This report presents the findings of a Delphi study coordinated by Linköping University (LiU) in collaboration with RISE Research Institutes of Sweden and the Chalmers University of Technology. The study was carried out in 2022 as part of a Vinnova-funded planning project aimed at establishing an interdisciplinary research environment to prepare an application for a new competence centre focused on building a long-term, sustainable Swedish industry. The Delphi study aimed to identify key challenges related to the ambition to develop a socially sustainable, competitive, and green industry subjected to an accelerating pace of change.

The Delphi study was based on an interactive research approach to facilitate the cocreation of knowledge for the dual purpose of advancing long-term theory development and innovation processes. The consortium and its reference groups consist of industrial companies (such as AstraZeneca, Ericsson IndustryLab, Rimaster, Saab Aeronautics, Scania, Volvo GTO and Volvo Cars), intermediaries and educational actors (such as Skill, IUC Sverige and Linköping Science Park), labour market organisations (including IF Metall, Industriarbetsgivarna, Unionen, and Teknikföretagen), governmental agencies (the Office for Sustainable Working life), and researchers from LiU, Chalmers, and RISE.

There are key industrial targets forming the starting point for the Delphi study that also guide policies and investments in strategic agendas for the industrial stakeholders. For the Swedish industry to be resilient and sustainable, new competence and organisational abilities are required to decrease the dependency on fossil energy in production. Transformation towards electrification, circular economy, and digitalisation are key enablers, and these transitions are ongoing and accelerating at a fast pace. Furthermore, new and constantly emerging targets require organisational resilience, like managing new requirements and targets within energy consumption and supply of competence.

The findings of this report include a total of 14 identified challenges.

1. To organise and create conditions for flexible work for all
2. To successfully manage crises and drastic external events
3. To successfully drive and contribute to the green industrial transformation
4. To facilitate employee-driven innovation and organisational learning
5. To attract, develop and retain employees with the right skills
6. To take advantage of and exploit the opportunities of digitalisation
7. To create inclusive workplaces and utilise diversity
8. To organise competence development
9. To collaborate with external parties to ensure the availability of competence
10. To design for socially sustainable work considering efficiency and good health in a dynamic environment
11. To organise the creation of added value for and together with customers and suppliers
12. To systematically drive continuous improvement work in parallel with long-term development work
13. To develop leadership that creates better opportunities both for a climate-neutral footprint and a competitive industry with good working conditions
14. To transform research- and policy-based knowledge into practice

The 14 challenges were further analysed according to perceived importance and ability and presented in a priority matrix. According to the priority matrix, the 14 challenges were then synthesised into six main research themes: A. Innovative competence supply practice, B. Resilient organisations & production systems, C. Analytics for improvement & learning, D. Socially sustainable work, E. Green transformation practices, and an open and undefined research theme labelled as Future challenges. The research themes are also presented together with six main analytical and theoretical perspectives in a matrix that can be used to intersect and interweave the research themes to guide the research agenda in a potential future research program.

BackgroundThis study investigates reflective and naturalistic approaches to patient involvement in quality improvement. The reflective approach, using, for example, interviews, provides insights into patient needs and demands to support an established improvement agenda. The naturalistic approach, for example, observations, is used to discover practical problems and opportunities that professionals are currently unaware of.MethodsWe assessed the use of naturalistic and reflective approaches in quality improvement to see whether they differed in their impact on patient needs, financial improvements and improved patient flows. Four possible combinations were used as a starting point: restrictive (low reflective-low naturalistic), in situ (low reflective-high naturalistic), retrospective (high reflective-low naturalistic) and blended (high reflective-high naturalistic). Data were collected through an online cross-sectional survey using a web-based survey tool. The original sample was based on a list of 472 participants enrolled in courses on improvement science in three Swedish regions. The response rate was 34%. Descriptives and ANOVA (Analysis of Variance) in SPSS V.23 were used for the statistical analysis.ResultsThe sample consisted of 16 projects characterised as restrictive, 61 as retrospective and 63 as blended. No projects were characterised as in situ. There was a significant effect of patient involvement approaches on patient flows and patient needs at the p<0.05 level (patient flows, (F(2, 128)=5.198, p=0.007) and patient needs (F(2, 127)=13.228, p=0.000)). No significant effect was found for financial results.ConclusionsMoving beyond restrictive patient involvement is important to meet new patient needs and improve patient flows. This can be done either by increasing the use of a reflective approach or by increasing the use of both reflective and naturalistic approaches. A blended approach with high levels of both is likely to produce better results in addressing new patient needs and improving patient flows.

The aim of this article is to explore improvisational handling of critical work practices during the COVID-19 pandemic and interpret these practices from a learning perspective. Based on an interview study with representatives of private, public and intermediary organisations, the study identified three different types of improvisational handling as responses to the pandemic crisis involving ‘scaling up’ and ‘scaling down’ critical work practices. By ‘scaling up’ and ‘scaling down’, we refer to practices for which, due to the pandemic, it has been imperative to urgently scale up an existing operational process or develop a new process, and alternatively extensively scale down or cease an existing process. The types of improvisational handling differed depending on the discretion of involved actors in terms of the extent to which the tasks, methods and/or results were given beforehand. These types of improvisational handling resulted in temporary solutions that may become permanent after the pandemic. The framework and model proposed in the article can be used as a tool to analyse and learn from the changes in work practices that have been set in motion during the pandemic. Such learning may improve the ability to cope with future extensive crises and other rapid change situations.

There is a growing interest in the use of digital technologies to create new roles and relations between health professionals and patients. This technology-enabled transformation extends the traditional interactional way to deliver healthcare services, which has been historically grounded for over 100 years. A compelling argument for this interest is that for many diseases, not least for chronically ill persons for whom the majority of practices related to treating their medical condition is carried out in their home, there is a space for healthcare service delivery that is largely invisible for the healthcare provider. Swedish healthcare is currently finding ways to adopt and utilize self-monitoring as an integral part of healthcare services. Even though there is consensus among many stakeholders that self-monitoring can be a potentially transformative force, the speed of transition is slow. The evolving phase of the healthcare service ecosystem becomes interesting to investigate and how a variety of institutional logics shape the future of the digitally engaged patient. A service ecosystem has previously been defined as “a relatively self-contained, self-adjusting system of resource-integrating actors connected by shared institutional arrangements and mutual value creation through service exchange” (Vargo and Lusch, 2016, p.10). By applying institutional theory to the case of self-monitoring in Sweden, we are responding to the call in service science to contribute to a better understanding of the service ecosystem of healthcare and what facilitates and constrains the changing roles of its actors in value creation. The purpose of this study is therefore to better understand the shift from the view of patients as passive receivers of care into being active co-producers that takes part in decision-making and in the care delivery through self-monitoring. Taking an institutional logic approach, the authors identify key “roles” (subjects), “materials” (objects) and “practices” (ways of acting) in the healthcare service ecosystem that facilitate and constrain the emergence of self-monitoring technologies. To do so, the study draws on multiple sources of evidence. First, 20 interviews have been conducted with respondents representing various key actors in the healthcare service ecosystem (e.g., health-care professionals, patient organizations, hospital managers, policy officials, pharma industries and information officers). Second, we observed a development project where new self-monitoring systems were piloted in cancer care. Our study offers several important implications for service theory and management. For service theory, this study shows how alignment and misalignment between practices, roles and materials facilitate and constrain the emergence of self-monitoring technologies within the health service ecosystem. For service management, this study raises four barriers – conflicts, compliance, lack of knowledge and appropriate technologies - that are crucial to overcome when implementing self-monitoring technologies

Våra organisationer blir alltmer komplexa och det blir allt svårare att fatta kloka beslut om var utveckling av verksamheter bör sättas in. Samtidigt växer mängden data som är tillgänglig – och som kan hjälpa till att förstå vad som faktiskt sker i verksamheter och i samhället...

Kvalitetsutveckling – en översikt är avsedd för undervisning i ämnet på grundläggande och avancerad nivå, till exempel i kurser inriktade på organisatoriska frågor eller kvantitativa metoder för att stödja kvalitetsförbättringar. Boken kan också läsas av yrkesverksamma som vill lära sig mer om ämnet...

BackgroundThe training of impaired attention after acquired brain injury is central for successful reintegration in daily living, social, and working life. Using statistical process control, we found different improvement trajectories following attention training in a group of relatively homogeneous patients early after acquired brain injury (ABI). ObjectiveTo examine the contribution of pre-injury factors and clinical characteristics to differences in outcome after early attention training. Materials and MethodsData collected in a clinical trial comparing systematic attention training (APT) with activity-based attention training (ABAT) early after brain injury were reanalyzed. ResultsStroke patients (p = 0.004) with unifocal (p = 0.002) and right hemisphere lesions (p = 0.045), and those with higher mental flexibility (TMT 4) (p = 0.048) benefitted most from APT training. Cognitive reserve (p = 0.030) was associated with CHANGE and APT as the sole pre-injury factor. For TBI patients, there was no statistical difference between the two treatments. ConclusionOur study identifies indiscernible factors predicting improvement after early attention training. APT is beneficial for patients with right-hemispheric stroke in an early recovery phase. Knowledge of prognostic factors, including the level of attention deficit, diagnosis, and injury characteristics, is vital to maximizing the efficiency of resource allocation and the effectiveness of rehabilitative interventions to enhance outcomes following stroke and TBI.

Under de senaste åren har samhället, företag och organisationer i de flesta sektorer och individerpåverkats och tvingats agera för att snabbt mobilisera och hantera den stora oförutsedda krissituationsom uppstått p.g.a. Covid-19 pandemin. Tidigare studier under allvarliga ekonomiska kriser visar attorganisationer har större förutsättningar att lyckas om de kan hantera sin dagliga verksamhet ochsamtidigt anpassa sig till stora förändringar (Wallo, Kock och Nilsson, 2012)1. Verksamheter behöversåledes en förmåga att samverka i det strategiskt arbete och mobilisering, men också att kunnaförebygga risker och realisera beslut, vilket kräver utformning av stöd och arbetssätt på en taktisknivå. Stora förändringar har också stor påverkan på en operativ nivå där förståelse behövs kringarbetsuppgifter från ett individ- och teamperspektiv, hur hela arbetssituationen påverkas och effekterom till exempel nya arbetssätt, ändrade roller och nya risker.

Syfte

Syftet är att lyfta fram olika perspektiv på betydelsen av samverkan inom och mellan strategiska,taktiska och operativa nivåer i organisationer under den inledande fasen av Covid-19 pandemin.

Metod

Resultaten baserar sig huvudsakligen på det pågående forskningsprojektet ”Förnyelseförmåga ochhållbar arbetsmiljö vid snabba svängningar, Spin-off” kompletterat med illustrativa exempel från detavslutade projektet ”Skyddsutrustning vid Covid-19: Metodik för produktion och instruktioner”, bådafinansierade av AFA Försäkring.

Metodik i Spin-off projektet: Data samlades in i en intervjustudie med utvalda respondenter medstrategisk funktion och intermediärer inom offentliga och privata organisationer. Totalt innefattadestudien semi-strukturerade intervjuer med 65 respondenter, samtliga ljudinspelade och transkriberade.Frågorna innefattade bland annat Covid-19-pandemins effekter i organisationer och arbetsplatser medfokus på upp- respektive nedskalning, effekter på verksamheten, arbetsuppgifter, samarbeten,arbetsmiljöarbetet och arbetsmiljön. Med upp- respektive nedskalning avses här arbetsprocesser sompå grund av pandemin har varit absolut nödvändigt att initiera/utveckla alternativt upphöra ellerdrastiskt dra ner på. I studien ingick även frågor kring möjliga långsiktiga effekter ”efter pandemin”,och lärdomar att ta tillvara inför framtiden för att stå bättre rustade i en allt snabbare förändringstakt.

Metodik i Skyddsutrustningsprojektet: Datainsamling gjordes genom produktionsprocesskartläggningoch dokumentation av metoder för tillverkning av skyddsvisir och långärmade skyddsrockar vid ettpar av de tillfälliga produktionsstationer som byggdes upp under pandemins första år. Underlag förriskbedömning och skriftliga rutiner för basal hygien och användning av skyddsutrustning samlades insom data från en kommun och för utveckling av visuella instruktioner. I digitala workshops med tvåhemtjänstenheter (totalt 42 medarbetare) samlades data in om hur och när de lärt sig användaskyddsutrustning och förutsättningar att följa instruktioner i det operativa arbetet.

Resultat

Spin-off-studien visade att organisationer och arbetsplatser påverkades drastiskt av yttre händelser därdet uppstod nya situationer som triggade initiativ till nya former av samverkan för att lösa problem.Studien visade att pandemin ”luckrade upp” tidigare fasta strukturer vilket accelererade innovativasamarbeten över traditionella gränser med potential för förnyelse på lång sikt. Resultat från bådastudierna belyste exempel på samverkan såväl inom som mellan olika nivåer (strategiskt, taktiskt, ochoperativt).

Exempel på samverkan på strategisk nivå var mobilisering och krishantering i många verksamhetergenom tvärfunktionellt och tvärorganisatoriskt samarbete. Nya strategier och arbetssätt utvecklades föraffärsverksamheten, men också för att säkra effektiv kommunikation, information och godaarbetsförhållanden under krisen. Exempel på samverkan på taktisk nivå var sektorsövergripandesamarbete mellan vård- och omsorgssektorn och svensk industri med syfte att säkra personligskyddsutrustning genom tillfällig beredskapsproduktion. Utmaningar var att snabbt ställa ombefintliga produktionsprocesser till nya typer av produkter, skala upp produktionsvolymer och säkrakvaliteten med relativt otränad personal. Samarbetet under produktionsstart av skyddsutrustning varberoende av ett tvärfunktionellt och tvärorganisatoriskt kunskapsutbyte relaterat till råmaterialkrav,standardiserade instruktioner, produktionsprocesser och produktinformation. Exempel på samverkanpå operativ nivå var tvärfunktionella samarbeten över organisationsgränser kring riskanalyser somsamordnats, såsom kombinerade patientssäkerhetsronder och arbetsmiljöronder som medförthelhetsförståelse och samordningsvinster.

Gap i samverkan mellan strategiska, taktiska och operativa nivåer synliggjordes iskyddsutrusningsprojektet där riskbedömning och rutiner för användning av skyddsutrustning iäldreomsorgen som tagits fram på strategisk samverkansnivå saknade anpassning till de faktiskaoperativa förutsättningarna att följa rutiner och instruktioner. Andra utmaningar var relaterade tillpartsgemensamt arbetsmiljöarbete där t.ex. en skyddskommitté utvecklade förslag och beslut omåtgärder (strategisk samverkansnivå) som sedan skulle genomföras i praktiken på arbetsplatser(operativ samverkansnivå). I den höga förändringstakten som pandemin krävde så synliggjordesutvecklingsbehov i Spin-off studien där strukturer ständigt behövde utvecklas och omstruktureras itakt med förändringar, och kontinuerlig samverkan behövdes mellan lokala arbetsplatser ochorganisationens verksamhetsutvecklingsprocesser. En styrka i verksamheter var den samladeuppslutning som uppstod under krisen och förmåga till snabb omställning för samverkan övertraditionella gränser. Främjande faktorer för samverkan både inom och mellan nivåer var uppbyggdasamarbeten och förtroendefulla relationer som fanns innan pandemin. Ytterligare en framgångsfaktorvar förmågan att nyttja digitala lösningar där arbetsuppgifter och samverkan behövde ske på distans.Den digitala tekniken var en central möjliggörare men resultat från Spin-off studien pekar påpotentiella risker för t.ex. segregering mellan yrkesgrupper/nyanställda och utmaningar för ledarskappå distans.

Vid större förändringar eller kriser pekar studierna på att det finns stora utmaningar i att få samverkanatt flöda mellan operativa, strategiska och taktiska nivåer, där fördjupade studier rekommenderas.

Quality management focuses on improvements aimed at enhancing the value createdfor various stakeholders. However, actions taken in response to a perceived problemsometimes lead to an inferior result rather than an improvement. Such actions havebeen denoted tampering. As an example, natural variation might unnecessarily beperceived as a problem, where the best way to handle that ‘problem’ would be to notact at all. However, for someone trained in quality management and striving forimprovement, doing nothing might be more challenging than acting. The researchquestion studied in this paper is: How do emotional, motivational and cognitivemechanisms influence tampering in problem-solving situations? Through interviewswith 17 respondents, 33 tampering situations were identified and analysed. Thefindings describe emotional, motivational and cognitive mechanisms that leadindividuals to take actions leading to tampering. Some examples of thesemechanisms are fear of the consequences of not acting, feelings of guilt if not actingto resolve a problem, and taking actions based on experiences of past problemsolving. To counteract this, it is advised to set aside time for reflections beforestarting problem-solving and to establish an environment encouraging of reflections.

Digital inclusion is the key for a sustainable andinclusive society. In particular, digital governmentalservices must be impartial, inclusive and available foreveryone eligible for the services. Digital inclusion is akey for trust of government in a more digital society.However, the motives access, use and competences to bedigital included varies in line with other forms socioeconomicstratification. It is also complicated to reachthose who are digital excluded in traditional surveymethods. This paper presents a field study on digitalinclusion in a disadvantaged Swedish suburb, where wemade a structured interview survey to reach groups thatare usually hard to survey. The analysis shows thatthose who find it easy to search on the Internet alsoexperience more inclusion in the Swedish society. Inaddition, more advanced use as on-line payments anduse of eID seems to increase the trust in publicauthorities. Thereby, digital inclusion can be seen as afactor enhancing even quality of government, that hasto be further investigated.

Digitalisation provides both challenges and opportunities for Quality Management (QM). The purpose of this study is to identify various roles QM practitioners play in digitalisation initiatives to uncover the challenges and potential of QM?s digitalisation journey. This issue is addressed through an analytical framework that stresses two dimensions: the exploration and exploitation of digitalised QM processes and value creation, which is performed by the customer or in interactions facilitated by the provider. Through a multiple-case study of four large Swedish organisations, we propose six different challenges and corresponding roles for QM. Further, the study identifies challenges of digitalisation affecting both exploitative and explorative practices throughout an organisation?s value creation process. This research contributes to the existing literature with empirical evidence on the challenges induced by digitalisation, an area often discussed but not as often studied empirically.

Decision-making and problem solving are central parts of managers’ working day, yet shortcomings such as making subjective or biased decisions and decisions based on incomplete data are reported. Attempting to resolve non-problems by changing a system perceived to have caused a problem is sometimes denoted as tampering. The purpose of this paper is to explore possible countermeasures for proposed types of tampering, namely overcompensation, derailing, disagreement, overruling and escalation. All tampering types studied require different countermeasures. Common countermeasures are to focus on problem identification, not attempt to find solutions too quickly and involve employees with first-hand knowledge on the problem.

ObjectivesThis study examined the relationship between professionals perceptions of a strengthened role for the patient and of patient involvement in quality improvement (QI) and whether professionals experiences in improvement science were a moderator on such a relationship.DesignFrom a predominantly close-ended, 44-item questionnaire, 4 questions specifically concerning professionals perception on patient involvement in QI were analysed.SettingThree Swedish regions.Participants155 healthcare professionals who had previously participated in courses in improvement science.ResultsThe covariate patient involvement was significantly related to a perceived strengthened patient role. There was also a significant interaction effect between degree of patient involvement and professionals experience in the area of improvement science on a strengthened patient role. The result shows that there is a relationship between the perceived level of patient involvement in improvements and professionals perceptions of a strengthened patient role. In this study, the covariate, perceived patient involvement, was significantly related to experiences of more equal relationships between patients and healthcare professionals. There was also a significant interaction effect between the degree of patient involvement and professionals experience in the area of improvement science, for a more equal relationship between patients and healthcare professionals.ConclusionIncreased patient involvement in QI is a means of strengthening the patient role and supporting a more equal relation between patients and healthcare professionals. Furthermore, empirical evidence shows that the healthcare professionals experiences in the area of improvement science support a strengthened patient role and a more equal power relationship, but for this to happen, the mindset of professionals is key. Future research is needed to capture and investigate the experiences from patients and relatives about being involved in QI in healthcare, and to study the effects on quality in care processes.

The lack of consumer acceptance for remanufactured products is preventing the transition towards sustainable consumption. When knowledge about remanufacturing among consumers is limited, more insight is required into the consumers expectations. The purpose of this paper is to examine the consumers expectations and willingness to engage in sustainable purchasing behaviour when considering buying remanufactured robotic lawn mowers. The theory of planned behaviour and variables from green marketing help form the research model, which was tested empirically using survey data from 118 samples. The results indicate that sustainable purchasing behaviour of remanufactured robotic lawn mowers is primarily influenced by the consumers attitude and evaluation of the remanufactured product, and less so by external influences. Consumers expecting high product quality, low price, and low risk, had a positive evaluation and were therefore more willing to engage in sustainable purchasing behaviour of remanufactured robotic lawn mowers. More concisely, consumers value performance and price reductions, and worry about the time the remanufactured robotic lawn mower remains functional. Environmental knowledge among consumers is sufficient but cannot be fully translated into positive evaluations and sustainable purchases of remanufactured robotic lawn mowers. This research provides guidance for how remanufacturing firms can improve their circular marketing and remanufacturing strategies.

Purpose Over one million organisations have a quality management system (QMS) certified to the ISO 9001 standard; however, the system requires a lot of resources and its value has been questioned. This critique also leads to a questioning of the strategic relevance of quality management. The purpose of this paper is to explore how different types of uses of QMS correlate with management perceptions of quality management in terms of respect, cost and strategic importance. Design/methodology/approach The paper is based on a mixed method data collection strategy, quantitative data being collected from a survey in 8 organisations (n = 108) and qualitative data being collected from 12 interviews with quality managers in 12 different organisations. Findings The paper shows that a compliance-oriented QMS usage will more likely lead to a view of quality management as costly and of little respect, than a business or improvement-oriented QMS usage. Moreover, it nuances the view on compliance-oriented usage, showing that it is mainly documentation that negatively influences how management views quality management, whereas standardisation that is part of the compliance-oriented use is perceived as more value-adding. Originality/value This paper suggests three types of QMS use, namely, business management, improvement, and compliance-oriented use, and that a wise selection of how to use the QMS will affect the respect, strategic importance and cost that management associates with quality management.

This study explores the various roles of quality departments and investigates whether their roles have different effects on business results. Based on a survey of quality managers in 211 Swedish organisations, the analysis identifies four roles of quality departments: firefighters, auditors, process improvers, and orchestrators. The roles vary in their predominant adoption of Quality Management practices ranging from a narrow scope focusing on quality management systems to a broader scope based on multiple practices. An analysis was performed to identify how each of the identified roles influences business results. The results show that quality departments with a broad focus that combines both explorative and exploitative quality practices contribute the most to business results.

Background and purpose Few empirical studies have focused on what quality management practitioners actually do, with even fewer studies focusing on what it actually takes to do quality management work, i.e. the competencies of quality management. The purpose of this paper is to introduce a competence-based terminology for describing general competencies of quality management work in organisations and to create a competence framework in order to understand what is needed to be a quality management practitioner.

Design/methodology/approach This paper is based on an embedded, qualitative multiple-case study design incorporating four Swedish large size organisations where designated quality management practitioners (n= 33) were selected and interviewed.

Findings A quality management competence framework incorporating four main quality management competence dimensions is presented: the human, the methods & process, the conceptual and the contextual competence dimensions. Four generic quality management role responsibilities are also posited: centralised & strategic, centralised & operational, local & strategic and local & operational role responsibilities. The competencies and role responsibilities are discussed in relation to the notion of emergent quality management and the emerging need of more integrative and business excellence-oriented quality management.

Background: Evaluation of outcome after intensive cognitive rehabilitation early after brain injury is complicated due to the ongoing biological recovery process. Objective: To evaluate the efficacy of Attention Process Training early after acquired brain injury through time-series measurement with statistical process control. Design: Randomized controlled trial. Method: Patients with acquired brain injury (n=59) within 4 months post-injury in interdisciplinary rehabilitation received an additional 20 h of attention training with Attention Process Training or with activity-based attention training. The primary outcome variable was Paced Auditory Serial Attention Test (PASAT) evaluated using statistical process control. Results: Both groups improved (p amp;lt; 0.001), although a higher number of patients improved with attention process training (chi(2) (1, n= 59) = 5.93, p= 0.015) and the variability was significantly decreased. The Attention Process Training group maintained or improved performance at 6 months follow-up (chi(2) (1, n=51)=6,847, p= 0.033). Attention Process Training required fewer intervention hours for improvement. Based on individual performance, 3 improvement trajectories were identified: stationary, steady, and rapid improvers. Conclusion: The results indicate that attention training is promising early after acquired brain injury and that Attention Process Training boosts functional improvement. Notably, in the present group of relatively homogeneous patients, 3 different trajectories were identified for recovery after acquired brain injury regardless of intervention.

The lack of consumer acceptance of remanufactured products prevents the transition to a circular econ- omy. The aim of this study was to determine the degree of importance of influencing factors to the con- sumer’s purchase intention of a remanufactured robotic lawn mower. The results indicated that the con- sumer’s purchase intention can be measured as a function of attitude, social pressure and the availability of remanufactured products, among which attitude had the highest effect on the purchase intention. The attitude was significantly predicted by the expected product quality, perceived risk and price advantages, among which expected product quality has the highest effect.

Purpose – This paper introduces interactive research as an emerging approach within a broad family of collaborative research approaches in management and organization research. Interactive research is a way to contribute to the dual tasks of long-term theory development and innovation and change processes in organizations. One of the distinguishing features of interactive research is a focus on continuous joint learning processes between the researchers and the involved practitioners. Design/methodology/approach – The basic concepts, contributions and challenges of the interactive research approach are presented and illustrated in the present paper through a practical case, the HELIX Centre. Findings – Interactive research is a way to advance scientific knowledge about the development of new types of work organizations and the development of sustainable operations. The multi-disciplinary and interactive research approach at HELIX has made it possible to reach a high degree of both rigour and relevance in research questions and projects. The authors identified five principles from the HELIX case that were instrumental in accomplishing the dual tasks of interactive research. Originality/value – The interactive research approach is a powerful method of collaboration between different stakeholders throughout the research process. This type of research makes it possible to interact at various levels of research, from the programme level, to research and development projects, to the individual level. The results from interactive research should not only be considered traditionally valid but also valid in relation to organizational and societal needs.

One of the important aspects of providing the high level of the enterprises competitiveness on the market is existence of the necessary level of IT-readiness. By using the term "IT-readiness" we mean the ability of the enterprise to reach the mission by the most effective use of modern information technologies. There are contradictions between the need of the enterprise operatively to reconstruct design and production structures accordingly to the market condition change and the level of the modern IT use for maintenance of science intensive samples creation projects. The problem situation becomes complicated because of the lack of possibility of the fast development of expensive information support systems through the absence of big financial resources for the machine building enterprises in the conditions of an unstable investment climate and a low level of profitability. It leads to the need of the stage-by-stage IT introduction in the course of a life cycle support of a new equipment creation project that is also a characteristic for the machine building enterprises. It turned out that the high technology development is carried out now under the conditions of essential restrictions of financial resources all around the world. In these conditions one of progressive ideologies is Lean Manufacturing methodology. World experience shows that the success of this ideology introduction is directly connected with an effective use of modern information technologies of the high technology samples design and business management. Thus, an important question is the compliance of the enterprise to the necessary level of IT-readiness which is directly connected with a technological maturity.

Quality Management. An Introduction is a multi-purpose book designed for both university students and practitioners. In the book, the authors elaborate on the fundamental principles of quality management by connecting it to relevant practices and methods. Why is this book important? Change and improvements, productivity, and focus on customers and other stakeholders are at the top of management agendas. Quality management is about managing change and improvements as well as reaching goals, whatever they may be, as efficiently as possible, and making effective efforts to do so. Scientific methods are the bases for quality management. Furthermore, quality management is a discipline that goes beyond science into the realms of philosophy. It assumes that the changes you seek are improvements, encouraging the idea that the best route is one that leads to improvements not only for yourself but also for other stakeholders. The book focuses on three fundamental themes in quality management: Customer and stakeholder focus, Models and methods for continuous improvements, and Teamwork and organisational aspects of quality management. The book is designed to be supplemented and supported by other in-depth practitioner texts and research articles in various courses in quality management.

Purpose

Conducting research that is both practice- and theory-relevant is important for the service research community. Action research can be a fruitful approach for service researchers studying the transformative role of service research and wanting to make contributions to both the research community and to practical development. By exploring the current use of action research in service research, this study aims to make suggestions for enhancing the contribution to theory and practice development and to propose criteria for research quality for action research in service research.

Design/methodology/approach

This study builds on a systematic literature review of the use of action research approaches in service research.

Findings

The study makes three main contributions. First, it posits that any action research project needs to consider the four elements of problem identification, theorization, creating guiding concepts and intervention. Second, based on these elements mirrored in service action research, it outlines and analyzes three approaches to action research (i.e. theory-enhancing, concept developing and practice-enhancing). Third, it suggests a move from instrumental to a more conceptual relevance of the research and elaborates on the criteria for research quality.

Originality/value

This study contributes to the understanding of how action research may be applied for conducting high-quality collaborative research in services and proposes measures to enhance research quality in action research projects focusing services.

The concept of quality accommodates a range of perspectives. Over the years, various conceptual definitions of quality have reflected the evolution and trends marking the history and development of quality management. The current and widely accepted understanding of the concept of quality focuses on customer-centric notions, where meeting or preferably exceeding customer needs and expectations defines quality. However, societal drivers such as sustainability and digitalisation require a perspective on quality that is inclusive of a broader range of stakeholders to serve current and future societal needs. The purpose of this paper is to elaborate on the concept of quality as practiced and extend this understanding in a framework designed to include objective and subjective aspects from a broad range of stakeholders. An integrated conceptual framework offering expanded views on the foundations for defining the meaning of quality is suggested. This framework is centred around the notion of quality-in-use, which offers a way to guide and enhance the actual practices of Quality Management. It incorporates two dimensions for understanding quality; form, which covers the constructive or predefined dimension and scope, which covers the single actor or multi-interested parties dimension. Four major perspectives on quality-in-use are presented: Quality-as-customer-value, Quality-as-agreed-delivery, Quality-as-ecosystems-integration, and Quality-as-societyvalues.

Background and purpose The concept of quality accommodates a range of perspectives. Over the years, various conceptual definitions of quality have reflected the evolution and trends marking the history and development of quality management. The current and widely accepted understanding of the concept of quality focusses on customer centred notions, where meeting or preferably exceeding customer needs and expectations defines what quality is. 

However, with the advent of more holistic and integrated conceptualisations (e.g. “Quality 4.0” and “Quality 5.0”), emphasising the inclusion of a wider range of stakeholders and with quality also geared towards achieving societal and environmental sustainability, it can be argued that customer centred notions of quality may be somewhat misaligned, overly narrow and ill-served for current and future societal needs. Customer centred notions on quality are, by definition, subjective and relative and this paper argues that more holistic approaches to sustainable quality calls for a need to further explore objective and possible absolute notions of quality. 

The purpose of this paper is thus to elaborate on the underpinnings of the concept of quality and extend the conceptual understanding of quality more apt for holistic and integrative interpretations of quality.

Design/methodology/approach This is a conceptual paper based on a literature review aiming for a conceptual reconfiguration that revises the current perspectives and understanding on quality. Cases from various sectors are used to illustrate the perspectives brought forward. 

Findings An integrated conceptual framework offering an expanded view on the foundations for the concept of quality is presented. This framework incorporates two dimensions for understanding quality; the subjective/objective dimension and the individual/societal (multi-actor) dimension. Derived from these dimensions, four major perspectives for perceiving and understanding quality are presented. The paper argues that any sustainable and viable notion on the practical realisation of actual quality, or quality-in-use, must be based on the relation and balance between four major perspectives.    

Background

Clinical practice improvements based on quality-register data are influenced by multiple factors. Although there is agreement that information from quality registers is valuable for quality improvement, practical ways of organising register use have been notoriously difficult to realise. The present study sought to investigate the mechanisms that lead various clinicians to use quality registers for improvement.

Methods

This research involves studying individuals’ decisions in response to a Swedish programme focusing on increasing the use of quality registers. Through a case study, we focused on heart failure care and its corresponding register: the Swedish Heart Failure Register. The empirical data consisted of a purposive sample collected longitudinally by qualitative methods between 2013 and 2015. In total, 18 semi-structured interviews were carried out. We used realist evaluation to identify contexts, mechanisms, and outcomes.

Results

We identified four contexts – registration, use of output data, governance, and improvement projects – that provide conditions for the initiation of specific mechanisms. Given a professional theoretical perspective, we further showed that mechanisms are based on the logics of either organisational improvement or clinical practice. The two logics offer insights into the ways in which clinicians choose to embrace or reject certain registers’ initiatives.

Conclusions

We identified a strong path dependence, as registers have historically been tightly linked to the medical profession’s competence. Few new initiatives in the studied programme reach the clinical context. We explain this through the lack of an organisational improvement logic and its corresponding mechanisms in the context of the medical profession. Implementation programmes must understand the logic of clinical practice; that is, be integrated with the ways in which work is carried out in everyday practice. Programmes need to be better at helping core health professionals to reach the highest standards of patient care.

Management and operations studies are predominated positive-sounding reports regarding change and improvement. In this paper, we challenge this perception by stating that solving every problem that arises in an organisation is impossible and pointless by highlighting the phenomenon of tampering. Tampering occur when decisions of change is not guided by knowledge of the cause of the problem and end up making things worse. To the authors best knowledge, there is little knowledge about how tampering is manifested in practice. The purpose of this paper is thus to fill this gap by gathering practical examples (incidents) of tampering through interviews.

Purpose – The purpose of this study is to use competence theory to explore the fit between actual competencies of quality management practitioners and the perception of quality management competence needs in organisations. 

Design/methodology/approach –This paper is based on a cross-case quantitative study design featuring a survey of quality management practitioners (n= 249) within eight large Swedish organisations. The research instrument was a questionnaire covering seven themes within quality management. The analysis is based on descriptive statistics.

Findings –The results show that while the perception of formal quality management competence may seem sufficient, the evolving nature of quality management requires knowledge, skills and attitudes that are also apt for more external and explorative perspectives. There is a bias towards competence for exploitative quality management rather than explorative quality management.  Organisational logics preserving and possibly reinforcing a perceived “competence lag” in organisations are identified and described.

Originality/value – Few empirical studies within quality management explore the competencies required for quality management practices. This paper contributes to quality management research in providing arguments for adopting competence theory as a foundation for organising current and future quality management work.

Over one million organisations have a Quality Management System (QMS) certified to the ISO9000 standard; however, the system requires a lot of resources and its value has been questioned. The purpose of this paper is to investigate how different types of uses of QMS correlates with management perceptions of QM in terms of respect, cost, and strategic importance. The paper is based on a survey within eight organisations and shows that a compliance-orientated QMS usage will more likely lead to a view on quality management as costly, and of little respect, than a business- or improvement-oriented QMS usage.

The growing cost and demand of healthcare is a major concern globally. Service innovation has been put forward as a top priority to address the challenges of healthcare. However, the concept of service innovation is poorly understood, in particular the differences between incremental and radical service innovation. The chapter makes two important contributions. Firstly, it conceptualizes incremental and radical service innovation based on internal and external changes; in particular, it identifies four types of service innovations. Secondly, it explores the effects and diffusion processes of service innovation. It aids practitioners and researchers to understand radical service innovation in a new way and to shed light on effects and diffusion of service innovation in healthcare.

Kvalitetsutveckling sker inte av sig självt. För att utveckla och förbättra verksamheter krävs systematiska sätt att arbeta med kvalitetshöjande insatser av många individer under lång tid.Leda för kvalitet ger en helhetsbild över centrala frågor som välfärdens tjänsteleverantörer behöver ställa sig i den systematiska kvalitetsutvecklingen. Den ger också förslag på inriktning av angreppssätt och metoder för att komma till rätta med kvalitetsproblem. Till boken finns en arbetsbok som kan användas av hela personalgruppen. Arbetsboken ger, förutom grundläggande kunskaper i kvalitetsarbete som man har nytta av för all framtid, en utmärkt start på det utvecklingsprojekt som just nu är aktuellt att sätta igång med.

Purpose When using a service, customers often develop their own solutions by integrating resources to solve problems and co-create value. Drawing on innovation and creativity literature, this paper aims to investigate the influence of place (the service setting and the customer setting) on customer creativity in a health-care context. Design/methodology/approach In a field study using customer diaries, 200 ideas from orthopedic surgery patients were collected and evaluated by an expert panel using the consensual assessment technique (CAT). Findings Results suggest that place influences customer creativity. In the customer setting, customers generate novel ideas that may improve their clinical health. In the service setting, customers generate ideas that may improve the user value of the service and enhance the customer experience. Customer creativity is influenced by the role the customer adopts in a specific place. In the customer setting customers were more likely to develop ideas involving active customer roles. Interestingly, while health-care customers provided ideas in both settings, contrary to expectation, ideas scored higher on user value in the service setting than in the customer setting. Research limitations/implications - This study shows that customer creativity differs in terms of originality, user value and clinical value depending on the place (service setting or customer setting), albeit in one country in a standardized care process. Practical implications - The present research puts customer creativity in relation to health-care practices building on an active patient role, suggesting that patients can contribute to the further development of health-care services. Originality/value As the first field study to test the influence of place on customer creativity, this research makes a novel contribution to the growing body of work in customer creativity, showing that different places are more/less favorable for different dimensions of creativity. It also relates customer creativity to health-care practices and highlights that patients are an untapped source of creativity with first-hand knowledge and insights, importantly demonstrating how customers can contribute to the further development of health-care services.

Objectives Involving patients in quality improvement is often suggested as a critical step for improving healthcare processes. However, this comes with challenges related to resources, tokenism, validity and competence. Therefore, to optimise the use of available resources, there is a need to understand at what stage in the improvement cycle patient involvement is most beneficial. Thus, the purpose of this study was to identify the phase of an improvement cycle in which patient involvement had the highest impact on radicality of improvement. Design An exploratory cross-sectional survey was used. Setting and methods A questionnaire was completed by 155 Swedish healthcare professionals (response rate 34%) who had trained and had experience in patient involvement in quality improvement. Based on their replies, the impact of patient involvement on radicality in various phases of the improvement cycle was modelled using the partial least squares method. Results Patient involvement in quality improvement might help to identify and realise innovative solutions; however, there is variation in the impact of patient involvement on perceived radicality depending on the phase in which patients become involved. The highest impact on radicality was observed in the phases of capture experiences and taking action, while a moderate impact was observed in the evaluate phase. The lowest impact was observed in the identify and prioritise phase. Conclusions Involving patients in improvement projects can enhance the quality of care and help to identify radically new ways of delivering care. This study shows that it is possible to suggest at what point in an improvement cycle patient involvement has the highest impact, which will enable more efficient use of the resources available for patient involvement.

Purpose – The purpose of this study is to contribute to a better understanding of the role of learning in performance measurement. Design/methodology/approach – We develop a theoretical framework combining workplace learning theory with purposes of performance measurement. We elaborate this framework empirically by identifying critical incidents from a case set within a context containing a broad range of different performance measurement activities. Finally, we discuss the results and the possible implications for using our theoretical framework in order to better understand facets of learning regarding the design of performance measurement. Findings – Workplace learning theory provides a deeper understanding of how the mechanisms of performance measurements support control or improvement purposes. We propose a tentative framework for learning as a driver for performance measurement and four facets of learning are identified: reproductive, rule-oriented, goal-oriented and creative learning. Research limitations/implications – The empirical material is limited to the healthcare context and further studies are needed in order to validate the findings in other settings. Practical implications – We argue that all managers must consider what kind of learning environment and what kind of learning outcomes best serve the interests of their organisation. Purposeful and carefully designed organisational arrangements and learning environments are more likely to induce intended learning outcomes. Originality/value –Previous connections between the fields of ‘performance measurement’ and ‘workplace learning’ often lack any deeper conceptualisations or problematisations of the concept of learning. In this paper, we provide a more nuanced discussion about the process of learning in performance measurement, which may provide a basis for further research and scholarly attention.

Hälso- och sjukvården liksom socialtjänsten är under ständig förändring – medicinska framsteg skapar nya möjligheter till behandling samtidigt som behoven av hälso- och sjukvård och socialtjänst ökar i takt med att allt fler lever längre med kroniska sjukdomar. Socialtjänsten kommer att behöva stödja fler med långvariga och komplexa behov, vilket band annat kommer att ställa krav på ändrade arbetssätt. En fortsatt utveckling i vården och omsorgen är viktigt för att i dag och i framtiden kunna tillhandahålla en god vård och omsorg som patienter och brukare känner förtroende för.Samtidigt finns tecken på att utvecklingen och lärandet inte sker i den omfattning som behövs. I olika analyser har Vårdanalys genom åren visat att lärandet mellan olika verksamheter och huvudmän är begränsat. Orsakerna bakom det är flera.Hösten 2017 initierade vi ett forskningsuppdrag med ambitionen att utifrån litteraturen identifiera övergripande utmaningar när det gäller implementering i hälso- och sjukvården och socialtjänsten. Vi gav professor Mattias Elg och postdoktor Mattias Örnerheim vid institutionen för ekonomisk och industriell utveckling (IEI), Linköpings universitet, uppdraget att presentera en kunskapsöversikt på detta tema.Deras översikt har varit ett värdefullt bidrag till Vårdanalys arbeten under 2017 och 2018 som på olika sätt analyserat utvecklingsarbete och deras förutsättningar att bidra till långsiktig utveckling. Det är vår förhoppning att den här promemorian kan tjäna som ett kunskapsunderlag i den fortsatta diskussionen om hur vi kan skapa bättre förutsättningar till lärande och utveckling i vården och omsorgen.Den här promemorian är författarnas redovisning av forskningsuppdraget i sin helhet och de står själva för innehållet.

Interactive research has emerged as a new approach to collaborative research in working life research, and it is characterized by a continuous joint learning process between the researchers and the practitioners. In this paper we argue that interactive research is a way to advance scientific knowledge about the development of new types of work arrangements and development of sustainable working life. We present the basic ideas and benefits of the interactive research approach, illustrated through a practical case, the HELIX Competence Centre and discuss potential limitation and challenges associated with this form of collaborative research.

Purpose Digitalization provides both challenges and opportunities for Quality Management (QM). The purpose of this paper is to identify challenges induced by digitalization on current QM practices, in order to uncover the potential of how QM may support digitalization in organizations. This issue is addressed through an analytical framework that stresses two dimensions: first exploration and exploitation of digitalized QM processes and second value creation, which is performed by the customer or in interaction facilitated by the provider.

Design/methodology/approach This paper is based on a cross-case study design with interview data collected from 33 quality management professionals in four large Swedish organizations.

Findings Six different challenges and corresponding roles are proposed for QM: The gardener involved in the design of the many different currently utilized technologies; the bridge-builder - a role that connects implemented digitalized solutions that enable the movement from human-to-human to a human-to-digital interface; the assistant a contributor to better value in the customer sphere for already implemented digitalized solutions; the architect including planning, designs, and reviews together with many different stakeholders; the connector focusing on the continuous management of value-in-use and open up for  opportunities for continuous interaction and value-adding;  and explorer drawing attention towards the challenges of the existing power structures.

Originality/value This paper contributes with empirical evidence on challenges induced by digitalization, an area often discussed but not as often studied empirically.  Further, the study identifies challenges of digitalization affecting both exploitative and explorative practices throughout an organisations value-creation process.

Background and purpose –Several studies and recent reports address emerging and expanding needs for Quality Management (QM) impacting the professional practices and activities and maybe also the conceptual underpinnings of QM. An integrative approach for QM, facilitating both operational and strategic leverage has been described as becoming increasingly more important. However, few empirical studies have focused on what QM professionals actually do with even fewer studies focusing on what it actually takes to do QM-work, i.e. the competencies of QM.

The purpose of this paper is thus to extend the conceptual understanding of QM by introducing an activity and practice-based terminology for describing competencies of QM work in contemporary Swedish organisations and to create a conceptual competence framework suited for successful QM.

Design/methodology/approach –This paper is based on a cross-case qualitative study design incorporating four Swedish large size organizations where designated QM professionals (n= 34) were targeted, selected and interviewed.

Findings –Four generic QM roles are posited: centralised & strategic, centralised & operational, decentralised & strategic and decentralised & operational roles. A QM competence framework incorporating four essential QM competence dimensions is presented: the human, the contextual, the methods & process and the development competence dimensions. Competencies are discussed in relation to the “production dilemma” of QM and the emerging need of more integrative and business excellence-oriented QM.

Purpose – The practice of quality management (QM) is transforming and the number, scope and complexity of QM tasks and related QM practices is increasing beyond what could be described as traditional QM. There is currently an ambiguity as to what constitutes a QM professional and the competencies needed to be one. The purpose of this study is to understand if QM professionals are equipped to support contemporary QM work by exploring their competencies, roles and practices in contemporary organizations.

Design/methodology/approach – The study is based on a survey of QM professionals (n= 249) within eight Swedish large size organizations, surveyed in the fall of 2016 (response rate 81 per cent). The questionnaire covered 7 themes within QM and key results covering competencies and practices were extracted and analysed.

Findings – The study shows that there is a difference between the levels of perceived formal competencies and levels of informal competencies with the QM professionals in the studied organizations. The most prominent role feature of a QM professional is that of a QM tools and methods specialist. However, though this mainly internally focused role is still in demand, a more strategic and externally focused role is also identified as becoming more in demand.

Research limitations/implications – The survey data is presented with descriptive statistics. Further studies are needed to extend the results in a more in-depth analysis.

Practical implications –There is a need for a structured approach in identifying QM competencies and practices for two overall QM roles: QM specialist and QM generalist. Ambitions to create and maintain ambidexterity necessitates both specialist competencies and generalist competencies to balance and harmonize exploitative and explorative organizational capabilities.

Originality/value – This study extends research on the competencies and practices of QM professionals, evaluating the purpose and practices of QM through the experiences of a large number of QM professionals.

The purpose of this paper is to describe HELIX Competence Centre at Linköping University and its work to contribute to sustainable working life. Research in HELIX Competence Centre is based on an interactive approach between researchers from different disciplines and partner organizations, including industrial organizations, public organizations, labour market organizations, and civil society organizations. The research programme includes four research themes: 1) Sustainable development processes in industrial production systems; 2) Growth and development in small enterprises; 3) Sustainable, innovative, and coordinated health and welfare processes; and 4) Diversity and inclusion in working life. Other activities include seminars and partnership meetings with different topics and a yearly HELIX day. The research and activities led by HELIX Competence Centre constitute an approach to integrate social and economic sustainability, produce scientific knowledge, and add value to practice in the partner organizations.

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.

Quality management (QM) plays an important role in public organisations’ efforts to create better access to, and effectiveness of, specific services. When transferring QM models from market-based firms to public services provided by public organisations, several basic contrasts and even contradictions must be addressed. Core values of the public sector differ from those of the private sector, but what are the consequences of this distinction? In this article we discuss the importance of four central arguments on public services: rights and access have to be considered; equality is an important facet of public services; coerciveness is a unique feature of public services; and legitimacy can be improved by high-quality services. These arguments have not been discussed explicitly in the context of QM. Adding these central aspects of public services to the QM field could generate more sustainable ways for developing quality and QM in public services in particular and the public sector in general.

Background: Progress in early cognitive recovery after acquired brain injury is uneven and unpredictable, and thus the evaluation of rehabilitation is complex. The use of time-series measurements is susceptible to statistical change due to process variation. Objective: To evaluate the feasibility of using a time-series method, statistical process control, in early cognitive rehabilitation. Method: Participants were 27 patients with acquired brain injury undergoing interdisciplinary rehabilitation of attention within 4 months post-injury. The outcome measure, the Paced Auditory Serial Addition Test, was analysed using statistical process control. Results: Statistical process control identifies if and when change occurs in the process according to 3 patterns: rapid, steady or stationary performers. The statistical process control method was adjusted, in terms of constructing the baseline and the total number of measurement points, in order to measure a process in change. Conclusion: Statistical process control methodology is feasible for use in early cognitive rehabilitation, since it provides information about change in a process, thus enabling adjustment of the individual treatment response. Together with the results indicating discernible subgroups that respond differently to rehabilitation, statistical process control could be a valid tool in clinical decision-making. This study is a starting-point in understanding the rehabilitation process using a real-time-measurements approach.

Purpose - The purpose of this paper is to synthesize findings from health care research with those in service research to identify key conceptualizations of the changing role of the health care customer, to identify gaps in theory, and to propose a compelling research agenda. Design/methodology/approach - This study combines a meta-narrative review of health care research, and a systematic review of service research, using thematic analysis to identify key practice approaches and the changing role of the health care customer. Findings - The review reveals different conceptualizations of the customer role within the ten key practice approaches, and identifies an increased activation of the role of the health care customer over time. This change implies a re-orientation, that is, moving away from the health care professional setting the agenda, prescribing and delivering treatment where the customer merely complies with orders, to the customer actively contributing and co-creating value with service providers and other actors in the ecosystem to the extent the health care customer desires. Originality/value - This study not only identifies key practice approaches by synthesizing findings from health care research with those in service research, it also identifies how the role of the health care customer is changing and highlights effects of the changing role across the practice approaches. A research agenda to guide future health care service research is also provided.

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.

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.