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  • 1.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Idvall, Ewa
    Malmö högskola, Fakulteten för Hälsa och samhälle.
    Perseius, Kent-Inge
    Landstinget i Kalmar län.
    Five Types of Practice-Based ImprovementIdeas in Health Care Services: An EmpiricallyDefined Typology2011In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 20, no 2, 122-130 p.Article in journal (Refereed)
    Abstract [en]

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

  • 2.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Idvall, Ewa
    Faculty of Health and Society, Malmö University.
    Perseius, Kent-Inge
    Kalmar County Council/Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Improvement Strategies: Forms and Consequences for Participation in Healthcare Improvement Projects2013Manuscript (preprint) (Other academic)
    Abstract [en]

    From a management point of view there are many different approaches from which to choose in how to engage staff in initiatives to improve performance. The present study investigates how two different types of improvement strategies stimulate and encourage involvement of different professional groups in healthcare organizations. The first type, Designed Improvement Processes, is constituted of a methodologically guided collaborative program. The second type, Intrapreneurship Projects, is characterized by an “intrapreneur” working with an improvement project in a rather free manner. The data analysis was carried out through classifying the participants´ profession, position, gender and the organizational administration of which they were a part. The result showed that nurses were the largest group participating in both improvement initiatives. Physicians were also well represented, although they seemed to prefer the less structured Intrapreneurship Projects approach. Assistant nurses, being the second largest staff group, were poorly represented in both initiatives. This indicates that the benefits and support for one group may push another group aside. Managers need to give prerequisites and incentives for staff who do not participate to do so.

  • 3.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Idvall, Ewa
    Faculty of Health and Society, Malmö University and Skåne University Hospital, 205 06 Malmö, Sweden.
    Perseius, Kent-Inge
    Research Unit, Psychiatry Division, Kalmar County Council, Sweden.
    Practice-based improvement ideas in healthcare services2010Conference paper (Other academic)
    Abstract [en]

    Objective. The present study will contribute to knowledge of how practitioners in a healthcare region engage in quality improvement initiatives. The focus is on individual placement needs, problems/issues and the ability to organize work on the development, implementation and institutionalization of ideas for the healthcare sector.

    Design and settings. This study is based on the Kalmar county council Improvement Program. Healthcare departments and primary healthcare centers in the county council were invited to apply for money to accomplish improvement projects. The aim is to empirically identify and present the different kinds of practice-based improvement ideas developed in healthcare services. The 202 applications received from various healthcare departments and primary healthcare centers are analyzed using qualitative content analysis.

    Outcome and Results. Five types of improvement projects were identified: Organizational Process; Evidence and Quality; Competence Development; Process Technology; and Proactive Patient Work. This illustrates the range of strategies that encourage letting individual units define their own improvement needs. In addition, a common characteristic among the studied project applications is to increase patient safety, effectiveness and availability of care, and education/training. Those intentions are found in many of the applications and therefore give the impression of being most important to caregivers today.

    Conclusions. These projects point to the various problems and experiences healthcare professionals encounter in their day-to-day work. This paper provides valuable insights into the current state of improvement work in Swedish healthcare, and will serve as a foundation for further investigations in this quality program.

  • 4.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Idvall, Ewa
    Faculty of Health and Society, Malmö University and Skåne University Hospital, 205 06 Malmö, Sweden.
    Perseius, Kent-Inge
    Research Unit, Psychiatry Division, Kalmar County Council, Sweden.
    Who conducts quality improvement initiatives in healthcare services? An evaluation of an improvement program in acounty council in Sweden2010Conference paper (Other academic)
    Abstract [en]

    Purpose – The aim of this paper is to contribute to the knowledge of who engages in quality improvement initiatives and to describe whether staff professions or gender are relevant variables.

    Design/methodology/approach – This paper contains an evaluation of the participants in a specific defined strategic improvement initiative program in one county council in southeast Sweden. The improvement program was initiated by county council politicians to encourage improvement initiatives and to spread improvement skills and knowledge in the organization. The program is driven both “top down” (teaching/convincing line managers to demand improvements) and “bottom up” through improvement programs using methodology to help teams identify, plan and adopt improvements in their daily work. Data was collected from special applications (called Free Applications, FA) and from participants in the education program (called Improvement Program, IP), both of which include information about profession and 2 gender. A content analysis was made. After the first categorization of which types of improvement projects practitioners engage in, further analysis of staff disciplines, professions (hierarchy) and gender was done. The results were compared to the overall structure of staff presence in the county council.

    Findings – Changes in participation occurred over time. The FA (Free Applications) part (n=202) shows a higher share of leaders and managers (35%), but their participation in the IP (Improvement Program) (n=477) fluctuated (8-26%). Physicians were more represented in the FA than in the IP. The largest single group was nurses. Overall the gender perspective reflects the conditions of the county council, but in FA the representation of women was lower. Five types of improvement projects were identified: 1) Organizational process focus; 2) Evidence and quality; 3) Competence development; 4) Process Technology; and 5) Proactive patient work. Managers were most represented in the category “Organizational process”. The largest difference was seen in the category “Proactive patient work” with the highest occurrence among women (86%) and less among men (17%) and managers (21%). The patient as a contributor taking active part was not found in either the FA or the IP.

    Research limitations/implications – This study shows differences in participation between free applications and methodology-guided programs when it comes to professions and gender in the country council improvement drive. It may be useful for further research regarding how to successfully work for and implement improvements and change in healthcare environments.

    Practical implications – The study will discuss and contribute to further knowledge of whether profession, hierarchy and gender have an impact (obstructive or as an asset) in performing improvement work in healthcare settings.

    Originality/value - Not much has been written about who is accomplishing quality improvements in terms of profession and gender. This paper provides some valuable insights into the differences between staff categories (professions) and gender in the improvement work in Swedish healthcare.

  • 5.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Perseius, Kent-Inge
    Research Unit, Psychiatry Division, Kalmar County Council, Sweden.
    Idvall, Ewa
    Faculty of Health and Society, Malmö University and Skåne University Hospital, 205 06 Malmö, Sweden.
    Adapting a survey to evaluate quality improvements in Swedish healthcareManuscript (preprint) (Other academic)
    Abstract [en]

    Quality improvement initiatives, a concept with origins in the manufacturing sector, have increased within the Swedish healthcare sector in recent decades. These efforts to improve quality can be seen as a response to demands for more cost-effectiveness and better medical results. However, studies have shown that less than 40% of these initiatives are successful (Olsson et al. 2007). The reason why specific improvement initiatives in healthcare fail or succeed is, therefore, a central question in studies of change. To be able to manage, improve and implement quality initiatives and improvements it is necessary to observe, measure and evaluate. Batalden and Davidoff (2007) point out that if there are no mechanisms to measure the changes, there is no way to know whether they actually lead to improvements. A more severe consequence, as stated by Sorian (2006), is that we sometimes accept an organizational system that not only fails to reward or encourage quality improvements but also sometimes punishes those who prioritize quality over cost-effectiveness. The need for more evidence about how to organize and manage new quality initiatives is identified as an important task within studies of healthcare improvement (Walshe 2009, Olsson et al. 2007).

  • 6.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Perseius, Kent-Inge
    Kalmar County Council, Sweden.
    Idwall, Ewa
    Malmö University, Sweden .
    Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare2013In: BMC Health Services Research, ISSN 1472-6963, Vol. 13, no 48Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Quality improvement initiatives have expanded recently within the healthcare sector. Studies have shown that less than 40% of these initiatives are successful, indicating the need for an instrument that can measure the progress and results of quality improvement initiatives and answer questions about how quality initiatives are conducted. The aim of the present study was to develop and test an instrument to measure improvement process and outcome in Swedish healthcare.

    METHODS:

    A questionnaire, founded on the Minnesota Innovation Survey (MIS), was developed in several steps. Items were merged and answer alternatives were revised. Employees participating in a county council improvement program received the web-based questionnaire. Data was analysed by descriptive statistics and correlation analysis. The questionnaire psychometric properties were investigated and an exploratory factor analysis was conducted.

    RESULTS:

    The Swedish Improvement Measurement Questionnaire consists of 27 items. The Improvement Effectiveness Outcome dimension consists of three items and has a Cronbach's alpha coefficient of 0.67. The Internal Improvement Processes dimension consists of eight sub-dimensions with a total of 24 items. Cronbach's alpha coefficient for the complete dimension was 0.72. Three significant item correlations were found. A large involvement in the improvement initiative was shown and the majority of the respondents were satisfied with their work.

    CONCLUSIONS:

    The psychometric property tests suggest initial support for the questionnaire to study and evaluate quality improvement initiatives in Swedish healthcare settings. The overall satisfaction with the quality improvement initiative correlates positively to the awareness of individual responsibilities.

  • 7.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering. Linköping University, The Institute of Technology.
    Idvall, Ewa
    Malmö University, Sweden Skåne University Hospital, Sweden .
    Perseius, Kent-Inge
    Kalmar County Council, Sweden Karolinska Institute, Sweden .
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Evaluating a Breakthrough Series Collaborative in a Swedish Health Care Context2014In: Journal of Nursing Care Quality, ISSN 1057-3631, E-ISSN 1550-5065, Vol. 29, no 2, E1-E10 p.Article in journal (Refereed)
    Abstract [en]

    This study evaluated the use of the Breakthrough Series Collaborative methodology in a Swedish county council improvement program, comparing measurements at the beginning and after 6 months. A questionnaire was used, and improvement processes and outcomes were analyzed. The results showed an overall large engagement in improvements, although the methodology and facilitators were seen as only moderately supportive.

  • 8.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Idvall, Ewa
    ) Faculty of Health and Society, Malmö University.
    Perseius, Kent-Inge
    Kalmar County Council/Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Evaluating a Breakthrough Series Collaborative in a Swedish healthcare context2013Manuscript (preprint) (Other academic)
    Abstract [en]

    Since the mid-1990s, increased attention has been placed on quality improvement and patient safety within the healthcare context. This study aims to evaluate the use of the Breakthrough Series Collaborative methodology in a Swedish county council improvement program, comparing measurements at the beginning and after six months. A questionnaire was used, and improvement processes and outcomes were analysed. The results showed an overall large engagement in improvements, although the methodology and the facilitators were seen as only moderately supportive. Nursing educators have highlighted the importance of improvement education amongst healthcare professions, and nurses could play an active role in improving healthcare practices and patient safety.

  • 9.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Idvall, Ewa
    Faculty of Health and Society, Malmö University.
    Perseius, Kent-Inge
    Kalmar County Council/Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Sustainable Outcomes of an Improvement Program: Do Financial Incentives Matter?2013Manuscript (preprint) (Other academic)
    Abstract [en]

    The purpose of this study was to evaluate whether an improvement program can contribute to positive sustainable improvements in an organization, and whether financial incentives are driving forces for improvements. The material was all projects (n=232) that applied for funding in a county council improvement program between 2007 and 2010. The projects were analyzed as to whether they received funding (n=98) or were rejected (n=95). In addition, a categorization of the projects’ intentions was analyzed. Some projects were still ongoing, but 50 projects were implemented and sustained two or more years after being finalized. Implemented improvements were on different levels, from (micro level) units up to the entire (macro level) organization. In addition, 27 rejected projects were finalized without funding. Eighteen of those 27 were sustainably implemented. This study indicates that there are incentives other than financial at work if an improvement program will contribute to sustainable improvements in the organization. To encourage practice-based improvements is one way of incentivizing the intention and effort to become and perform better.

  • 10.
    Andersson, Ann-Christine
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology. Development Department , Kalmar County Council , Kalmar and Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Idvall, Ewa
    Department of Care Science, Faculty of Health and Society, Malmö University, Malmö and Department of Intensive Care and Perioperative Medicine , Skåne University Hospital, Malmö, Sweden.
    Perseius, Kent-Inge
    Nyckeln Competence Centre for Health Education, Kalmar County Council , Kalmar and Department of Neurobiology, Caring Sciences and Society , Karolinska Institutet , Stockholm , Sweden.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology. Linköping University, HELIX Vinn Excellence Centre.
    Sustainable outcomes of an improvement programme: do financial incentives matter?2013In: Total Quality Management and Business Excellence, ISSN 1478-3363, E-ISSN 1478-3371, Vol. 24, no 7-8, 959-969 p.Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to evaluate whether an improvement programme can contribute to positive sustainable improvements in an organisation, and whether financial incentives are driving forces for improvements. The material was all projects (n=232) that applied for funding in a county council improvement programme between 2007 and 2010. The projects were analysed as to whether they received funding (n=98) or were rejected (n=95). In addition, a categorisation of the projects intentions was analysed. Some projects were still ongoing, but 50 projects were implemented and sustained two or more years after being finalised. Implemented improvements were on different levels, from (micro-level) units up to the entire (macro-level) organisation. In addition, 27 rejected projects were finalised without funding. Eighteen of those 27 were sustainably implemented. This study indicates that there are incentives other than financial at work if an improvement programme contributes to sustainable improvements in the organisation. To encourage practice-based improvements is one way of incentivising the intention and effort to become and perform better.

  • 11.
    Andersson, Ann-Christine
    et al.
    School of Health Sciences, Jönköping University, Sweden.
    Idwall, Eva
    Skåne University Hospital, Malmö, Sweden .
    Perseius, Kent-Inge
    Kalmar County Council, Sweden and red Cross University College, Stockholm, Sweden.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology. Linköping University, HELIX Vinn Excellence Centre.
    Two Different Strategies to Facilitate Involvement in Healthcare Improvements: A Swedish County Council Initiative2014In: Global Advances in Health and Medicine, ISSN 2164-957X, E-ISSN 2164-9561, Vol. 3, no 5, 22-28 p.Article in journal (Refereed)
    Abstract [en]

    Background: From a management point of view, there are many different approaches from which to choose to engage staff members in initiatives to improve performance.

    Objective: The present study evaluated how two different types of improvement strategies facilitate and encourage involvement of different professional groups in health-care organizations.

    Methods/Design: Empirical data of two different types of strategies were collected within an improvement project in a County Council in Sweden. The data analysis was carried out through classifying the participants' profession, position, gender, and the organizational administration of which they were a part, in relation to their participation.

    Setting: An improvement project in a County Council in Sweden.

    Participants: Designed Improvement Processes consisted of n=105 teams and Intrapreneurship Projects of n=202 projects.

    Intervention: Two different types of improvement strategies, Designed Improvement Processes and Intrapreneurship Projects.

    Main Outcome Measures: How two different types of improvement strategies facilitate and encourage involvement of different professional groups in healthcare organizations.

    Results: Nurses were the largest group participating in both improvement initiatives. Physicians were also well represented, although they seemed to prefer the less structured Intrapreneurship Projects approach. Assistant nurses, being the second largest staff group, were poorly represented in both initiatives. This indicates that the benefits and support for one group may push another group aside.

    Conclusions: Managers need to give prerequisites and incentives for staff who do not participate in improvements to do so. Comparisons of different types of improvement initiatives are an underused research strategy that yields interesting and thoughtful results.

     

     

  • 12.
    Andersson Hagiwara, Magnus
    et al.
    University of Borås, Sweden.
    Andersson Gare, Boel
    Jönköping University, Sweden.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering. Linköping University, HELIX Vinn Excellence Centre.
    Interrupted Time Series Versus Statistical Process Control in Quality Improvement Projects2016In: Journal of Nursing Care Quality, ISSN 1057-3631, E-ISSN 1550-5065, Vol. 31, no 1, E1-E8 p.Article in journal (Refereed)
    Abstract [en]

    To measure the effect of quality improvement interventions, it is appropriate to use analysis methods that measure data over time. Examples of such methods include statistical process control analysis and interrupted time series with segmented regression analysis. This article compares the use of statistical process control analysis and interrupted time series with segmented regression analysis for evaluating the longitudinal effects of quality improvement interventions, using an example study on an evaluation of a computerized decision support system.

  • 13.
    Ayas Pinar, Ebru
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering, Quality Technology and Management .
    Eklund, Jörgen
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering, Industrial ergonomics .
    Elg, Mattias
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering, Quality Technology and Management .
    Affective Engineering Design of Waiting Areas in Swedish Health Centres2007In: International QMOD Conference,2007, 2007Conference paper (Refereed)
  • 14.
    Daneryd, Peter
    et al.
    Ernst & Young, Stockholm.
    Stenberg, Jesper
    Enheten för strategisk utveckling, Region Skåne, Malmö.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology. Linköping University, HELIX Vinn Excellence Centre.
    Intermountain Healthcare: Styrning för kvalitet i ett högpresterande system2014Report (Other academic)
    Abstract [sv]

    Rapporten ”Strategier och ledningsredskap för framgångsrik hälso- och sjukvård” (Calltorp och Maathz, 2009) beskriver och analyserar lärdomar från ett antal internationellt erkända och högpresterande sjukvårdssystem. Intermountain Healthcare1 i Utah har väckt intresse i Sverige som en representant för denna grupp av avancerade och med vanligt använda mått högpresterande vårdsystem. Intermountain täcker ungefär hälften av Utahs 2,4 miljoner invånare, och har en starkt sammanhållen och integrerad karaktär trots att de konkreta vårdgivarna till cirka hälften är privata utförare. Vårdsystemet har framförallt utvecklat modeller för kunskapsstyrning, kvalitetsstyrning och process-utveckling och är allmänt erkända för sitt sätt att beskriva mål, mäta och följa upp resultat samt återkoppla dessa resultat som central styrningsinformation inom vårdsystemet. Man har konkret utvecklat det som numera ofta kallas ”värdebaserad” styrning av vården. Intermountain har rönt allt större uppmärk-samhet i USA och under de senaste 10 åren rankats som ett av de 5 bästa integrerade USA-systemen.

    Syftet med rapporten är att beskriva generella drag i organisering, principer, arbetssätt och metoder för kvalitetsstyrning inom Intermountain Healthcare. En central aspekt är att detta relaterar till och kan berika den pågående svenska utvecklingen av kunskaps-/kvalitetsstyrning av vården.

    Denna rapport är en introduktion till ett av de främsta hälso- och sjukvårds-systemen i USA, Intermountain Healthcare, huvudsakligen i Salt Lake City och i delstaten Utah. Intermountain har varit ett vårdsystem i snart 40 år och har under mer än 25 år byggt en organisationskultur med stark värdegrund som plattform och ständiga förbättringar. Resultatet är vård av hög kvalitet och till en lägre kostnad än de flesta andra hälso- och sjukvårdssystem i USA. Genom att man redan på 1960-talet började utveckla och använda IS och IT i vården, så finns en unikt lång tradition av beslutstöd både för vård och för management.

    Internationella jämförelser mellan svensk hälso- och sjukvård och den i andra länder har fått ökande betydelse på senare år. Intresset fokuseras dels mot framgångsfaktorer generellt och dels mot vårdens resultat i termer av kvalitet och ekonomi. Eftersom framgång ofta är kontextuell, behövs en djupare förståelse genom systematisk beskrivning och analys av det vårdsystem man möter i en jämförelse, för att säkerställa att positiva exempel ska få genomslag inom den svenska hälso- och sjukvårdens förbättringsområden. Lärdomar från arbetet med rapporten visar tydligt att lära av andra hälso- och sjukvårdssystem är ett kunskapsområde i sig vilket är centralt för att vara del i en pågående internationalisering.

  • 15.
    Eklund, Jörgen
    et al.
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology. Division of Ergonomics, Royal Institute of Technology, Huddinge, Sweden.
    Pettersen, Jostein
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, HELIX Vinn Excellence Centre. Linköping University, The Institute of Technology.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, HELIX Vinn Excellence Centre. Linköping University, The Institute of Technology.
    Bolling, Andreas
    Linköping University, Department of Management and Engineering. Linköping University, HELIX Vinn Excellence Centre. Linköping University, The Institute of Technology.
    Interactive research for production and work development2008In: The 40th Nordic Ergonomics Society Annual Conference: Ergonomics is a lifestyle, 2008Conference paper (Other academic)
    Abstract [en]

    Interactive research performed as a collaborative approach in conjunction with organizations is considered a new and promising alternative to other research approaches. The purpose of this paper is to describe how interactive research could be used in the interaction between researchers and organizations when running projects to develop production systems and work performed in these systems. It also aims to identify advantages and disadvantages when applying interactive research. Two long term interactive research projects, organised in collaboration with the partnership of Helix Vinn Excellence Centre at Linköping University were performed and data were collected from documentation of interactive seminars, from notes and from interviews with key actors. Interactive research offers several advantages in comparison with traditional research approaches, foremost higher practitioner involvement and validation opportunities of the results. There are also several difficulties, foremost the need of extensive resources and competencies for the research. The overall experiences from participating practitioners were that they considered that the discussions had been useful, stimulating and interesting, and that the fast feedback from data collection was appreciated. One crucial issue is to what extent this interactive research approach may contribute to high quality research, or to what extent the pressure from the practitioners for actionable practical results will take over.

  • 16.
    Elg, Mattias
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering, Quality Technology and Management .
    Hur skapar vi god kvalitet i vår data? Ständiga förbättringar av prestationsmätningssystem.2007In: Att lyckas med förbättringsarbete - förbättra, förändra, förnya, Lund: Studentlitteratur , 2007, 135-153 p.Chapter in book (Other (popular science, discussion, etc.))
  • 17.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Mätetalens betydelse för ledarskapet i teambaserad verksamhet2009In: Mot ett förändrat ledarskap? om chefers arbete i team. och processorganiserad verksamhet / [ed] P. Ellström, & H. Kock, Lund: Studentlitteratur , 2009, 1, 202- p.Chapter in book (Other academic)
    Abstract [sv]

    Många organisationer har under senare år påbörjat ett förändringsarbete som syftar till en organisering i form av målstyrda arbetsgrupper/team, och en processorientering av hela eller delar av verksamheten. Detta innebär också att nya krav och förväntningar riktas mot chefer i organisationen, exempelvis vad gäller ledarskapets inriktning och den kompetens som ledare bör ha. Den kategori chefer som denna bok främst handlar om är vad som brukar kallas första linjens chefer - en grupp chefer som ofta möter förändrade och motstridiga förväntningar och krav på sitt ledarskap. I bokens inledande kapitel ges en översiktlig beskrivning av de teorier och skolbildningar som varit dominerande i ledarskapsforskningen. Här ges också en mer utförlig beskrivning av de riktningar som utvecklats under de senaste 10-15 åren och som har hög relevans för förståelsen av ledarskap i team- och processorganiserade verksamheter. Andra frågor/områden som behandlas är: o Vilka dilemman och utmaningar i arbetet möter första linjens chefer? o Vilken betydelse har en ökande användning av mätetal för ledarskapet i team- och processorganiserade verksamheter? o Hur ser första linjens chefer på betydelsen av delaktighet i den egna organisationen? o Hur kan ledarskapet i team- och processorganiserade verksamheter förstås från ett genusperspektiv? o I vilken grad framträder ett mer utvecklings- och lärinriktat ledarskap i de studerade organisationerna? Boken är lämplig som kurslitteratur vid universitet och högskolor, men också inom olika typer av personal- och ledarutbildningar. Den vänder sig också till forskare och alla som i olika praktiska sammanhang intresserar sig för frågor om ledarskap och ledarutveckling.

  • 18.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology. Linköping University, HELIX Vinn Excellence Centre.
    Mätningar för bättre styrning: att synliggöra och hantera variation för styrning och förbättring av offentlig verksamhet2013Report (Other academic)
    Abstract [sv]

    Denna metodhandbok handlar om hur variation kan synliggöras och hanteras i offentliga verksamheter ur ett systemperspektiv. Här presenteras och exemplifieras hur man kan arbeta med metoder för att analysera data från olika processer. Innehållet bygger på kunskap om kvalitetsutveckling, mätning och statistik som har sitt ursprung i forskning om kvalitets- och verksamhetsutveckling. I Metodhandboken presenteras olika metoder för att synliggöra variation med exempel från olika offentliga verksamheter. De som bidragit med data är Bolagsverket, Migrationsverket, Skatteverket och Försäkringskassan.

  • 19.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Arts and Sciences.
    Mätningar och utvecklingsorienterat lärande2014In: Lärande i arbetslivet: möjligheter och utmaningar : en vänbok till Per-Erik Ellström / [ed] Henrik Kock, Linköping: Linköpings universitet , 2014, 65-78 p.Chapter in book (Other academic)
    Abstract [sv]

    I detta kapitel vill jag utmana båda dessa ståndpunkter genom att lyfta fram ett perspektiv på mätningar som inte har diskuterats så utförligt i forskningen, nämligen organisering av mätetalsanvändning för ett utvecklingsorienterat lärande. Jag menar att under vissa betingelser fungerar mätetal och mätningar som stöd för verksamhetsinriktad utveckling och lärande. Jag försöker ta fasta på argumentet att mer avancerade former av lärande i arbetet kräver arbetsplatser som har en inbyggd design för lärande (Ellström, 2011). Frågan blir då hur användningen av mätetal kan bli en del av den inbyggda designen för lärande på arbetsplatsen och hur man kan förstå på vilka sätt organisering kan gå till. Finns det någon systematik för detta? Genom tre berättelser av tillämpningar av mätningar som stimulerat och även lett till utveckling i en vårdverksamhet belyser jag möjligheter och begränsningar i lärandet med stöd av mätetal. Vad som speciellt lyfts fram i dessa fall är att mätningar möjliggör upptäckter av avvikelser i arbetsrutiner och processer. Sådana avvikelser kan upptäckas genom olika former av mätsystem, här illustrerat genom månatliga mätningar av vårdhygien, patientdagbok och kvalitetsregister. Mätningarna blir här en processens röst som byggs in i lärandet på arbetsplatsen. En slutsats är att när mätningar är relevant och meningsfullt inbäddade i organisatoriska sammanhang möjliggörs reflektion och utvecklingsorienterat lärande.

  • 20.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering. Linköping University, HELIX Vinn Excellence Centre.
    Mätningarnas roll i chefers styrning och förbättringsarbete2016In: Mot ett förändrat ledarskap?: om chefers arbete och ledarskap i ett organisationsperspektiv / [ed] Per-Erik Ellström, Anna Fogelberg Eriksson, Henrik Kock, Andreas Wallo, Lund: Studentlitteratur AB, 2016, 2, 147-161 p.Chapter in book (Other academic)
  • 21.
    Elg, Mattias
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology. Linköping University, HELIX Vinn Excellence Centre.
    Organisera för ständiga förbättringar2013In: Sjuksköterskans kärnkompetenser / [ed] Janeth Leksell & Margret Lepp, Stockholm: Liber, 2013, 1, -345 p.Chapter in book (Other academic)
    Abstract [sv]

    Boken inleds med ett kapitel om begreppet kompetens och följs av kapitel om sjuksköterskeprofessionen och sjuksköterskan som omvårdnadsexpert. Därefter följer kapitel om de sex kärnkompetenserna. Ett kapitel ger dessutom röst åt innebörden av att vara patient. Avslutningsvis följer ett kapitel om framtiden med dess förändringar, pågående eller förväntade, som har konsekvenser för hälso- och sjukvården och därmed även för sjuksköterskans roll och funktion. Författarna vill inspirera, problematisera och söka svar på vad sjuksköterskans profession och kompetens innebär, med avsikt att bidra till en kvalitativt god vård inom hälso- och sjukvård. I första hand är boken avsedd som kurslitteratur för sjuksköterskestudenter på grundläggande nivå. Men även studenter på avancerad nivå och kliniskt verksamma sjuksköterskor och andra inom hälso- och sjukvården kan ha nytta av boken

  • 22.
    Elg, Mattias
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Quality Technology and Management.
    Statistisk Process Styrning -ett använtbart beslutsstöd i vårdens förbättringsarbete?!1999In: Kvalitet99,1999, 1999Conference paper (Other academic)
  • 23.
    Elg, Mattias
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering, Quality Technology and Management .
    The Process of constructing performance measurement2007In: TQM Magazine, ISSN 0954-478X, Vol. 19, no 3, 217-228 p.Article in journal (Refereed)
  • 24.
    Elg, Mattias
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Quality Technology and Management.
    André, Bengt
    Federation of County Councils.
    Lindmark, Jan
    Federation of County Councils.
    Implementing Performance Measurement Systems in Swedish Psychiatry: A Method for Supporting Management Teams in Complex Implementation Situations2004In: PCSE,2004, 2004Conference paper (Refereed)
  • 25.
    Elg, Mattias
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Quality Technology and Management.
    André, Bengt
    Landstingsförbundet.
    Lindmark, Jan
    Landstingsförbundet.
    Organisation och design av verksamhetsuppföljning -En metod för implementering av uppföljningsfrågor i ett löpande ledningsarbete i psykiatrisk vård2004In: Verksamhetsuppföljning inom psykiatrin,2004, 2004Conference paper (Refereed)
  • 26.
    Elg, Mattias
    et al.
    Linköping University, Department of Mechanical Engineering.
    Dahlgaard, Jens Jörn
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Quality Technology and Management.
    Dettner, Fredrik
    Implementing Performance Measurement Systems: An Application of SPC in a Swedish Industrial Organization2004In: International QMOD Conference,2004, 2004, 359- p.Conference paper (Refereed)
  • 27.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering. Linköping University, HELIX Competence Centre.
    Daneryd, Peter
    Kommunalförbundet Avancerad Strålbehandling.
    Lindmark, Jan
    Hållbart sjukdomsförebyggande arbete?: En studie av hur man arbetar med sjukdomsförebyggande arbete i två vårdsystem i USA2017Report (Other academic)
    Abstract [sv]

    Det finns en stor enighet om att vårdens uppdrag behöver förändras för att möta behoven hos befolkningen på ett bättre sätt. Hälsoläget i de rika delarna av världen är i hög grad beroende av den demografiska utvecklingen (med åldrande befolkning) och våra levnads­vanor, som gör att vi drabbas av livsstilssjukdomar. I WHOs nuvarande globala strategi för “health for all” ingår hörnpelare som integrerad befolkningsorienterad hälso- och sjukvård där aspekter som prevention, sjukdomsförebyggande, patientmedverkan lyfts fram (WHO 2015). I EUs forsknings- och utvecklingsprogram och strategiska planering stödjer man projekt som visar hur man kan identifiera, sprida och stödja ”best practices” för kostnadseffektiv prevention vad beträffar rökning, missbruk av alkohol, övervikt och HIV/AIDS (EU 2016).

    I Sverige har vi utvecklat nationella riktlinjer för sjukdomsförebyggande metoder. Rikt­linjerna har tagits fram av Socialstyrelsen för att stärka det sjukdomsförebyggande arbetet i vården och därigenom förbättra patienternas levnadsvanor. I riktlinjerna fokuseras fyra områden – tobak, riskbruk av alkohol, fysisk aktivitet och matvanor. Landstingen och kommunerna, har sedan introduktionen av riktlinjerna år 2011 arbetat med implemente­ringen. Huvudmännen har kommit olika långt i arbetet men bland annat utifrån den an­strängande situationen i stora delar av den svenska vården har det varit svårt att få till­räckligt genomslag för arbetet. Som ett led i insatserna för att stärka upp det sjukdoms­förebyggande arbetet i Sverige har Socialstyrelsen uppdragit åt Linköpings universitet att belysa hur de sjukdomsförebyggande insatserna hanteras i två framstående hälso- och sjukvårdsorganisationer i USA. Den huvudsakliga frågeställningen är hur man organise­rar arbetet med det sjukdomsförebyggande arbetet. Uppdraget innefattar även en genom­gång av internationell vetenskaplig litteratur med syftet att komplettera de två ovan nämn­da fallstudierna. Socialstyrelsen vill härigenom bidra med ökad kunskap om förutsätt­ningar och metoder för att arbeta med sjukdomsförebyggande metoder i kliniskt arbete, företrädesvis primärvården. Denna studie vill därför bidra till kunskapsunderlag om hur realiseringen av de sjukdomsförebyggande metoderna kan ske.

    En utgångspunkt för att kunna ringa in de relevanta frågeställningarna ur ett svenskt perspektiv är de resultat som identifierats i tidigare rapport Översättning av riktlinjer – Fallstudier av sjukdomsförebyggande metoders genomslag av Elg m.fl. (2016). Här stu­derades fyra svenska vårdsystem och deras väg fram i det sjukdomsförebyggande arbetet. Fokus i föreliggande arbete är i likhet med tidigare studie de strukturer och processer som används för att styra, leda och organisera det sjukdomsförebyggande arbetet. Vi tar således utgångspunkt i slutsatserna från den tidigare studien och undersöker empiriskt hur man försöker utveckla och vidmakthålla lösningar på Southcentral Foundation (SCF) och Intermountain Healthcare (IH), två vårdsystem i USA.

    De studerade verksamheterna arbetar aktivt med sjukdomsförebyggande arbete, men uti­från delvis olika utgångspunkter. En viktig skillnad är att medan Intermountain Health­care successivt, med nya initiativ, utökar sitt uppdrag, så ligger det sjukdomsförebyggan­de arbetet redan inbäddat i Southcentral Foundations grundläggande idé för primärvår­den. Det är också stora skillnader i patientpopulationernas storlek och socioekonomiska förhållanden. I analysen gör vi jämförelser mellan de två verksamheterna för att identi­fiera likheter och särdrag i hur man organiserar styrning och ledning om och för sjuk­domsförebyggande. Genom denna analys identifierar vi angreppssätt och metoder som vi bedömer kan ha betydelse ur ett svenskt perspektiv.

    Fyra, som vi ser det, viktiga dimensioner av hur man i de två fallen arbetar med sjukdoms­förebyggande presenteras i studien, nämligen 1) strategiskt styrnings- och ledningsfokus på frågorna; 2) lärande om sjukdomsförebyggande arbete i vårdens vardag; 3) skapande av tekniska stödsystem och processer som underlättar för sjukdomsförebyggande arbetet i vardagen; samt 4) vikten av att genom fysisk design av vårdens arbetsplatser underlätta integration av arbetsmoment och tekniska stödsystem och därigenom genomförandet av strategier för sjukdomsförebyggande arbete. Vi ser även i fallstudierna hur digitala designlösningar möjliggör för medskapande av sjukdomsförebyggande metoder hos med­borgare och patienter.

    Såväl Intermountain Healthcare som Southcentral Foundation har visioner som betonar vikten av hälsofrämjande och sjukdomsförebyggande verksamheter, vilket för båda inne­bär att det strategiska styr- och ledningsarbetet också har fokus på sjukdomsförebyggande arbete som en naturlig del i verksamhetens uppdrag.

    Men en vision kan bli verkningslös om det inte finns strategier och ägarskap på högsta ledningsnivå, som aktivt arbetar för realisering av frågorna. I diskussionen lyfter vi fram betydelsen av detta aktiva ägarskap i termer av resurssättande, hur man knyter strategiskt viktiga partners till arbetet, hur man på strategisk nivå prioriterar sjukdomsförebyggande bland olika patientgrupper samt hur man också knyter an analys och uppföljning på strateginivå.

    Att man även prioriterar resurser för förbättringsarbete och forskning med inriktning mot sjukdomsförebyggande skapar också en förutsättning för långsiktighet. Det finns som vi ser det en dynamik och ett tilltagande fokus för just dessa frågor. I rapporten vill vi ringa in och sätta fokus på hur realiseringen av det sjukdomsförebyggande arbetet har gått till – vad som kan ligga bakom ett framgångsrik införande. Det är därför de organisatoriska processerna snarare än innehållet som vi tar fasta på och som vi också vill lyfta fram som avgörande för ett långsiktigt hållbart sjukdomsförebyggande arbete.

    Att lära om och för det sjukdomsförebyggande är en viktig del i framgången. Här ser vi exempel från våra fall där man via kontinuerlig träning och utbildning av de professionel­la lär sig att hantera frågorna genom vidareutbildningsinsatser. Det finns även fasta rutiner för att kontinuerligt träffas över organisationsgränser där frågorna diskuteras av kliniskt verksamma. Vi ser också att man proaktivt arbetar med berättelser om vad som kan åstad­kommas genom sjukdomsförebyggande arbete. Därutöver finns på SCF särskilda funktio­ner inom primärvården som är specialister på att åstadkomma beteendeförändring hos patienter. Denna kompetens vill vi särskilt lyfta fram då den skapar goda möjligheter att hantera de ofta komplexa problem som behöver hanteras i primärvården.

    Både SCF och IH arbetar mycket aktivt för att skapa tekniska stödsystem och processer som underlättar arbetet i vardagen. Ett uttryck som används är ”det ska vara lätt att göra rätt” och i våra amerikanska fallstudier arbetas det aktivt med att identifiera lösningar som faktiskt gör det lättare att göra rätt. Det gäller till exempel arbetsprocedurer för sjuk­domsförebyggande som bäddas in i den elektroniska patientjournalen, kriterier för att identifiera patienter som är i behov av förebyggande insatser samt standardiserade analys- och utvärderingsinstrument som underlättar beslut i vardagens vårdproduktion. Före­trädare för de studerade vårdsystemen menar att nya sätt att kommunicera med patienter behöver utvecklas, ett arbete som man anser ännu är i sin linda. Digitaliseringen lyfts fram som en möjliggörare där tid och rum inte är avgörande för god vård.

    Man pekar speciellt inom SCF också på vikten av den fysiska designen av vårdens arbets­platser. Det handlar om arbetsplatsens miljö och hur funktioner och kompetenser fysiskt är arrangerade i förhållande till varandra. När det gäller stöd för patienters sjukdomsföre­byggande arbete spelar dessa frågor en viktig roll. Framförallt ser vi hur man fysiskt sam­lokaliserar team och hur man rumsligt placerar undersökningsrum, samtalsrum och led­ning av primärvårdspersonal i avsikt att försöka optimera arbetet. Devisen ”out of sight, out of control” beskriver väl hur man anstränger sig för att ordna den fysiska miljön så att patienten konkret sätts i centrum. Inom IH breddas uppdraget bland annat genom att eftersträva lokalisering av sjukdomsförebyggande aktiviteter på nya sätt i kultur- och samhällscentrala institutioner. Dessa förebyggande insatser bedrivs inom ramen för det definierade vårduppdraget.

    Sammanfattningsvis, baserat på de reflekterade iakttagelser vi har gjort i de två amerikanska organisationerna, finns det en rad möjligheter till tips och råd som kan underlätta det svenska arbetet med sjukdomsförebyggande. Dessa sammanfattar vi i följande punkter:

    1. Ha en strategisk avsikt – De sjukdomsförebyggande insatserna har strategisk betydelse i de båda studerade vårdsystemens arbete. Ägarskapet i vårdsystemens ledningar är påtagligt. Detta är nödvändigt för att man ska få till ett hållbart arbete. Ta bort det ägarskapet och frågan är förlorad.
    2. Säkra resurser – framförallt säkerställande av kompetens – behöver prio­riteras för att kunna hantera uppdrag som omfattar sjukdomsförebyggande in­satser. Vi ser att både SFC och IH gör strategiska prioriteringar av resurser till primärvården för att detta uppdrag ska kunna få fotfäste.
    3. Balansera styrningen – Frågan om detaljstyrning av de sjukdomsföre­byggande insatserna är komplex och hanteras olika på SCF och IH. På SCF är ansvaret för beslut om vård i primärvården fördelat till integrerade team som gör en kollektiv, professionell bedömning tillsammans med patient och anhöriga om patientens problem och behov av insatser utifrån önskemål och förmåga att ta emot. På IH är processtyrningen mer betydelsefull. Här arbetar man efter vad som kallas ”shared baselines” och ”care process models”, man kommer överens om hur arbete ska utföras och följer sedan upp processvariationer.
    4. Arbeta behovsstyrt med utgångspunkt i kunskap om patientens problem – Analyser av behov hos befolkningen spelar en viktig roll i hur uppdragen formuleras. Här behöver vårdsystemen fortsätta driva och fördjupa forskning och utvecklingsin­satser i syfte att förstå behoven på ett djupare plan. Utredningar från forskare och kvalificerade utredare är förstås en viktig del i detta, men det finns även behov av att involvera patienter och medborgare på en regelbunden basis för att få större förståelse om var och hur insatser bör sättas in. Det kan till exempel göras genom olika former av segmenteringar av patienter med olika önskemål och behov. Kon­kret kan behovsanalyser genomföras t.ex. med fokusgrupper eller patientinflytan­de i olika beslutsorgan.
    5. Utveckla kompetens i förbättringskunskap – Både SCF och IH har bred kunskap om hur man driver förbättringsarbete på säkra och effektiva sätt. Till exempel genomförs pilottester – en form av lärandestyrt förbättringsarbete – i specifika verksamhets­delar för att maximera lärande och minimera effekterna av misstag. De pekar på risker att tidigt i utvecklingsprocesser genomdriva fullskaliga implementeringar – att istället testa i begränsad skala för att se effekter av satsningar. En annan viktig ingrediens i förbättringskunskapens verktygslåda är kompetens om mätningar. Här behöver man förstå och kunna argumentera syfte och vilka mätningar som behöver genomföras samt hur man använder mätningar för olika former av beslut i organisationen.
    6. Konstnärligt utvärdera insatser för sjukdomsförebyggande – De insatser som görs för att förebygga sjukdom behöver utvärderas ur flera perspektiv. Det är viktigt att den personal som utför arbetet också kan delta i eller åtminstone följa processerna för utvärdering. På så sätt ges möjligheter till lärande. Kompetens för att genom­föra utvärderingar bör byggas i vårdsystemet, exempelvis:
    1. Analys av behovsbilden hos befolkningen och verksamhetens bidrag till dess utveckling.
    2. Analys av värdet av insatserna för det egna vårdsystemet.
    3. Proaktiv identifiering av patienter som bedöms ha behov av sjukdomsföre­byggande insatser.
    4. Utvärdering av insatsernas effektivitet utifrån professionens perspektiv.
    5. Utvärdering av insatsernas effektivitet utifrån patientens perspektiv.
    6. Utvärdering av hur ofta insatser genomförs.
    7. Utvärdering av resultat och effekter av insatser.

    Författarna till denna rapport har inspirerats under vår datainsamling och analys. Svenska initiativ som möjliggör fördjupade jämförelser och analyser av svenska primärvårdssys­tem utifrån exempelvis de studerade amerikanska vårdsystemen skulle kunna göras. Vad skulle då framstå som möjliga utvecklingsområden för svensk primärvård på makro-, meso och mikronivå? Vi skulle också gärna se mer lust och möjligheter till systematiska experiment inom svensk primärvård, i det här fallet inom området sjukdomsförebyggande metoder. Sådana experiment kräver naturligtvis design, metodkunskap, förbättringskun­skap, utvärdering och diskussion av resultat.

    Vi menar att såväl fördjupade jämförelser och experimentsituationer bör gå att ordna i samverkan mellan landsting, kommuner, verksamheter och forskarsamhället för att for­mulera frågeställningar, design för aktiviteter, föreslå metoder för utvärdering, ordna kommunikation runt resultat med mera.

  • 28.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering. Linköping University, HELIX Vinn Excellence Centre.
    Ellström, Per-Erik
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Klofsten, Magnus
    Linköping University, Department of Management and Engineering, Project Innovations and Entrepreneurship. Linköping University, Faculty of Science & Engineering. Linköping University, HELIX Vinn Excellence Centre.
    Tillmar, Malin
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Sustainable development in organizations2015In: Sustainable development in organizations: Studies on Innovative Practices / [ed] Elg, Mattias, Ellström, Per-Erik, Klofsten, Magnus, & Tillmar, Malin, Cheltenham: Edward Elgar Publishing, 2015, 1-15 p.Chapter in book (Refereed)
  • 29.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering. Linköping University, HELIX Vinn Excellence Centre.
    Ellström, Per-ErikLinköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences. Linköping University, HELIX Vinn Excellence Centre.Klofsten, MagnusLinköping University, Department of Management and Engineering, Project Innovations and Entrepreneurship. Linköping University, Faculty of Science & Engineering. Linköping University, HELIX Vinn Excellence Centre.Tillmar, MalinLinköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Sustainable development in organizations: studies on innovative practices2015Collection (editor) (Other academic)
    Abstract [en]

    An increasingly competitive environment can lead to considerable problems for many organizations as they struggle to adapt to change. As a result, they fail to create the conditions that can lead to sustainable development over the long term, thus affecting the capabilities of employees. This book provides a fresh perspective on sustainable change and development in organizations, as well as a critical perspective on lean implementation, work environment and sustainability.

    The expert contributors address the development in, and of, organizations, as well as the development process between organizations, such as in networks or clusters. They discuss topics, such as the role of customers in the development of public organizations; developing knowledgeable practice at work; exploring evidence-based practice and the challenge of regional gender contracts.

    Undergraduates and postgraduates in different management fields including organizational theory, innovation, human resources, quality development and entrepreneurship will find this book to be of interest. The empirical results and interdisciplinary approach will appeal to practitioners and policy-makers at national, as well as international levels.

  • 30.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering. Linköping University, HELIX Vinn Excellence Centre.
    Ellström, Per-Erik
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Kock, Henrik
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Tillmar, Malin
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, Faculty of Arts and Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Impact Evaluation report: Helix Vinn Excellence Centre 2006 - 20152016Report (Other academic)
    Abstract [en]

    This impact evaluation report concerns the activities of HELIX VINN Excellence Centre at Linköping University. HELIX is an established Centre within working life research, focusing specifically on sustainable development in organizations. This entails research and innovation activities that promote good working conditions, learning, health and gender equality in combination with an effective and innovative production system.

    In the HELIX VINN Excellence Centre, the interactive collaboration between researchers from different disciplines and the partner organizations has enabled us to face the challenges and the complexity of contemporary working life. The research strategy contained three key elements. Firstly, research and innovation activities were carried out with the well-established interactive research approach. Secondly, a multidisciplinary, integrative research approach was used. Researchers from different disciplines within behavioral sciences, management, business and public administration, entrepreneurship and innovation, as well the health and work sciences, collaborate within the Centre. Thirdly, a partnership approach was used, engaging universities and private firms as well as actors within the public sector and labour market organizations. The problems and issues defined in dialogue between partner organizations and researchers enabled the research activities.

    HELIX vision can be captured by the phrase Knowledge for Sustainable Development in Organizations. Our research programme has focused on organizational development across a broad front in working life, including attractive working environments, high welfare standards, and effective organizations, offering sustainable job opportunities.

    The research at HELIX has advanced scientific knowledge about development of new types of work arrangements and development of sustainable working life in Sweden. The Centre has also strengthened the potential for Swedish organizations to be more sustainable in the long-term and to stimulate endeavors between public and private organisations. As expressed by the partner organizations, they have joined HELIX to get support in developing their organization towards better economical and social sustainability. Our overarching goal has been to contribute significantly to scientific knowledge and, at the same time, add value to practice – that is, to put working-life research to use.

    The HELIX program has also had a considerable impact on partners and other organizations. Indeed, most partners report clear benefits from the research collaboration. These benefits may concern a direct, instrumental impact (e.g. changes in organizational policies and/or routines), an indirect impact (e.g. access to new knowledge and ideas or know-how), or impact in a broader sense (e.g. interactions with other participating companies, cross-fertilization of ideas). Participation in the HELIX partnership has also for many partners meant increased interaction with research and the university, and, thereby, a significantly increased access to research-based knowledge concerning issues covered by the HELIX research program.

    In spite of the often-reported difficulties in reaching direct and instrumental types of knowledge use, that is, types where research results are used more or less directly as input or guidelines for action or organizational change, our analysis shows that more than half of the respondents report direct, instrumental benefits from their engagement in HELIX, and almost three quarters of the respondents reported different forms of indirect impact. These findings are supported also by our impact cases.

    A closer analysis of the HELIX program and the cases reported above, indicate a number of key success factors. First, the multi-disciplinary and interactive research approach has made it possible to reach a high degree of relevance in research questions and projects. Second, the partner organizations have had a high degree of joint ownership of the HELIX program and the projects through the HELIX partnership. Third, in the most successful cases with respect to research use and impact, we have been able to anchor the projects at the top management level and, thereby, to assure a high degree of management attention and support for the research and innovation efforts. Fourth, that there is one or more enthusiasts or “idea champions” within the organization that can promote a project or a new idea. Fifth, in the most successful cases we have also been able to create opportunities for individual and collective learning through different types of learning activities, for example, joint analysis seminars and workshops for dissemination and use of research results.

  • 31.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Engström, Jon
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Witell, Lars
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Poksinska, Bozena
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Co-­‐creation and learning in healthcare service development2012In: Journal of Service Management, ISSN 1757-5818, Vol. 23, no 3, 328-343 p.Article in journal (Refereed)
    Abstract [en]

    Purpose - This study has the purpose of developing and evaluating a model for patient cocreation and learning based on diaries for use in healthcare service development. In particular, we investigate the process of patient co-creation and different mechanisms through which healthcare service providers can learn from the patient.

    Design/methodology/approach – The study is based on an action research approach. First, a development phase for patient co-creation and learning leading to a proposed model was conducted. Second, a test phase of the diary-based method was performed on 53 patients in three cases: orthopaedic care, rehabilitation care and gastroenterology care.

    Findings – We suggest a model for co-creation and learning in healthcare service development with three ways of learning. Firstly, the model may be used as a means for generating and collecting patient ideas; secondly, a single patient’s story can be illustrated, and serve as an incentive for healthcare service development and creation of patient-centred care; finally, a larger number of diaries can be analysed and combined with patient surveys to provide a deeper understanding of how the patient experiences health care services.

    Originality/value – This study extends the research on diary-based methods as an operationalisation of co-creation in two ways. Firstly, the study offers new and more diverse ways of using the rich material provided by customer diaries in the development of services. Secondly, the study suggests a co-creation approach of involving patients in healthcare service development through patient diaries.

  • 32.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology. Linköping University, HELIX Vinn Excellence Centre.
    Fundin, A
    Volvo Construction Equipment, Customer Support Division, Strategy and Business Development Department, Eskilstuna, Sweden.
    Quality assurance of information in performance easurement systems2012In: International Journal of Productivity and Quality Management, ISSN 1746-6474, Vol. 10, no 4, 514-530 p.Article in journal (Refereed)
    Abstract [en]

    The objective of this paper is to develop and empirically investigate a conceptual framework for quality assurance of information in performance measurement systems. Three different strategies that may be applied for improving the quality of information in performance measurement systems are elaborated upon: craftsmanship, communicative actions and pragmatic assessment. These three strategies focus on different aspects: The craftsmanship strategy pays attention to the procedures that generate information; the communicative action strategy draws attention to the information itself; and the third model, pragmatic assessment, looks at how performance measurement influences decision making from a holistic perspective. Each of the strategies employs different tactics for ensuring quality of information. Based on empirical identification and elaboration of the three strategies, we argue that they have complementary roles. Copyright © 2012 Inderscience Enterprises Ltd.

  • 33.
    Elg, Mattias
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Quality Technology and Management.
    Fundin, Anders
    Division of Quality Sciences Chalmers University.
    Persson, Bodil
    Sveriges kommuner och landsting.
    Principles for Improvement of Data Quality in Performance Measurement Systems2005In: QMOD Conference,2005, Palermo: Ordinelngegneri della provincia di Palermo , 2005, 935- p.Conference paper (Refereed)
  • 34.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Gauthereau, Vincent
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Witell, Lars
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Att lyckas med förbättringsarbete - förbättra, förändra, förnya2007Book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Att arbeta med ständiga förbättringar är en utmaning, men också en nödvändighet för att kunna möta konkurrens från låglöneländer. Genom att använda uppmärksamheten från vad företaget gör till hur det görs skapas det förutsättningar för att arbeta med att förbättra och förnya verksamheten. I ett lyckat förbättringsarbete involveras de anställda för att genom småskaliga och ständiga förbättringar skapa något som är bättre både för de anställda och organisationen. Denna bok förmedlar ett antal olika perspektiv på förbättringsarbete och ständiga förbättringar. Arbetet med ständiga förbättringar speglas utifrån ett teoretiskt, filosofiskt och praktiskt perspektiv. Vidare visar boken på hur förbättringsarbete kan ta olika utgångspunkter för att förändra, förbättra och förnya olika delar av en verksamhet. Boken består av två huvudsakliga delar. Den första delen behandlar olika former av ständiga förbättringar, s.k. förbättringsprogram, olika metoder och kulturella skillnader mellan olika delar av världen. I den andra delen ge en fördjupning i olika perspektiv på ständiga förbättringar med ett speciellt fokus på hur stända förbättringar används och tillämpas i svenska organisationer idag. Exempel hämtas från ett antal olika branscher och verksamheter som hälso- och sjukvård, kärnkraftsindustrin, tjänstesektorn samt tillverkningsindustrin.

  • 35.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Gremyr, Ida
    Division of Quality Sciences, Chalmers University of Technology, Göteborg.
    Hellström, Andreas
    Division of Quality Sciences, Chalmers University of Technology, Göteborg.
    Witell, Lars
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    The Role of Quality Managers in Contemporary Organisations2011In: Total Quality Management and Business Excellence, ISSN 1478-3363, E-ISSN 1478-3371, Vol. 22, no 8, 795-806 p.Article in journal (Refereed)
    Abstract [en]

    A key question for firms nowadays is how to organise work with quality management. This naturally includes the role of the quality managers and it appears as if the profession of quality managers is at a crossroads. Alternatives are that the role of a quality manager broadens to include quality at a strategic level in the firm and that Six Sigma specialists and Lean Production managers drive the development of quality management in the future. In this paper, we present the results from a survey of 212 quality managers in Swedish organisations. The purpose is to contribute to an understanding of how the management of quality is designed and practised in contemporary organisations. This study shows that a quality manager's operational responsibility is quite narrowly defined. The agenda of the quality manager is mainly related to quality standards, such as ISO 9000 and environmental management systems. These programmes frame the work of the quality manager, which in many cases leaves other programmes, such as Six Sigma and Lean Production, to other departments or parallel improvement structures.

  • 36.
    Elg, Mattias
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Quality Technology and Management.
    Gustafsson, Anders
    Centrum för tjänsteforskning Karlstad universitet.
    Huber, Frank
    Herrmann, Andreas
    An Integrative Framework for Product Development and Satisfaction Measurement1999In: In proceedings of the 3rd Annual International QFD Symposium,1999, 1999Conference paper (Refereed)
  • 37.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Kollberg, Beata
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Alternative arguments and directions for studying performance measurement2009In: Total Quality Management and Business Excellence, ISSN 1478-3363, E-ISSN 1478-3371, Vol. 20, no 4, 409-421 p.Article in journal (Refereed)
    Abstract [en]

    The purpose of this article is to present and discuss alternative arguments and directions for the study of performance measurement. We classify and discuss performance measurement in three phases: the design and structure of the performance measurement system, the implementation of performance measurement, and the utilisation of performance measurement in everyday work. We argue the need for a general approach to the examination of performance measurement in organisations, a perspective that addresses the key questions identified by managers and how they deal with the design, implementation, and usage of performance measurement in real-time settings. Studies of performance measurement in the various three phases are proposed by means of an organisational framework. This framework takes into account internal dimensions, situational/contingency factors, external innovations, dimensions and outcomes. These various dimensions are developed in relation to performance measurement systems analysis.

  • 38.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology. Linköping University, HELIX Vinn Excellence Centre.
    Kollberg, Beata
    Linköping University, Department of Management and Engineering, Industrial Marketing and Industrial Economics. Linköping University, The Institute of Technology.
    Conditions for reporting performance measurement2012In: Total Quality Management and Business Excellence, ISSN 1478-3363, E-ISSN 1478-3371, Vol. 23, no 1, 63-77 p.Article in journal (Refereed)
    Abstract [en]

    The purpose of this paper is to identify factors affecting the quality of a performance measurement (PM) system with particular focus on its ability to produce valid, trustworthy information. The study is based on a cross-case study design. Interviews were conducted with reporters to the national performance measurement system of waiting times in Swedish healthcare. The study focuses on the premises that managing operations through measures is not possible without a functioning reporting system. Thus, in order to put any performance measurement system into practice, several types of resources are needed. The results from the study show large differences in the conditions for reporting within a healthcare performance measurement system. We propose how various resources, contextual factors and internal dynamics create conditions for reporting of waiting time data. This is described in a framework that clarifies six different patterns: (1) Encouraging reporting; (2) Active responsibility; (3) Limited opportunities for reporting; (4) Abandoned reporting; (5) Passive responsibility; and (6) Total inactivity. This study provides the scholarly field of quality management research with a theoretical model for understanding various components of a performance measurement system.

  • 39.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Kollberg, Beata
    Linköping University, Department of Management and Engineering, Industrial Marketing and Industrial Economics . Linköping University, The Institute of Technology.
    En metodansats för utvärdering av prestionsmätningssystem2004Report (Other academic)
  • 40.
    Elg, Mattias
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Quality Technology and Management.
    Kollberg, Beata
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Quality Technology and Management.
    Lindmark, Jan
    Sveriges kommuner och landsting.
    Development of Process Oriented Innovations in Swedish Healthcare: a Longitudinal Study of Development Projects2005In: QMOD Conference,2005, Palermo: Ordinelngegneri della provincia de Palermo , 2005, 511- p.Conference paper (Refereed)
  • 41.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Kollberg, Beata
    Linköping University, Department of Management and Engineering. Linköping University, The Institute of Technology.
    Lindmark, Jan
    Olsson, Jesper
    Goal Orientation and Conflicts: Motors of Change in Development Projects in Health Care Service2007In: Quality Management in Health Care, ISSN 1063-8628, Vol. 16, no 1, 84-97 p.Article in journal (Refereed)
    Abstract [en]

    The article presents parts of a larger research study which aims to explain how a process-oriented innovation unfolds and develops over time in the health care system in Sweden. It is said that local development teams have a rather broad notion of what it takes to implement the flow model. The theory used to explain the developmental patterns which have been identified in the national and local projects was presented.

  • 42.
    Elg, Mattias
    et al.
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Kollberg, Beata
    Linköping University, Department of Management and Engineering, Industrial Marketing and Industrial Economics. Linköping University, The Institute of Technology.
    Palmberg, Klara
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Performance measurement to drive improvements in healthcare practice2013In: International Journal of Operations & Production Management, ISSN 0144-3577, Vol. 33, no 11/12, 1623-1651 p.Article in journal (Refereed)
    Abstract [en]

    Purpose – The purpose of this study is to contribute to the knowledge base on how performance measurement drives improvements in healthcare practice.

    Design/methodology/approach – The study is based on a single in-depth case study. The critical incident technique (CIT) has been applied in order to identify significant occurrences of performance measurement in terms of events, incidents, processes, and issues identified by respondents from the case organization. These critical incidents have been analysed and interpreted using a theoretical framework suggesting that performance measurement may be applied for exploratory or regulatory purposes as well as ad hoc or continuously in healthcare practice.

    Findings – The study suggests that performance measurement may be a versatile method for driving improvement in healthcare organizations. Six types of activities directly or indirectly drive improvement in the clinical department: continuous follow-up in formal arenas and meetings; improvement work; professional efforts; goal deployment; reporting based on external demands; and creating awareness in everyday clinical work. Healthcare organizations that strive to practice performance measurement as a driver for improvement need to find infrastructures in which it is being integrated into the daily life of organizational healthcare practice.

    Originality/value – The study provides an original account of the prerequisites and actions for driving improvement through performance measurement in a healthcare setting. Since the operations management perspective in healthcare is significantly lacking, the study offers a unique perspective which may be the basis for both practice development and further scholarly inquiry and theory development.

  • 43.
    Elg, Mattias
    et al.
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Langstrand, Jostein
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, The Institute of Technology.
    Balanced Scorecard as Organizational Practice: A multi-perspective analysis2010Other (Other academic)
    Abstract [en]

    Much academic attention has been directed towards management models, but there is limited research into the details of how these models are put to use in organizations. In this paper, we employ a multi-theoretical process perspective on the introduction of Balanced Scorecard in a Swedish healthcare organization. Through the application of actor-network theory, behavior setting theory and distributed cognition, we have identified a set of complementary observations and conclusions. First, we claim that a critical mass of actors is needed to support the change effort. We also emphasize the need for a problematization process in which critical voices are given room to influence the introduction. Further, we stress the importance of aligning the physical environment with organizational goals, and argue that well-designed feedback mechanisms may prevent undesired decoupling of managerial practice.

  • 44.
    Elg, Mattias
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering, Quality Technology and Management .
    Li, Nan
    Eklund, Jörgen
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering, Industrial ergonomics .
    The diffusion of lean production: a literature study2007In: International QMOD Conference,2007, 2007Conference paper (Refereed)
  • 45.
    Elg, Mattias
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Quality Technology and Management.
    Lindmark, Jan
    Sveriges kommuner och landsting .
    Process orientation in health care services: the flow model as a way to follow the patient's journey through the health care system2006In: 9th International QMOD Conference,2006, Liverpool: Liverpool JMU , 2006Conference paper (Refereed)
    Abstract [en]

       

  • 46.
    Elg, Mattias
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Quality Technology and Management.
    Lindmark, Jan
    Sveriges Kommuner och Landsting.
    Stakeholder information needs in psychiatric care: a qualitative study of political and administrative perspectives2005In: PCS/I Conference,2005, Ljubljana: PSC , 2005Conference paper (Refereed)
  • 47.
    Elg, Mattias
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Mechanical Engineering, Quality Technology and Management.
    Lindmark, Jan
    Sveriges kommuner och landsting.
    André, Bengt
    Sveriges kommuner och landsting.
    Implementing multidimensional control systems in psychiatric organizations: an intervention based approach2005In: PCS/I Conference,2005, Ljubljana: PCS , 2005Conference paper (Refereed)
  • 48.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering. Linköping University, HELIX Vinn Excellence Centre.
    Lindmark, Jan
    CIO Axfood AB.
    Wiger, Malin
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering.
    Wihlborg, Elin
    Linköping University, Department of Management and Engineering, Political Science. Linköping University, Faculty of Arts and Sciences.
    Översättning av riktlinjer: Fallstudier av sjukdomsförebyggande metoders genomslag2016Report (Other academic)
    Abstract [en]

    The National Board of Health and Welfare decided in November 2011 on the national guidelines for methods of preventing disease. The guidelines focus on four areas: tobacco use; hazardous use of alcohol; insufficient physical activity; and unhealthy eating habits. Health care systems in Sweden, ie, county councils and municipalities, have since the introduction of the guidelines established effort for the implementation of these guidelines. The National Board of Health and Welfare has also since January 2011 been assigned to support its implementation. It turns out that there is variation regarding how far the various county councils have A utilize these guidelines in clinical work. A central question is why there is varied result and how implementation efforts may be strengthened. This report addresses these two issues. More specifically we analyze the implementation processes of the guidelines for methods of preventing disease in a multi-level perspective and with respect to how they are translated into clinical activities in meetings with patients. The overall aim is to analyze the translation of the guidelines for disease prevention methods from policy level through administrative levels of administration to the clinical activities in meetings with patient. We are, thus, especially interested in how translation processes are constructed and sustained in the interplay between policy making and healthcare management.

    The central problem motivating our study is the perceived difficulty of managing policy guidelines into practice. From experience we know that there are an increasing number of attempts that fail to effectively deliver implemented policy initiates. Therefore, a great deal of scholarly work focus on analyses and explanation of why organizations accomplish their policy implementation initiative and why others have good, well-founded reasons to refrain from applying new ideas.

    As a starting point for our analysis, we argue that there is a need to view healthcare organizational systems and their policy implementations from a network perspective. The theoretical input that frame our analysis of the implementation, management and control of public services is about making sure these implementation processes function as a continuous translation between different actors of a rather complex organization.

    We used a multiple case study approach of efforts in four regions to implement the guidelines for methods of preventing disease. The four regions studied were: Norrbottens County Council, Stockholm County Council, Region Östergötland and Skåne Region . The case studies are based mainly on interviews with key people in each county / region as well as the study of policy documents. Overall, 31 people were interviewed in different parts of the county councils/regions; from public policy makers, administrative management, healthcare developers and clinicians. The interviews have both given insight into implementation efforts, the current work on the guidelines and settings in which these guidelines, with various success, have been immersed.

    Our findings show that there are several ways in which the policy guidelines enter the regional level: (1) directly from the national guidelines, (2) through earlier efforts in nearby areas, and (3) through participation in the development of the guidelines along with previous work in nearby areas. The various entries into the regional level also have different implications as it assembles different networks of actors. A mechanism that explains this is problematization where the leading actors define the orientation of the work.

    Management of the guidelines are then carried out through a variety of activities: prioritization of actions, initiating projects, financial prioritization, competence development efforts, technology and process development of clinical guidelines in clinical care programs.  All of these activities take place at the system-wide regional level, leading then to various entries into clinical work. However, uncertainties in the environment create constrains for actors in their implementation efforts. It may be a county’s internal financial and organizational choices that lead to a slowdown of the translation process. Also uncertainty about how to interpret and understand the use of the methods may have important impact on the effectiveness of implementation.

    Further, ideas about how to handle methods of preventing disease developed at the regional level are to various extent translated into local practice. In primary care units the guidelines are when implemented fully adapted and integrated into the local clinics management structure. An important mechanism for use in these work units is dedicated, active employees. The final choice weather a patient may or may not enter the health promotion activities are decided mainly by the individual caregiver.

    The conclusions in the report points to a number of mechanisms that support guideline implementation:

    • Active ownership - a necessary factor for success in the work of implementing the guidelines is that it is driven by active players in all parts of the health care system. It is manifested for example by the National Board of Health and Welfare’s support to implementation in order to clarify the statutory mandate, further development of the disease prevention methods and support in learning between the county councils. At the county level overall is the active ownership of the questions to prioritize and allocate resources. But the top management leaders also need to be more actively involved and engaged in the process of developing the utilization of disease prevention methods.
    • Wide anchored processes - It is clear that in the context in which the disease-prevention work has leveled out into clinical practice, there have been inclusive, participatory processes. The leading players who control the implementation work therefore should be aware of how exclusion may be created through a variety of resources at their disposal. For example, our study shows that the actors involved in public health issues in the county councils / regions have had an influence on how the work has been formulated.
    • Translators who create and support conditions - In addition to the need for an active ownership at the political level on the issues we also see a great need for resource support in the operations environment. This is an important component of maintaining a sustainable implementation chain. The translators create the links in this chain and binds together different activities with its surroundings. Translators can provide support and create conditions by participating in the development of clinical guidelines and decision support, support and drive improvement, skills development, develop new IT solutions and quality work at operational level.
    • Developmental oriented leadership among operations managers - the same way that other levels of the health care system requires a development-oriented leadership among managers. We see that these managers can use a range of different approaches and tools to support the implementation of the guidelines. They have a key role in the translation, motivations and the design of the work in the clinical practice. It is therefore necessary that the managers of the clinical departments have the ability and discretion to run the operations in such a way that the implementation is enhanced - that the chain is held together. When managers and other professionals succeed in this then it will increase guideline legitimacy both internally within the organization and towards others.
    • Impact of projects and its embeddedness in everyday work - Many projects run test new solutions and have short time horizons. Evaluation of the projects is ongoing and changes are recorded continuously. The effects of a sustainable work can only be realized if the project results are integrated in daily work - something that is perceived problematic when the project will move into daily operations and management. This means that project ideas that go well must be embedded in the everyday work and become more long-term in order to really have an impact.
    • Meanings of role models - We note in particular that there are no stories about best practices and successful implementation in organizations or among individuals. A hallmark of successful realization is that any activity can be highlighted as a good example that shows the possibilities for a good implementation with good effects.
  • 49.
    Elg, Mattias
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering, Quality Technology and Management .
    Olsson, J.
    Swedish Association of Local Authorities and Regions, Stockholm, Sweden.
    Dahlgaard, Jens Jörn
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering, Quality Technology and Management .
    Implementing statistical process control: An organizational perspective2008In: International Journal of Quality & Reliability Management, ISSN 0265-671X, Vol. 25, no 6, 545-560 p.Article in journal (Refereed)
    Abstract [en]

    Purpose - The purpose of this paper is to contribute to the understanding of how statistical process control (SPC) methodology can be implemented and used in organizational settings. Design/methodology/approach - An action research model was used. Data were collected through formal meeting protocols, interviews and participant observation. Findings - Based on the results of an action research project, the paper emphasizes the need for: top management support with respect to roles such as infrastructural assistance, mentor, critic, financer, creating system validity through the involvement of people with experiential knowledge about the "world" in which SPC should be applied, keeping a small, highly knowledgeable development team with appropriate expertise together during the whole process from beginning to end, keeping the various end-users in focus but separate and prioritising between their different needs, and working with iterative design methodology. Research limitations/implications - The paper provides the research field with a unique case of implementing SPC using a computerized administrative data system. Practical implications - Organizations are given guidelines to use when implementing SPC. Originality/value - The paper contributes knowledge in an underdeveloped field of research. It may provide a basis for further research and scholarly analysis. © Emerald Group Publishing Limited.

  • 50.
    Elg, Mattias
    et al.
    Linköping University, Department of Management and Engineering, Quality Technology and Management. Linköping University, HELIX Vinn Excellence Centre. Linköping University, The Institute of Technology.
    Stenberg, Jesper
    Medical Management Centre, Karolinska Institute, Stockholm, Sweden.
    Kammerlind, Peter
    Qulturum, County Council of Jönköping, Jonköping, Sweden.
    Tullberg, Sofia
    Swedish Association of Local Authorities and Regions, Stockholm, Sweden.
    Olsson, Jesper
    Swedish Association of Local Authorities and Regions, Stockholm, Sweden.
    Swedish healthcare management practices and quality improvement work - development trends2011In: International journal of health care quality assurance/MCB University Press, ISSN 0952-6862, Vol. 24, no 2, 101-123 p.Article in journal (Refereed)
    Abstract [en]

    Purpose – The purpose of this paper is to empirically examine developmental trends in healthcare organisation management practice and improvement work.

    Design/methodology/approach – Primary healthcare centre (n ¼ 1; 031) and clinical hospital department (n ¼ 1; 542) managers were surveyed in spring 2007 (response rate 46 per cent). This article compares results from this survey with a study in 2003. A theoretical framework based on organisational inner context, organisational outer context, external environment and outcomes form the analytical base. Comparisons were made using independent two-sample t-tests.

    Findings – A general aspect, identified empirically, is the tendency toward increased external pressure on leaders in their improvement work. Higher management decisions, patient pressure and decisions made by policymakers increasingly influence and shape the choices made by healthcare managers about where to focus improvement efforts. Three different trends are empirically identified and elaborated: take-control logic; practice-based improvement; and patient-centeredness.

    Research limitations/implications – Healthcare leaders should carefully design new management control systems that support healthcare micro systems. Findings support the general assumption that staff increasingly tend to focus organisational changes on management control.

    Originality/value – This study extends management research with a unique survey. Through two measurements made in 2003 and 2007, several important trends about how healthcare organisations are managed and developed are identified.

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