dementia in Sweden2016In: Risk and resilience: global learning across the age span / [ed] Charlotte Clarke, Sarah Rhynas, Matthias Schwannauer and Julie Taylor, Edinburgh: Dunedin Academic Press, 2016, p. 116-129Chapter in book (Other academic)
  • 40.
    Nedlund, Ann-Charlotte
    et al.
    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.
    Taghizadeh Larsson, Annika
    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.
    To protect and to support: How citizenship and self-determination are legally constructed and managed in practice for people living with dementia in Sweden2016In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 15, no 3, p. 343-357Article in journal (Refereed)
    Abstract [en]

    Since living with dementia implies increasing difficulties in taking charge of rights due to cognitive as well as communicative impairments, many people with dementia are vulnerable and in need of support in order to realize full citizenship. In Sweden, all adults right to self-determination is strongly emphasized in law, regulations, and policies. Further, and in contrast to the situation in many other countries, people living with dementia cannot be declared as incompetent of making decisions concerning social care and their right to self-determination cannot legally be taken away. The article shows that in the Swedish welfare system, the focus is more on protecting the self-determination of citizens than on supporting people in making decisions and exercising citizenship. Subsequently, this causes legally constructed zones of inclusion and exclusion. This article examines and problematizes how different institutional contexts, legal constructions, norms, and practices in Sweden affect the management of issues concerning guardianship, supported decision-making and self-determination, and outline the implications for people living with dementia.

  • 41.
    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.
    Taghizadeh Larsson, Annika
    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.
    Örulv, Linda
    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.
    Österholm, Johannes
    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.
    Voice: An Analytical Framework for Exploring Citizenship in Dementia Research2015Conference paper (Refereed)
    Abstract [en]

    We will present voice as an analytical framework to enhance the problematization and investigation of citizenship for people living with dementia. We will also discuss the strengths and the potential of using such a framework when doing research on citizenship in general, and more specifically, for people living with dementia. The analytical framework that we will propose focuses on the multiple accounts of voice in use. Thus, the framework does not only embrace the issue of "whose voices?", but also the various ways voice has been conceptualised, framed and understood in different theoretical and empirical contexts as well as how these together in different ways have the potential to shed light on the possibility for people with dementia to remain participative actors in their neighbourhood, in society and furthermore, to have the opportunity to claim full citizenship.

  • 42.
    Nordh, Jonas
    et al.
    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.
    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.
    The work of citizenship: How do welfare-state policy workers interpret 'reasonable standard of living' in the case of people with dementia2014Conference paper (Refereed)
  • 43.
    Nordh, Jonas
    et al.
    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.
    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.
    To Coordinate Information in Practice: Dilemmas and Strategies in Care Management for Citizens with Dementia2017In: Journal of social service research, ISSN 0148-8376, E-ISSN 1540-7314, Vol. 43, no 3, p. 319-335Article in journal (Refereed)
    Abstract [en]

    This qualitative study, based on 19 interviews with care managers, explores the experiences of care-managers involved in assessing the need for social services for people with dementia. The study shows that social workers, as care managers, face several dilemmas in their practice concerning people with dementia, in relation to the exchange of information and in regards to conflicting interests between different actors involved in the assessment of the need for support for people with dementia. Strategies used to handle problematic situations that arise in their work are using other sources for information (e.g., relatives and actors from other professions), persuading, and pursuing creative forms of consent. However, the study shows that dilemmas and strategies used generate other, prominently moral, dilemmas for care managers in their practice, which relate to participation and self-determination by the person with dementia. The study shed light on the problematic situation for care managers in their work to coordinate information and further the new “realities“ that they encounter as well as on how to handle these new situations. This study suggests possible ways to improve the everyday work of care managers, as well as how policies concerning social work and people with dementia can be improved.

  • 44.
    Odzakovic, Elzana
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. 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 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.
    Taghizadeh Larsson, Annika
    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 and Social Inclusion for People with Dementia: A Register Study in a Swedish Context on the Distribution of Social - Care Services2015Conference paper (Refereed)
    Abstract [en]

    In Sweden, every citizen has equal right to social-care. The purpose of this session is to investigate how social support is distributed for people with dementia and to compare this distribution in an ethnicity perspective. A statistical analysis will be presented based on data in progress.

  • 45.
    Roback, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Alwin, Jenny
    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.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Evidence-based disinvestment as a tool for sustained healthcare quality2012In: "HTA in Integrated Care for a Patient Centered System", Barcelona: Elsevier, 2012, p. 54-54Conference paper (Other academic)
  • 46.
    Taghizadeh larsson, Annika
    et al.
    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.
    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.
    Being a Full Citizen with Cognitive Impairment: How Supported Decision-Making Is Managed For People with Dementia in Sweden2016Conference paper (Refereed)
1 - 46 of 46
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